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Obstetrics > Antenatal > Flashcards

Antenatal Flashcards

1
Q

What is the purpose of antenatal care?

A

To identify mothers who need medical attention

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2
Q

What is involved in pre conceptual counselling ?

A

Discuss outcomes of previous pregnancies and implications of another. Also discuss health and possible smear results. Also check rubella status and immunise if necessary. (strict pre-conceptual glucose control in Diabetes reduces the incidence of congenital abnormalities.) Medication can also be optimised. Eg. Lamotrigine is safer than sodium valporate.

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3
Q

What is the routine pre-conception recommended administration does of folic acid and why is it used?

A

0.4mg/day of folic acid, in order to reduce the chance of neural tube defects.

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4
Q

When is the ideal time for the booking visit?

A

9-11 weeks gestation

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5
Q

What is the purpose of the booking visit?

A

to assess risk

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6
Q

What congenital abnormalities are associated with mothers over the age of 35?

A

chromosomal trisomies

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7
Q

How do you work out the EDD?

A

LMP + 7 days + 9 months

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8
Q

How do you work out the accurate EDD with a dating ultrasound scan?

A

Dating ultrasound(10-13 weeks + 6 days)

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9
Q

What diseases are important to ask specifically about when taking the family history?

A

Gestational diabetes, HTN, thromboembolic, autoimmune diseases and pre-eclampsia

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10
Q

What factors are involved in the risk assessment at the booking visit?

A

BP, urine, BMI, lifestyle factors. (if pre-existing HTN then there is an increase in the risk of eclampsia.)

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11
Q

When does the second trimester begin?

A

14 weeks

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12
Q

How many weeks gestation is the uterus palpable?

A

12 weeks, if its palpable before this it may suggest multiple pregnancy

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13
Q

What if the mother has not had a smear in 3 years, when should she have a smear?

A

Usually done 3 months postnatally

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14
Q

What should women with a history of preterm labour be considered for?

A

Cervical cerclage, where a suture is inserted into the cervix to strength it and keep it closed. Vaginal route is usual but it can be placed abdominally if the cervix is short or scarred.
If not cervical cerclage then at least cervical ultrasound and screening for BV.

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15
Q

When should the cerclage happen?

A

It is elective between 12 and 14 weeks.
It can be scanned regularly and only sutured if there is significant shortening.
It can also be used as rescue suture that will occasionally prevent delivery even when the ‘incompetent’ cervix is dilated

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16
Q

Which drug increases the risk of preterm labour?

A

Metronidazole

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17
Q

Why is the knowledge of sub fertility in the PMH important?

A

Sub-fertility increases the risk of perinatal problems. Also if fertility drugs or assisted conception have been used. the likelihood of multiple pregnancy is increased.

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18
Q

Why is it important to ask about past surgical history?

A

A woman with previous uterine surgery needs a c-section.

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19
Q

In the PMH, what conditions specifically need specialist referral?

A

HTN, DM, autoimmune diseases, haemoglobinopathy, thromboembolic disease, cardiac and renal disease.

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20
Q

What is confirmed at the booking visit?

A

Gestation and viability. Will give maternal reassurance and will diagnose multiple pregnancies.

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21
Q

What can be screened for with the USS and how?

A

Chromosomal abnormalities can be screened for, by measuring nuchal translucency. The larger it is then the higher the RISK of structural, particularly cardiac abnormalities.

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22
Q

What is nuchal translucency?

A

This is the space between the skin and the soft tissue overlying the cervical spine and is measured between 11 and 14 weeks.

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23
Q

What percentage of foetuses with trisomies have structural abnormalities too?

A

50%

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24
Q

What is exomphalos and when is it visible?

A

This is the weakness of the babies abdominal wall where the umbilical cord joins it. The bowel and the liver protrude outside the abdominal cavity where they are contained in a loose sack that surrounds the umbilical cord.

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25
Q

Which blood tests are carried out at the booking visit?

A

FBC, serum antibodies (anti-D, identify those at risk of intrauterine isoimmunization), Blood glucose levels (maybe), blood tests for syphillis, rubella immunity offered, HIV, Hep B, haemoglobin electrophoresis.

26
Q

Why is a haemoglobin electrophoresis blood test carried out?

A

This is performed in women at risk of the sickle cell anaemias or thalasseimias. The former is common in Afro-carribean women and the latter in Mediterranean and Asian women.

27
Q

What other tests are used for screening at the booking visit?

A

Infections which are implicated in preterm labour such as Chlamydia and BV could be performed.
Urine microscopy and culture are performed because asymtomatic bacteriuria in pregnancy commonly (20% leads to pyelonephritis).
Urinalysis for glucose, protein and nitrites screen for underlying diabetes, renal disease and infection.

28
Q

What happens if the neonate is found to be rhesus positive after birth?

A

A kleimhaur test is used to assess the no. of foetal cells in maternal circulation. Anti-D can be given up to 72 hours after birth.

29
Q

How many antenatal visits are ideal for a primip and multi respectively?

A

A primip has 10 and a multip has 7

30
Q

How many calories are recommended daily for a pregnant woman?

A

2500

31
Q

When should folic acid supplementation be continued to?

A

12 weeks

32
Q

When is coitus contraindicated in pregnancy?

A

When there is known placenta preavia or there has been rupture of membranes.

