Antenatal care

Question 1

When does the booking visit take place?

Answer 1

8 - 12 weeks

Question 2

When does the dating USS take place?

Answer 2

11 - 12 weeks

Question 3

When does the anomaly scan take place?

Answer 3

20 weeks

Question 4

When do you get monthly visits in pregnancy?

Answer 4

Up to 28 weeks

Question 5

When do you get fortnightly visits in antenatal care?

Answer 5

28 - 36 weels

Question 6

When do you get weekly visits in antenatal care?

Answer 6

37 weeks until delivery

Question 7

What needs to be done at every antenatal visit?

Answer 7

BP
Urinalysis
FSH
Fetal heart/kicks
Any problems refer to consultant

Question 8

A women has hypertension present as 12 weeks gestation. What is the diagnosis?

Answer 8

Essential hypertension (not pregnancy related)

Question 9

When does gestational hypertension occur?

Answer 9

After 20 weels

Question 10

When does pre eclampsia occur?

Answer 10

After 20 weeks

Question 11

What is HELLP syndrome?

Answer 11

Haemolysis
Elevated Liver Enzymes
Low platelets

Question 12

What drug is given to women who are thought to be at risk of pre eclampsia?

Answer 12

Aspirin

Question 13

What BP are you aiming for in pregnancy?

Answer 13

Less that 150/80

Question 14

What BP are you aiming for in pregnancy if there is target organ damage?

Answer 14

Less than 140/90

Question 15

If a women has pre eclampsia when should you aim to deliver the baby?

Answer 15

37 weeks

Question 16

If the mother is diabetes is the baby more likely to be hypo or hyperglycaemia at birth?

Answer 16

Hypoglycaemia

Question 17

How often should diabetic women have retinal screening in pregnancy?

Answer 17

Every trimester

Question 18

What should the HBA1C be during pregnancy?

Answer 18

Less than 6%

Question 19

Above what predicted weight of the fetus should a caesarean section be advised?

Answer 19

4000g

Question 20

Why is there an increased risk of VTE in pregnancy?

Answer 20

Stasis secondary to venous compression by the pregnant uterus
Hypercoagulability due to oestrogen

Question 21

Levels of which blood clotting factors increase in pregnancy?

Answer 21

VII, VIII, X and Fibrinogen

Question 22

Levels of which blood clotting factors decrease in pregnancy?

Answer 22

XI and antithrombin 3

Question 23

Which test for VTE should you not do in pregnancy?

Answer 23

D Dimer

Question 24

How should you investigate VTE in pregnancy?

Answer 24

Duplex US

Question 25

What is the treatment of VTE in pregnancy?

Answer 25

Heparin

Question 26

Does heparin cross the placenta?

Answer 26

No

Question 27

What investigations would you do if you suspected a PE?

Answer 27

``` ABG CXR ECG Duplex US of the lower limbs VQ scan CTPA ```

Question 28

What is the treatment for PE?

Answer 28

Heparin

Question 29

When should warfarin definately be avoided in pregnancy?

Answer 29

Week 6 - 12

Question 30

Is warfarin safe during breastfeeding?

Answer 30

Yes

Question 31

When does hyperthyroid get worse during pregnancy and why?

Answer 31

First trimester due to HCG

Question 32

How often should you do thyroid function tests in pregnancy?

Answer 32

Every trimester

Question 33

Describe the respiratory changes seen in pregnancy?

Answer 33

- Increase O2 demand - Tidal volume INCREASE - INCREASE respiratory rate - INCREASED inspiratory capacity - DECREASED residual volume - DECREASED expiratory reserve - DECREASE in functional residual capacity - FEV1 and PEFR UNCHANGED

Question 34

Why is there a decrease in functional residual capacity during pregnancy?

Answer 34

Diaphragmatic elevation | - Increase in tranvsverse thoracic diameter and subcostal angle

Question 35

How is asthma treated in pregnancy?

Answer 35

Same as not in pregnancy!

Question 36

How much folic acid should epileptic women take in pregnancy?

Answer 36

5mg

Question 37

What vitamin should pregnancy women take from 36 weeks in they are taking liver enzyme inducing anticonvulsants?

Answer 37

Vitamin K

Question 38

Why do epileptic women have an increased risk of seizure in the first trimester?

Answer 38

Hyperemesis and haemodiluation cause less available anti convulsant

Question 39

What anomoly scans should pregnant epileptic women get?

Answer 39

Detailed fetal scan at 18 - 20 weeks | Fetal cardiac scan at 22 weeks

Question 40

You suspect HELLP syndrome is a women who is 32 weeks pregnant. What tests would you perform?

Answer 40

``` FBC Coagulation screen LFTs U&E Lactate dehydrogenase ```

Question 41

A women presents with abdominal pain and confusion is the 35th week of pregnancy. Her lactate dehydrogenase is elevated.

Answer 41

HELLP syndrome

Question 42

What is the lactate dehydrogenase a marker of in HELLP syndrome?

Answer 42

Haemolysis

Question 43

How do you treat HELLP syndrome?

Answer 43

Delivery of the baby DIC is treated with fresh frozen plasma IV fluids (Magnesium sulphate may help stop seizures)