Antenatal care

Question 1

When does the booking visit typically occur?

Answer 1

Before 12 weeks gestation

Question 2

What aspects of history should be discussed at the booking visit?

Answer 2

Past medical
Obstetric
Gynaecological/menstrual
Family
Social

Question 3

What aspects of social history/lifestyle should be addressed at the booking visit? (5)

Answer 3

Smoking; alcohol; diet (Vit D, folate) ; exercise; occupation

Question 4

Which examinations/procedures should be carried out at the booking visit? (5)

Answer 4

BMI
Blood pressure
Urine dipstick
Abdo
CVS

Question 5

Booking bloods (5)

Answer 5

FBC 
ABO/Rh status
Red cell alloantibodies
Haemoglobinopathies
Serologies

Question 6

Immunological investigations arranged at booking visit

Answer 6

Syphilis, rubella, HIV, Hep B and C serology

Question 7

What does the initial ultrasound confirm?

Answer 7

Foetal viability; number of foetuses; gestational age (crown-rump length)

Question 8

Which routine procedures should be carried out at all subsequent antenatal visits?

Answer 8

Blood pressure 
proteinuria screen 
symphysis-fundal height measurement 
lie and presentation 
foetal heart auscultation

Question 9

Four common classes of congenital abnormality

Answer 9

Heart defects; neural tube defects; abdominal wall defects; chromosomal abnormalities

Question 10

Main risk factors for Downs Syndrome (2)

Answer 10

Maternal age; previous history

Question 11

How is Downs risk assessed in a) first trimester b) second trimester

Answer 11

a) combined test (nuchal thickness + HCG/PAPP-A)

b) quadruple serum test (HCG, aFP, uE3, inhibin A)

Question 12

When are further investigations for Downs syndrome warranted?

Answer 12

Likelihood ratio >1:250

Question 13

What further investigations are carried out for Down syndrome and when?

Answer 13

Chorionic villus sampling (after 12 weeks)

Amnioscentesis (after 15 weeks)

Question 14

When should the dating scan take place?

Answer 14

10-14 weeks

Question 15

First-line treatment for nausea and vomiting antenatal

Answer 15

Antihistamines (promethazine)

Question 16

When should the anomaly scan take place?

Answer 16

18-21 weeks

Question 17

Nutritional advice in pregnancy:

a) vitamin A
b) vitamin D
c) folic acid

Answer 17

a) avoid excessive intake- teratogenic
b) 10 micrograms/day
c) 400 micrograms/day (5mg in those taking anti-epileptic drugs)

Question 18

Risks of smoking during pregnancy (3)

Answer 18

Low birth weight
Pre-term birth
Stillbirth

Question 19

Foods to avoid in pregnancy (three groups)

Answer 19

Soft cheese and pate (listeriosis)
Raw/partially cooked eggs/poultry (salmonella)
Liver (vitamin A)

Question 20

In low-risk pregnancy, how is surveillance of the fetus achieved? (3)

Answer 20

Maternal vigilance for foetal movements in the latter half of pregnancy
Symphyseal-fundal height charting
Doppler auscultation of the foetal heart

Question 21

Surveillance of high-risk pregnancies? (4)

Answer 21

Serial measurements of:

Foetal growth (head, abdominal, and estimated foetal weight)
Umbilical artery Doppler
Amniotic fluid volume
Biophysical parameters- HR, movements, tone and breathing

Question 22

Abnormalities on scan: choroid plexus cysts, clenched hands, rocker bottom feet, small placenta

Answer 22

Edwards syndrome (Trisomy 18)

Question 23

Trisomy 13

Answer 23

Patau syndrome

Question 24

Trisomy 21

Answer 24

Downs syndrome