8B) Antenatal Care - Other

Question 1

How many appointments should an uncomplicated primip receive?

Answer 1

10

Question 2

How many appointments should an uncomplicated multiple receive?

Answer 2

7

Question 3

When should dating scan be done?

Answer 3

10-13+6

Question 4

How much vitamin A is toxic?

Answer 4

> 700 micrograms

Question 5

Food with lots of vitamin A

Answer 5

Liver

Question 6

How much vitamin D in standard pregnancy?

Answer 6

10 micrograms (equivalent to 400 units) (found in pregnacare/healthy start)

Question 7

What foods should be avoided to avoid listeriosis?

Answer 7

Only drinking pasteurised/UHT milk.

NO: soft cheeses, pate (even veggie), undercooked ready meals.

Question 8

What foods should be avoided to avoid salmonella?

Answer 8

Raw/partially cooked eggs/mayonnaise

Raw/partially cooked meat.

Question 9

When to screen for haemoglobinopathies and how?

Answer 9

Ideally by 10 weeks.
If prevalence sickle cell disease is high (>1.5 cases/100,000) then do lab screening.
If prevalence of sickle cell disease is low then do Family Origin Questionnaire. If high risk on FOQ or if MCH <27 then do lab screening.

Question 10

When to do anomaly scan?

Answer 10

18-20+6

Question 11

What infection screening is done at booking?

Answer 11

Asymptomatic bacteriuria
Hepatitis B
HIV
Syphilis

Question 12

When to assess presentation by palpation?

Answer 12

From 36 weeks

Question 13

When to auscultate FH?

Answer 13

Only if requested by mother

Question 14

What percentage of deliveries in the UK were induced?

Answer 14

20%

Question 15

What proportion of induced labours deliver without further intervention?

Answer 15

<2/3

15% Instrumental
22% EMCS

Question 16

Preferred method of IOL

Answer 16

Vaginal PGE2 (tablets/gel one dose followed by second after 6h. pessary one dose over 24h)

Question 17

When should post-dates IOL be offered?

Answer 17

Between 41+0 and 42+0

Question 18

What monitoring should be offered to women who decline post-dates IOL?

Answer 18

Twice weekly CTG an ultrasound examination of maximum amniotic pool depth

Question 19

When should women be offered sweeps?

Answer 19

Prior to any formal IOL.

40+41 weeks nullip. 41 weeks parous.

Question 20

What monitoring should be offered during IOL?

Answer 20

Before IOL - assess Bishop score and do CTG.

Once contractions begin - CTG and if normal can then do I/A.

Question 21

When to reassess Bishop score?

Answer 21

6h after tablet/gel, 24h after pessary

Question 22

When is IOL classed as failure?

Answer 22

After 1 cycle

Question 23

Risks of vitamin D deficiency in pregnancy

Answer 23

Classical:

• Low calcium and phosphate
• Secondary hyperparathyroidism
• Osteomalacia and Rickets
• Neonatal hypocalcemic tetany

Non-classical:

• Pre-eclampsia
• SGA
• GDM
• Fetal lung development
• Neonatal immune conditions e.g. asthma
• Increased risk primary CS
• Bacterial vaginosis

Question 24

How much calcium does a developing fetes require?

Answer 24

30g

Question 25

How much vitamin D is delivered after 30 mins in sunlight in white skin?

Answer 25

50,000 units

Question 26

By how much does melanin diminish cholecalciferol production?

Answer 26

90%

Question 27

Vitamin D supplementation in women at high risk of PET

Answer 27

800 units combined with calcium

Question 28

Vitamin D supplementation in women at high risk of vitamin D deficiency

Answer 28

1000 units daily

Question 29

Treatment of vitamin D deficiency

Answer 29

Cholecalcierol: 2800 units OD and 20,000 units OW for 4-6 weeks. Ergocalciferol: 2800 units OD and 10,000 units BW for 4-6 weeks.

Question 30

What are the key physiological changes that occur during air travel?

Answer 30

Altitude --> Reduced barometric pressure --> Reduced partial pressure O2 --> Reduced blood O2 saturation 10% Humidity low 15% --> Increased insensible fluid losses.

Question 31

Effect of air travel on pregnancy outcomes

Answer 31

No increase in adverse pregnancy outcomes

Question 32

Change in fetal O2 pressures during air travel

Answer 32

None

Question 33

Radiation risk from air travel/body scanners

Answer 33

Radiation not significant for passengers but can be for staff. Total radiation from body scanners <2 min flying or 1h on ground.

