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cOGtext > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

what dose of folic acid should be given pre-conception?

A

400mg

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2
Q

folic acid 400mg should be given from before conception until __ weeks

A

12

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3
Q

which patients should receive a higher dose of folic acid from 12 weeks gestation?

A
  • BMI >30
  • individuals with diabetes
  • individuals on antiepileptics
  • individuals with a previous pregnancy affected by a neural tube defect
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4
Q

the booking visit should be done between _ and _ weeks

A

week 10-12

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5
Q

a fetal anomaly scan is done between _ and _ weeks

A

18-20+6

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6
Q

the first stage of trisomy screening is done between _ and _ weeks

A

11-13+6 weeks

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7
Q

what does the ultrasound scan look for when we screen for down’s syndrome?

A

nuchal translucency

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8
Q

a normal value for nuchal translucency is

A

<3.5mm

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9
Q

the second stage of trisomy screening (quadruple blood test) is done at _ to _ weeks

A

15-16 weeks

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10
Q

what 4 pregnancy hormones are measured in the quadruple test?

A

AFP
hCG
unconjugated estriol
inhibin A

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11
Q

the first stage of trisomy screening involves…

A

a blood test

an USS

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12
Q

what hormones are checked in the combined test for downs syndrome?

A

PAPP-A
AFP
bHCG

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13
Q

PAPP-A and AFP levels will be ___ if the fetus has downs syndrome

A

low

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14
Q

when do women get their first USS in pregnancy

A

10-13+6 weeks at the booking visit

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15
Q

what does the booking USS look for?

A
  • viability
  • determines gestation
  • confirms intrauterine pregnancy
  • number of pregnancies
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16
Q

when is symphyseal fundal height first measured?

A

24 weeks

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17
Q

when is an OGTT offered to check for gestational diabetes

A

28 weeks

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18
Q

women with preexisting diabetes or women with new gestational diabetes are offered extra scans between _ and _ weeks

A

28-36 weeks

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19
Q

when mothers are first exposed to the rhesus antigen they form Ig__ antibodies which are too big to cross the placenta and harm the fetus

A

IgM

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20
Q

when mothers are exposed to the rhesus antigen for a second time the body forms Ig_ antibodies which are smaller and can cross the placenta and harm the fetus

A

IgG

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21
Q

how does anti-D work?

A

removes Rh positive blood cells from the mother’s circulation before antibodies are formed

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22
Q

when is anti-D given

A

to rhesus NEGATIVE mothers who have been exposed to a sensitising event

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23
Q

name a sensitising event that would require use of anti-D in a Rh -ve mother

A
  • vaginal bleeding from 12 weeks
  • TOP
  • amniocentesis/CVS
  • surgical management of miscarriage
  • molar pregnancy
  • ectopic pregnancy
  • delivery if baby is Rh +ve
  • fetal death
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24
Q

how long does a dose of anti-D last?

A

6 weeks

will cover further sensitising events in this period

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25
Q

when is prophylactic anti-D given to Rh -ve mothers and why?

A

28 weeks

to cover silent sensitising events

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26
Q

when is diagnostic testing such as CVS and amniocentesis offered to women?

A

if they are:
A. found to be at high risk of downs syndrome at trisomy screening
B. fetal anomaly seen at 20 week scan

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27
Q

which can be done before 15 weeks: CVS or amniocentesis?

A

CVS

can be done from 11-13+6 weeks

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28
Q

if twins are referred to as monochorionic diamniotic this means…

A

they share a placenta but not an amniotic sac

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29
Q

AFP is ___ in multiple pregnancy

A

high

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30
Q

how regularly are women seen who have confirmed monochorionic twins on scan?

A

every 2 weeks by a consultant

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31
Q

how regularly are women seen who have confirmed dichorionic twins on scan?

A

every 4 weeks

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32
Q

what supplementation are women with multiple pregnancy given?

A

iron
folic acid
low dose aspirin

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33
Q

when should DCDA twins be delivered?

A

37-38 weeks

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34
Q

when should MCDA twins be delivered? what precautionary management should be given?

A

36+0 weeks with steroids

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35
Q

when should MCMA twins be delivered?

A

32-34+0 weeks with steroids

should be delivered by LSCS due to risk of cord entanglement

36
Q

how should a breech fetus be managed prior to delivery?

A

USS to confirm presentation then external cephalic version

NB mums have the option to choose LSCS over vaginal birth for breech presentations

37
Q

non-cephalic presentation is normal up to __ weeks

A

36

38
Q

____ breech is the most risky form of breech presentation

A

footling

risk of cord prolapse

39
Q

term pregnancy is considered to be between __ and __ weeks gestation

A

37-42 weeks

40
Q

women with prolonged pregnancy are monitored every _ weeks to assess fetal wellbeing and are offered induction of labour at ___ to ___ weeks

A

2 weekly

41-42

41
Q

the umbilical artery _____ its resistance in fetal hypoxia and the middle cerebral artery ___ its resistance in fetal hypoxia

A

UA increases

MCA decreases

42
Q

a stillbirth is defined as death of the fetus at or after ___ weeks gestation

A

28

43
Q

why are women induced who are post-dates?

A

they are at increased risk of a stillbirth

44
Q

how is gestational hypertension different to pre-eclampsia?

A

no proteinuria or oedema

45
Q

hypertension in pregnancy is defined as having a systolic BP > ___mmHg and a diastolic BP of >___mmHg

A

> 140 systolic

>90 diastolic

46
Q

an increase in systolic BP >__mmHg or a diastolic BP >__mmHg since booking would also qualify a patient as having gestational hypertension

A

30mmHg systolic

15mmHg diastolic

47
Q

preeclampsia (PET) is defined as hypertension after __ weeks gestation with proteinuria >___g in 24hrs

A

20 weeks

0.3g

48
Q

what does HELLP syndrome stand for? what is it a complication of?

