Antenatal care and dates

Question 1

what is gravidity

Answer 1

number of confirmed pregnancies a woman has had regardless of the outcome of the pregnancy

Question 2

what is parity

Answer 2

the total number of pregnancies a woman has carried beyond 20 weeks (and delivered, live or stillborn)
total number of births after 20 weeks

Question 3

when is the booking appointment

Answer 3

10 weeks gestation

Question 4

What screening should be offered at the booking appointment

Answer 4

provide information about baby development, nutrition, pelvic floor exercises
offer antenatal screening eg BBV, STIs, asymptomatic bacteriuria, Down’s, structural anomalies, gestational age, GDM, PET, mental health conditions

Question 5

What assessments should be done at the booking appointment

Answer 5

height, weight, BMI
blood group
RhD status
anaemia, haemoglobinopathies, HBV, HIV, syphilis
urinalysis
USS to determine gestational age using CRL

Question 6

what is CRL

Answer 6

crown rump length - from top to toe of foetus

Question 7

when can CRL be measured

Answer 7

between 10-13+6 weeks

Question 8

When can you do a Down’s screening test

which is more accurate

Answer 8

1st and 2nd trimesters

1st trimester is more accurate

Question 9

what is done in a 1st trimester Down’s screening test, and when

Answer 9

NT is measured
PAPP-A levels
HCG levels
11-13+6 weeks

Question 10

what is NT in Down’s screening

Answer 10

Nuchal thickness = measure of skin thickness behind foetal neck

Question 11

PAPP-A levels are high/low in Down’s screening

Answer 11

low

Question 12

HCG levels are high/low in Down’s screening

Answer 12

high

Question 13

what is done at 2nd trimester Down’s screening

Answer 13

blood test 15-20 weeks
HCG levels
AFP levels

Question 14

AFP levels are high/low in Down’s screening

Answer 14

low

Question 15

what happens if there is a high risk of Down’s with the screening tests

Answer 15

you do a definitive test such as amniocentesis or chorionic villi sampling

Question 16

What should the USS assess on booking visits

Answer 16

viability of pregnancy 
single vs multiple pregnancy 
gestational age estimate 
structural anomalies 
offer Down's screening

Question 17

when is the next appointment after the 10 week booking appointment

Answer 17

16 weeks

Question 18

what is done at the 16 week appointment

Answer 18

discuss results of screening tests

BP and check for proteinuria

Question 19

when is the anomaly scan

Answer 19

18-20 weeks

Question 20

if placenta previa is found at the anomaly scan, how should she be followed up

Answer 20

offer another USS at 32 weeks

Question 21

for nulliparous women, when is the next appointment after the anomaly scan

Answer 21

25 weeks

Question 22

What is done at the 28 weeks appointment

Answer 22

screening for anaemia
anti-D prophylaxis to Rh- women
BP and urinalysis

Question 23

when is a second dose of anti-D administered

Answer 23

34 weeks

Question 24

when can external cephalic version be offered

Answer 24

36 weeks

Question 25

Increased NT is specific to Down's syndrome, true or false

Answer 25

false | can be associated with a range of conditions

Question 26

list biomarkers for aneuploidy screening

Answer 26

AFP HCG UE3 inhibin A

Question 27

what is non-invasive prenatal testing NIPT

Answer 27

detects cell free foetal DNA cffDNA

Question 28

when can amniocentesis be carried out

Answer 28

>15 weeks

Question 29

when can chorionic villus sampling be carried out

Answer 29

>12 weeks

Question 30

how are sickle cell anaemia and thalassemias inherited

Answer 30

autosomal recessive

Question 31

who manages women in the green pathway

Answer 31

midwives

Question 32

who manages women in the red pathway

Answer 32

obstetricians + midwifery support

Question 33

why is it important to give anti-D to Rh- women

Answer 33

to prevent formation of antibodies against Rh which can attack baby in future pregnancy

Question 34

what is looked for in urinalysis in pre-eclampsia

Answer 34

proteinuria ++

Question 35

what are RF for GDM

Answer 35

``` BMI>30 previous macrosomic baby previous GDM FH ethnic minority ```

Question 36

what should women take if they are at high risk of PET

Answer 36

75mg aspirin from 12 wk until delivery

Question 37

what are RF for PET

Answer 37

