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Obstetrics > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

How many antenatal visits is a multip likely to receive? And at what stages of her pregnancy will these be?

A

8 visits:
Booking visit (hx and bloods) ideally by 10/40
Dating scan at 11-13+6/40
Results at 16/40
Anomaly scan is at 18-20/40
Hb, antibodies, OGTT bloods. Anti-D given if necessary at 28/40
34/40
36/40
38/40
Offer membrane sweep and discuss induction 41/40

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2
Q

What are the two ways it is possible to estimate the date of delivery?

A

Menstrual EDD - The first day of the woman’s LMP is taken and 9 months + 1 week added to give an estimation of the due date
Dating scan EDD - More accurate than menstrual EDD, the dating scan at 11-13+6/40 is used to determine the due date based on the size of the foetus (which varies very little between pregnancies

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3
Q

True / False - All pregnant women are given an oral glucose tolerance test to screen for gestational diabetes

A

False - Women are risk assessed at booking and if they are deemed to be high risk they are offered a GTT at 24-28 weeks (earlier if previous gestational diabetes)

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4
Q

What does a ‘monozygotic’ multiple pregnancy mean?

A

Multiple embryos result from the mitotic division of a single zygote, and result in ‘identical’ twins

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5
Q

What does ‘dichorionic diamniotic’ multiple pregnancy mean?

A

Separate placenta, separate amniotic sacs

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6
Q

What does ‘monochorionic diamniotic’ multiple pregnancy mean?

A

Shared placenta, separate amniotic sacs

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7
Q

True / False: Sodium valproate is safe in pregnancy

A

False - Valproate is teratogenic and associated with neonatal seizures. It should be avoided in pregnancy.

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8
Q

True / False: Sodium valproate is a cytochrome p450 inhibitor

A

True - This means it reduces the efficacy of the COCP and should be avoided in women of childbearing age

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9
Q

Which trimester is trimethoprim considered unsafe and why?

A

Avoid in 1st trimester as it is a folate antagonist

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10
Q

Which trimester is nitrofurantoin considered unsafe and why?

A

Avoid in 3rd trimester as it is associated with fetal haemolytic anaemia

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11
Q

What is the ‘combined’ test and when is it done?

A

A test carried out between 10 and 14 weeks gestation which involves a blood test for beta-hCG and PAPP-A, and a nuchal translucency ultrasound scan

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12
Q

What is the ‘combined’ test aiming to detect?

A

Risk of Down’s syndrome primarily, but also Edward’s syndrome and Patau’s syndrome

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13
Q

Which test can a woman have for Down’s syndrome detection if she missed her ‘combined’ test screening?

A

The ‘quadruple’ test is still available to her

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14
Q

What is the ‘quadruple’ test and when can it be done?

A

Blood test for beta-HCG, AFP, oestriol, Inhibin A…carried out between 14 and 20 weeks

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15
Q

At what gestation can amniocentesis be carried out? What is the risk of misscarriage?

A

Performed after 15 weeks

1% risk of miscarriage

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16
Q

At what gestation can chorionic villus sampling be carried out? What is the risk of misscarriage?

A

Performed at 11-14 weeks

1-2% risk of miscarriage

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17
Q

Why does maternal BP drop in the first part of her pregnancy?

A

Decreased vascular resistance due to progesterone

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18
Q

What is the normal folic acid dose in pregnancy?

A

400mcg daily

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19
Q

What is the higher dose of folic acid recommended for high risk women?

A

5mg daily

20
Q

Which women are recommended to take high dose (5mg daily) folic acid?

A

When either mother or father has neural tube defect
Previous pregnancy affected by neural tube defect
Fix of neural tube defect
Mother on anti-epileptic drugs
Chronic conditions: Coeliac disease, diabetes, thalassemia trait, Sickle cell
BMI above 30

21
Q

How long should women take folic acid for during pregnancy?

A

Until 12/40

Until birth if thalassemia trait or other haemoglobinopathy

22
Q

How do you determine whether a twin pregnancy is monozygotic or dizygotic?