A

haemolysis, elevated liver enzymes, low platelets

pre-eclampsia

49
Q

what investigations should be done to check for PET

A

BP
urinalysis
bloods: Hb, platelets, U+Es, LFTs, coag screen, urate

50
Q

some risk factors for PET include ___parity, BMI >__, age __ or over

A

nulliparity (1st baby)
BMI >35
age >40

51
Q

name a severe symptom of pre-eclampsia

A
  • visual disturbance
  • headache
  • RUQ/epigastric pain
  • papilloedema
  • hyperreflexia/clonus
  • HELLP syndrome
52
Q

which drugs are first line for hypertension in pregnancy

A

labetalol
nifedipine

NOT ACEi!!

53
Q

IM steroids are given

A

34

54
Q

which hypertensive drug should not be given to asthmatics in pregnancy

A

labetalol

55
Q

eclampsia is managed with what IV drug?

A

magnesium sulfate

56
Q

how is pre eclampsia managed with medication in the antenatal period?

A

antihypertensives

low dose aspirin from 12 weeks

57
Q

what are some signs of gestational diabetes (GDM)?

A

polyhydramnios

glycosuria

58
Q

HbA1c should be ___mmol in women with GDM

A

48

59
Q

what supplementation should women with GDM be given?

A
  • high dose folic acid (5mg)
  • low dose aspirin from 12 weeks
  • metformin if diet and exercise do not improve HbA1c
60
Q

LSCS should be offered to women with diabetes/GDM if the EFW is >___kg

A

4.5

61
Q

there is a recurrence risk of ___% in women who have previously had GDM

A

50

62
Q

describe how an OGTT is done to investigate for diabetes

A

a fasting venous blood sample is taken, the woman is then given a 75g sachet of glucose, a venous blood sample is taken 2hr after ingestion

63
Q

how is preterm premature rupture of membranes (PPROM) diagnosed?

A

sterile speculum examination

64
Q

what would speculum examination show in PPROM?

A

pooling of blood in the posterior vaginal fornix

65
Q

how is PPROM managed?

A
  • monitor for infection
  • erythromycin for 10 days
  • nifedipine if between 26 and 33+6 weeks
  • steroids
  • MgSO4 IV until the birth of the baby
  • fetal monitoring using CTG
66
Q

if fetal anaemia is not detected soon, the baby can develop a condition called..

A

hydrops fetalis

67
Q

name a cause of antepartum haemorrhage

A 
placenta praevia
placental abruption
vasa praevia
uterine rupture
ectropion
cervical cancer
68
Q

massive haemorrhage is defined as blood loss >___ml and/or signs of…

A

1000

clinical shock

69
Q

bright painless vaginal bleeding in 3rd trimester…

A

placenta praevia

70
Q

“hard woody uterus”

A

placental abruption

71
Q

“painful vaginal bleeding in the 3rd trimester”

A

placental abruption

72
Q

“clinical shock that is out of proportion to the amount of visible blood in a woman in her 3rd trimester”

A

placental abruption

73
Q

name a risk factor for placental abruption

A 
pre-eclampsia
hypertension
trauma
smoking/drugs
polyhydramnios
previous abruption
PPROM
multiple pregnancy
74
Q

how is a placental abruption managed?

A

resuscitate mother
urgent c section
replace blood products
anti-D if necessary

mum comes before baby

75
Q

define vasa praevia

A

fetal blood vessels overlying close to the internal cervical os

76
Q

“small amount of dark vaginal bleeding accompanied by acute fetal bradycardia and decelerations on CTG”

A

vasa praevia

77
Q

how is vasa praevia managed?

A

steroids at 32 weeks
ELCS at 34-36 weeks

if emergency, emergency LSCS and maternal/neonatal resus

78
Q

the biggest risk factor for uterine rupture is..

A

previous uterine surgery eg previous LSCS or myomectomy

79
Q

maternal collapse in the third trimester preceded by severe abdominal pain…

A

uterine rupture

80
Q

if maternal infection with chicken pox occurs in the last __ weeks of pregnancy there is a significant risk of varicella of the newborn

A

4

81
Q

a woman is not immune to varicella zoster virus and is pregnant, she has been exposed to the virus in her pregnancy. she is not symptomatic. what should you do?

A

give varicella zoster immunoglobulins

82
Q

a woman is not immune to varicella zoster virus and is pregnant, she has been exposed to the virus in her pregnancy. she has a mild rash. what should you do?

A

give oral aciclovir within 24h
paracetamol and fluids

NB should only be given to women over 20 weeks gestation

83
Q

what abnormalities would be seen in a fetus with cytomegalovirus infection?

A

cerebral abnormalities eg microcephaly, ventriculomegaly, white matter abnormalities, intracerebral haemorrhage

84
Q

a baby is born with jaundice, a petechial rash, hepatosplenomegaly and microcephaly. what infection are they likely to have contracted?

A

congenital cytomegalovirus (CMV) infection

85
Q

a baby is born with severe anaemia, heart failure and hydrops fetalis. what infection are they likely to have contracted?

A

parvovirus B19

86
Q

women with parvovirus B19 infection are infections until __day(s) after the rash develops

A

1

87
Q

parvovirus B19 infection presents very similarly to what other infection?

A

rubella

serology should be done to distinguish between the two

cOGtext (11 decks)

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