33
Q

What health promotion advice is given? (this could be an osce station!!)

A

Medications, diet, folic acid, coitus, alcohol, smoking advice, alcohol avoidance, avoidance of infection, dental check up, exercise ideally swimming ( heavy contact sports are avoided), travel.

34
Q

How is infection avoided in pregnancy?

A

listeriosis is avoided by drinking only pasteurised or UHT (ultra high temperature), by also avoiding blue cheese, pate and uncooked or partially cooked ready prepared food.

35
Q

What is commonly carried out at routine antenatal visits?

A

BP, urinalysis and measurement of symphysis-funal height. Lie, presentation and engagement are assessed.The anterior shoulder is located and a sonic aid is used.

36
Q

What happens at 16 weeks?

A

Results of screening tests for chromosomal abnormalities and blood tests should be reviewed. A triple test is offered if screening for chromosomal abnormalities was missed.

37
Q

What happens at 20 weeks?

A

The anomaly scan , this enables detection of most structural feral abnormalities.

38
Q

What is involved in ultrasound screening for risk assessment?

A

Doppler of the uterine arteries at 23 weeks can be used as a screening test for IUGR and pre-eclampsia.

39
Q

How is pre-eclampsia indicated on a uterine doppler?

A

There is an increase in placental vascular resistance

40
Q

In terms of the spinal arteries, describe pre-eclampsia.

A

In women who develop preeclampsia there is failure of trophoblast invasion of the uterine muscalar wall with the result that the spiral arteries retain the muscle elastic coating andimpedance to blood flow persists. (high resistance). In normal pregnancy trophoblast invasion leads to vasodilation, this is incomplete in pre-eclampsia. The result is decreased uteroplacental flow.

41
Q

What tests are diagnostic for chromosomal abnormalities?

A

Amniocentesis and CVS

42
Q

What is the ‘combined test’?

A

Chromosomal abnormality risk can be assessed by integrating the risk from maternal age, with PAPP-A and beta-hcg blood tests and a nuchal translucency measurement at 11-13 + 6 weeks. PAPPA low

43
Q

What is PAPP-A?

A

Pregnancy-associated plasma protein A. this is a placental hormone, the maternal level of which is reduced in the first trimester. It is now known that a low level constitutes a high risk of IUGR, placental abruption and consequent stillbirth. This is in the first trimester.

44
Q

What is the quadruple test?

A 
This is a blood test, carried out at 16 weeks which uses AFP, hCG and oestriol, inhibin A
HCG= high
Inhibin= high
AFP= low
Oestrial= low
45
Q

What is hcG?

A

Human chorionic gonadotrophin, it is made by the placenta during pregnancy. It may also be raised by germ cell tumours.

46
Q

What is AFP?

A

Alpha-fetoprotein is a substance made in the liver of an unborn baby

47
Q

What are the risk factors for Down’s syndrome?

A

High maternal age, previous affected baby (risk increased by 1%), balanced parental translocation (RARE).

48
Q

Which results would indicate a high risk of Down’s on ultrasound?

A

Thickened nuchal translucency, some structural abnormalities, absent or shortened nasal bone and tricuspid regurgitation.

49
Q

What is a screening test?

A

A screening test is offered to all women and gives a measure of the risk of (the fetus) being affected by a particular disorder. The ‘higher risk’ patient can be offered a diagnostic test.

50
Q

What is a diagnostic test?

A

This is performed on a woman with a ‘high risk’ to confirm or refute the possibility.

51
Q

Which screening blood test results indicate a high risk of the fetus having Down’s syndrome?

A

A low PAPP-A (1st trimester), high human chorionic gonadotrophin beta-subunit (b-hcg) (1st/2nd trimester), lower AFP(1st/2nd trimester), low oestriol (2nd trimester), high inhibin (2nd trimester).

52
Q

What percentage of pregnant women are affected by heart burn?

A

70%

53
Q

What physiological changes occur in the cardiovascular system of pregnant women?

A

Cardiac output increases by 40% and peripheral resistance reduces by 50%.

54
Q

What is pre-eclampsia?

A

This is hypertension and proteinuria in the second half of pregnancy.

55
Q

What does a uteroplacental blood flow reduction cause?

A

It causes an exaggerated inflammatory response and endothelial damage followed by increased vascular permeability (oedema and proteinuria), vasoconstriction (hypertension, eclampsia, liver damage and clotting abnormalities).

56
Q

When is the earliest diagnostic test for Down’s offered and what is it?

A

After 10 weeks gestation- CVS

After 15 weeks gestation- Amniocenteisis

57
Q

What are the risks of performing a CVS pre 10 weeks and an amnio pre 15 weeks?

A

Limb reduction defects in an early CVS and a higher risk of miscarriage in amnio

58
Q

What is high resistance flow aka uterine ‘notching’ at 20-24 weeks associated with?

A

Increased risk of IUGR and pre-eclampsia later in pregnancy in a high risk population

59
Q

What is IDDM?

A

insulin-dependent diabetes mellitus

60
Q

What are women who have IDDM offered antenataly and why?

A

They are offered fetal cardiac echos due to the higher risk of congenital heart defects. They are also offered nuchal translucency tests earlier on (11-13 weeks)

61
Q

Which vaccines are routinely offered in pregnancy?

A

Pertussis and rubella

Obstetrics (14 decks)

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