``` HTN during previous pregnancy CKD autoimmune disease T1/2DM chronic HTN BMI>35 multiple pregnancy ```

Question 38

why should women take folic acid in early pregnancy and at which doses

Answer 38

to prevent NTD e.g. spina bifida and anencephaly 400ug normally 5mg if: obese, AED, DM, coeliac, FH/personal history of NTD

Question 39

what should be offered by 41 weeks for women who have not yet given birth

Answer 39

membrane sweep induction of labour BP and urinalysis symphyseal fundal height

Question 40

how many USS scans does a normal pregnancy get

Answer 40

2

Question 41

purpose of USS at booking

Answer 41

``` gestational age abnormalities e.g. gastrochisis multiple pregnancy viable foetus in utero ```

Question 42

rank multiple pregnancy chorionicity from most dangerous to safest

Answer 42

monoamniotic monochorionic diamniotic dichorionic diamniotic

Question 43

TTTS is more likely to occur in monochorionic/dichorionic

Answer 43

mono

Question 44

which trisomies are screened for in the 1st trimester

Answer 44

Downs - 21 Edwards - 18 Pataus - 13

Question 45

order of anomaly screening

Answer 45

1. NT and maternal blood markers (hCG and PAPP-A) 2. NIPT or go straight to 3. diagnostic amniocentesis / CVS

Question 46

teratogenic drugs

Answer 46

``` ACEI warfarin Na valproate Lithium Methotrexate ```

Question 47

are TCA and SSRIs safe in pregnancy generally?

Answer 47

yes

Question 48

you must stop teratogenic drugs ASAP e.g. lithium

Answer 48

false, must refer to specialist ASAP instead

Question 49

previous c-section increases the risk of

Answer 49

uterine rupture

Question 50

any operation that has breached the uterine cavity can increase the risk of ..

Answer 50

uterine rupture

Question 51

what are the booking bloods that are done in absolutely everyone who is pregnant

Answer 51

``` FBC - Hb (booking, 28 weeks) Blood group Rh status and red-cell antibodies haemoglobinopathies HIV, HBV, HCV, syphilis CMV only if in contact or symotomatic or foetal anomalies detected ```

Question 52

what does maternal anaemia put a woman at increased risk of

Answer 52

maternal death by PPH

Question 53

are congenital infections routinely screened for

Answer 53

``` not routinely screened: CMV toxoplasmosis rubella HSV HZV ```

Question 54

are women screened for PID

Answer 54

no | unless symptomatic etc..

Question 55

is D antigen the only one that can cause foetal anaemia

Answer 55

no, it is one of many | it is the only one that we can do anything about ie giving anti-D to Rh- mothers

Question 56

USS can be used to identify foetal anaemia by looking at MCA, true or false

Answer 56

true

Question 57

who is the primary responsibility for, mother or baby

Answer 57

mother

Question 58

TVUSS is safe in pregnancy, true or false

Answer 58

true

Question 59

what is cervical 'incompetance'

Answer 59

the cervix just silently opens up meaning the baby can be lost

Question 60

150mg aspirin taken at night instead of 75mg?

Answer 60

150mg is from new research and is found to be more effective

Question 61

contraindications to aspirin

Answer 61

some asthmatics | PUD

Question 62

vaccines available to pregnant women

Answer 62

flu whooping cough covid - for high risk women at any gestation - maybe after 20 weeks

Question 63

elective c-section indications

Answer 63

maternal choice

Question 64

dont want to do c-section before 39 weeks

Answer 64

risk of ADHD and autism in child

Question 65

IOL is safe at 39-42 weeks | it is always offered at 42 weeks

Answer 65

from increased risk of stillbirth

Question 66

GBS prophylaxis

Answer 66

previous babies affected if she is known to have it yes - antibiotics

Question 67

postnatal contraception

Answer 67

mirena coil...

Question 68

if you fall pregnant within a year of c-section, risk of

Answer 68

accreta | rupture

Question 69

where can a woman deliver

Answer 69

home community labour suite

Question 70

any one at increased risk of PPH should be encourage to have active/physiological 3rd stage

Answer 70

active does increase risk of N+V reduces risk of PPH by 50%

Question 71

anyone at risk of an emergency should have IV access, true or false

Answer 71

true | e.g. PET, epileptic, obese, twins

Question 72

epidural labour for patients who are at high risk of needing an operation

Answer 72

yes