Question 34

When to advise against flying?

Answer 34

37 weeks in uncomplicated singletons and 32 weeks multiples.

Question 35

Contraindications to air travel

Answer 35

- Hb <75 - Recent sickling crisis - Recent haemorrhage - Otitis media & sinusitis - Serious cardiac or respiratory disease - Recent GI surgery (where anastomoses could come under stress with gaseous expansion) - Fracture (significant leg swelling can occur in flight)

Question 36

What is the increased risk of VTE with prolonged air travel?

Answer 36

3 x increased | 18% increase in risk for each 2 hour increase in travel time.

Question 37

What is the incidence of VTE after flight?

Answer 37

1 in 4600 flights >4 hours

Question 38

What percentage of non-pregnant people at high risk for VTE will develop DVT after prolonged air travel?

Answer 38

4-5%

Question 39

What is the benefit of TEDs during air travel?

Answer 39

RR 0.1

Question 40

How often to do in flight exercises?

Answer 40

Every 30 minutes

Question 41

What is the change in steroid hormone physiology in pregnancy?

Answer 41

3 x increased cortisol levels (due to oestrogen stimulation of CBG and placental stimulation CRH) which peak in third trimester. Postpartum cortisol levels remain normal but CRH and ACTH fall.

Question 42

What is the placental enzyme which protects fetus from high doses of steroids?

Answer 42

11B-HSD2 (metabolises cortisol)

Question 43

Duration of action of betamethasone/dexamethasone/prednisolone.

Answer 43

Beta and dex are long acting - 36-54h. | Prednisolone medium acting - 12-36h.

Question 44

Which steroids are not inactivated by placental enzymes?

Answer 44

Betamethasone and dexamethasone.

Question 45

Adverse effects of exogenous steroids

Answer 45

- May be increased risk orofacial clefts - May be association with PTB - May be association with reduced fetal weight, head and height - GDM - Trend towards poorer neurological outcomes.

Question 46

What is the increase in risk of GDM for someone on LT steroids?

Answer 46

5-10 x increased

Question 47

BF on steroids

Answer 47

Safe but avoid BF for 4h after dose of pred

Question 48

Which drug involved in early pregnancy care can't be used in women on long term steroids?

Answer 48

Mifepristone

Question 49

What should happen if woman on LT steroids starts COCP?

Answer 49

Monitor for steroid toxicity

Question 50

How many days background radiation is CXR equivalent to?

Answer 50

10 days

Question 51

Background radiation dose to fetes during pregnancy

Answer 51

1mGY

Question 52

What are stochastic effects of radiation?

Answer 52

Effects which can occur at any radiation level without known threshold e.g. increased risk of childhood malignancy.

Question 53

What are deterministic effects of radiation?

Answer 53

Effects which are dependent on gestational age and dose used for diagnostic test.

Question 54

Units of measurement for exposure

Answer 54

C/kg

Question 55

Units of measurement for dose

Answer 55

Gy

Question 56

Units of measurement for relative effective dose

Answer 56

Sv

Question 57

Which types of imaging are very low dose (<0.1mGy)?

Answer 57

``` CXR Cervical XR Extremities Mammography CT Head and Neck ```

Question 58

Which types of imaging are low to moderate dose (0.1-10mGy)?

Answer 58

Chest CT | Limited pelvimetry

Question 59

Which types of imaging are high dose (10-50mGy)?

Answer 59

Abdominal/Pelvic CT | PET/CT

Question 60

What can sonographers do to ensure safety of USS?

Answer 60

Keep mechanical index and thermal index as low as possible and limit exposure < 60 minutes.

Question 61

Risks of gad contrast with MRI?

Answer 61

Nephrogenic systemic fibrosis, rheumatological/skin/inflammatory conditions. Increased risk SB and NND.

Question 62

Which radioactive isotopes can be used?

Answer 62

Technetium-99m (for V/Q scans) | Don't use radioactive iodine (don't become pregnant in 6 months after)

Question 63

Deterministic effects of radiation at different gestations

Answer 63

0-2 weeks: No effect at any dose 3-4 weeks: Possible increased miscarriage if >100Gy 5-10 weeks: Possible congenital anomaly at >100Gy, Fetal growth restriction (200-250) 11-17 weeks: Diminished IQ and Microcephaly Gestational age >18 weeks - Effects not noted.

Question 64

What is the reduction in mammography risk by lead shielding?

Answer 64

50%

Question 65

What percentage of CTPA inconclusive v V/Q scan?

Answer 65

6% v 4%