Antenatal Care and Screening

Question 1

In what cases is morning sickness sometimes worse?

Answer 1

Conditions where human chorionic gonadotrophin is higher (twin, molar pregnancy)

Question 2

What can morning sickness progress to?

Answer 2

Hyperemesis gravidarum

Question 3

What cardiac changes occur during pregnancy?

Answer 3

Cardiac output increases by 30-50%
Blood pressure drops in second trimester
Heart rate increases
Palpitations are a common complaint

Question 4

Why does blood pressure drop in the second trimester?

Answer 4

Expansion of the usero-placental circulation
Fall in systemic vascular resistance
Reduction in blood viscosity
Reduction in sensitivity to angiotensin

Question 5

What changes occur to the urinary system during pregnancy?

Answer 5

Increased urine output
GFR increases
Serum urea and creatinine decrease
Increased risk of UTI

Question 6

What haematology changes occur during pregnancy?

Answer 6

Platelet count falls by dilution
WBC increase slightly
Plasma volume and RBC mass increase, results in a drop in haemoglobin

Question 7

What main haematological problem can occur due to changes during pregnancy?

Answer 7

Anaemia

Question 8

When should iron be given for treatment of anaemia during pregnancy?

Answer 8

Hb <110 at booking

<100on routine testing at 28 weeks

Question 9

What respiratory changes can occur during pregnancy?

Answer 9

Progesterone acts centrally to reduce CO2
Respiratory rate increases
O2 consumption increases
Increases plasma pH
Hyperaemia of respiratory mucous membranes

Question 10

What gastrointestinal changes can occur during pregnancy?

Answer 10

Oesophageal peristalsis is reduced
Gastric emptying slows
Cardiac sphincter relaxes
GI motility is reduced

Question 11

Why is GI motility reduced during pregnancy?

Answer 11

Progesterone is increased

Motilin is decreased

Question 12

What changes can be made in primary care to optimise pregnancy?

Answer 12

Improve diet 
Optimise BMI 
Reduce alcohol consumption 
Smoking cessation 
Folic acid 
Confirm immunity to rubella

Question 13

What must be checked in an antenatal examination?

Answer 13

Blood pressure 
Urinalysis 
Abdominal palpation (size of baby, liquor volume, symphyseal fundal height) 
Determine fetal presentation 
Listen to fetal heart

Question 14

What infections should be screened for in pregnancy?

Answer 14

Hepatitis B 
Syphilis 
HIV 
Rubella 
Iron deficiency anaemia 
Rhesus disease

Question 15

What should be looked for in a first scan?

Answer 15

Viable pregnancy
Multiple pregnancy
Identify abnormalities incompatible with life
Offer and carry out Down’s syndrome screening

Question 16

What should be looked for in detailed anomaly scan?

Answer 16

Systematic structural review of baby

Identify problems that need intrauterine or postnatal treatment

Question 17

What is Down’s syndrome?

Answer 17

Chromosomal abnormality characterised by 3 copies of chromosome 21 (trisomy 21)

Question 18

When should a first scan be carried out?

Answer 18

10-14 weeks gestation

Question 19

What can be used for measurement purposes in a first scan?

Answer 19

Maternal risk factors
serum B-human chorionic gonadotrophin
Pregnancy associated plasma protein A
Nuchal translucency

Question 20

Where are NT measurements taken from?

Answer 20

Crown Rump length

Question 21

What further testing can be used for Down’s syndrome?

Answer 21

Amniocentesis

Chorionic venous sampling

Question 22

When should chorionic venous sampling take place?

Answer 22

10-14weeks

Question 23

When should an amniocentesis take place?

Answer 23

15 weeks onwards