A

Presence of a ‘lambda’ sign on ultrasound scan indicates dizygotic pregnancy - it is a triangular sign seen between the 2 amniotic fluid sacs (dizygotic pregnancies are always dichorionic)

23
Q

List the different types of monozygotic twin pregnancy

A

Dichorionic diamniotic
Monochorionic diamniotic
Monochorionic monoamniotic
Conjoined twins

24
Q

What determines the type of placenta seen in monozygotic twins?

A

The timing of the mitotic separation

25
Q

What type of monozygotic twin results if mitotic division occurs before Day 3?

A

Dichorionic diamniotic - This is the case for about 1/3 of monozygotic twin pregnancies

26
Q

What is the most common type of monozygotic multiple pregnancy?

A

Monochorionic diamniotic i.e. shared placenta, separate amniotic sacs - makes up about 70% of monozygotic pregnancies

27
Q

What type of monozygotic twin results if mitotic division occurs between day 4 and 8?

A

Monochorionic diamniotic

28
Q

What type of monozygotic twin results if mitotic division occurs between day 9 and day 11?

A

Monochorionic monoamniotic

29
Q

What type of monozygotic twin results if mitotic division occurs after Day 12?

A

Conjoined twins

30
Q

Which type of monozygotic pregnancy carries the highest mortality?

A

Monochorionic monoamniotic

31
Q

Which type of multiple pregnancy will be affected by twin to twin transfusion syndrome?

A

Monochorionic pregnancies

32
Q

What is the mechanism of twin to twin transfusion syndrome?

A

Occurs in monochorionic pregnancies due to a shared placenta. There are anastomosing vessels within the placenta which connect Twin 1 to Twin 2. Deoxygenated blood from the donor twin is oxygenated within the placenta but it travels to the recipient twin rather than returning to the donor. This results in a starved donor twin and a recipient who grows much larger.

33
Q

List some complications affecting the donor twin in twin to twin transfusion syndrome

A

Oligohydramnios
IUGR
Hypotension
Anaemia

34
Q

List some complications affecting the recipient twin in twin to twin transfusion syndrome

A 
Polyhydramnios
Polycythaemia
Cardiac hypertrophy
Oedema (Hydrops)
Macrosomia
Hypertension
35
Q

When is measuring symphysis / fundal height useless?

A

Multiple pregnancies - it is no longer accurate

36
Q

How many antenatal visits is a primip likely to receive? And at what stages of her pregnancy will these be?

A 
11 visits:
Booking visit (hx and bloods) ideally by 10/40
Dating scan at 11-13+6/40
Results at 16/40
Anomaly scan is at 18-20/40
25/40
Hb, antibodies, OGTT bloods. Anti-D given if necessary at 28/40
31/40
34/40
36/40
38/40
40/41
Offer membrane sweep and discuss induction 41/40
37
Q

What is the ‘gravidity’?

A

How many times a woman has been pregnant - includes normal pregnancies, ectopics, terminations, miscarriages, molar pregnancies, stillbirths

38
Q

What is the ‘parity’?

A

How many pregnancies a woman has delivered at 24+ weeks gestation, whether the baby was born alive or dead. Pregnancies before 24 weeks are written as a suffix e.g. P2+1 means 2 births after 24 weeks and one pregnancy which ended before 24 weeks

39
Q

At what gestation is a rhesus negative mother given anti-D prophylaxis?

A

28/40 and 24/40

40
Q

What value is considered ‘high risk’ for Downs syndrome?

A

More than 1 in 150 change

41
Q

What diagnostic tests are available to a woman who’s results classify her as ‘high risk’ for Downs pregnancy?

A

Non-invasive prenatal test
Amniocentesis
Chorionic villus sampling

42
Q

What results would you expect in the combined screening test for a foetus with Down’s syndrome?

A

Beta-HCG raised
Nuchal translucency raised
PAPP-A reduced

43
Q

What would you expect the AFP result (in a quadruple test) to be in a pregnancy in which the foetus has Down’s syndrome?

A

AFP is reduced

44
Q

A combined test result comes back with low beta-HCG and low PAPP-A…what defect does this point to?

A

Edward’s syndrome (Trisomy 18)

45
Q

What results would you expect in the quadruple test for a foetus with Down’s syndrome?

A

Beta-HCG raised
Inhibin-A raised
AFP reduced
Oestriol reduced

Obstetrics (5 decks)

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