Antenatal Care and Screening Flashcards by Shauneen Kiernan

Describe the antenatal care timeline

Booking scan before 10 weeks (8-12)

Dating scan 10-13 weeks (down syndrome/nuhal translucency screening also)

Antenatal appointment 16 weeks

Anomaly scan 18-20 weeks

28 weeks second screening for anaemia

Further antenatal appointments at 25, 31, 34, 36, 38 etc

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What is covered at routine antenatal appointments?

Symphisis-fundal height measurement from 24

Fetal presentation from 36

Urine dipstick and protein

Urinalysis, for asymptomatic bacteriuria

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What bloods are done at booking?

FBC

Anaemia

Haemoglobinopathy

Thalassaemia, for all women
Sickle cell, for women at high risk

Blood group

Rhesus status

Viral screen

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When are women screened for anaemia in pregnancy?

Booking

28 weeks gestation

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Why does anaemia occur in pregnancy?

During pregnancy, the plasma volume increases, and so the blood is more diluted, resulting in reduced haemoglobin concentration

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What dose of folic acid is reccomended in pregnancy?

400mcg

Women with neural tube risk factors should be given 5mg instead

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What supplements, other than folic acid, should also be advised for pregnant women?

Vitamin D 10 micrograms

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What supplements are not reccomended in pregnancy?

Vitamin A in high doses can be teratogenic

(Liver is high in this so should also be avoided)

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What foods should be avoided in pregancy?

Vitamin A

Liver

Listeriosis

Unpasteurised milk
Ripened soft cheeses
Pate
Undercooked meat

Salmonella

Raw or partially cooked eggs and meat, especially poultry

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What medications cannot be used in pregnancy?

Methotrexate

Lithium, avoided unless other options have failed

Sodium valproate

DOACs

ACEI/ARBs

B Blockers, switch for labetalol

NSAIDs typically avoided unless necessary

Opiates, can cause neonatla withdrawl

Warfarin

Roaccutane

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When should methotrexate be stopped before conception?

Both men and women must stop methotrexate 6 months prior to conception

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When should NSAIDS be stopped in pregnancy?

May be used until 32 weeks but after this time should be withdrawn due to the risk of early close of the ductus arteriosus

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What anti-depressants are used in pregnancy and breast feeding?

Sertraline or paroxetine are the SSRIs of choice in breastfeeding women

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What are the safest epileptic drugs to use in pregnancy?

Carbamazepine and lamotrigine

Sodium valporate carries the highest risk of congenital defects

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Give drug contraindications for breastfeeding

Antibiotics

Ciprofloxacin
Tetracycline
Chloramphenicol
Sulphonamides

Lithium

Benzodiazepines

Aspirin

Carbimazole

Methotrexate

Sulfonylureas

Cytotoxic drugs

Amiodarone

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Describe the pathophysiology of rhesus disease in pregnancy

If a Rh -ve mother delivers a Rh +ve child, a leak of fetal red blood cells may occur

This causes anti-D IgG antibodies to form in mother

In later pregnancies, these antibodies can cross the placenta and cause haemolysis in fetus

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When is anti-D immunoglobulin therapy given in pregnancy?

Delivery of a Rh +ve infant, whether live or stillborn

Any termination of pregnancy

Miscarriage if gestation is > 12 weeks

Ectopic pregnancy if managed surgically

External cephalic version

Antepartum haemorrhage

Amniocentesis, chorionic villus sampling, fetal blood sampling

Abdominal trauma

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When should anti-d therapy be given to unsensitised Rh - mothers?

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28 and 34 weeks

What infections are screened for in pregnancy?

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HIV

Rubella

Hep B

Syphillis

What vaccines are offered to pregnant women?

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Whooping cough/pertussis) from 16 weeks

Influenza when available in autumn or winter

What organism causes Rubella?

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Togavirus

How does congenital rubella syndrome present?

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Aqueductal stenosis and congenital hydrocephalus

Sensorineural deafness

Congenital cataracts

Congenital heart disease/patent ductus arteriosus

Congenital cataracts

Growth retardation

Hepatosplenomegaly

Purpuric skin lesions

Chorioretinitis

Microphthalmia

Cerebral palsy

When is there a risk of congenital rubella syndrome?

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In first 8-10 weeks risk of damage to fetus is as high as 90%

Damage is rare after 16 weeks

When are Rubella patients infectious?

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Individuals are infectious from 7 days before symptoms to 4 days after the onset of rash

When is the MMR vaccine offered?

Offered in post natal women but not offered to pregnant women or those attempting to get pregnant

Describe the management of chickenpox exposure in pregnancy

If less than 20 weeks and not immune, give varicella zoster immunoglobulin (VZIG) as soon as possible, effective up to 10 days post exposure If more than 20 weeks and not immune, give either VZIG or aciclovir 7-14 days after exposure If any doubt on the patient having previous chickenpox, check for varicella antibodies

Describe the managemet of chickenpox in pregnancy

If over 20 weeks and presenting within 24 hours of onset of rash, give aciclovir If less than 20 weeks aciclovir should be given with caution

How does congenital varicella zoster virus present?

Low birth weight Limb hypoplasia Skin scarring Microcephaly Eye defects Learning disability

What is the management of pregnant mothers who are hepatitis B positive?

Babies should receive vaccination at 1-2 months and 6 months and hepatitis B immunoglobulin within 12 hours of birth Little evidence to suggest caesarean section reduces vertical transmission rates hepatitis B cannot be transmitted via breastfeeding

What is the management of pregnant mothers who are HIV positive?

Zidovudine infusion should be started four hours before beginning the caesarean section Zidovudine administered orally to neonate Advised not to breastfeed

What is asymptomatic bacteriuria and what is the relevance in pregnancy?

Refers to bacteria present in the urine, without symptoms of infection Pregnant women with asymptomatic bacteriuria are at higher risk of developing UTIs and pyelonephritis, and subsequently at risk of preterm birth

How are UTIs managed in pregnancy?

7 days of antibiotics Nitrofurantoin, avoid in the third trimester due to neonatal haemolysis Amoxicillin, only after sensitivities are known Cefalexin

Why should cats be avoided in pregnancy?

Toxoplasmosis

Why should unpasturised cheese be avoided in pregnancy?

Listeria monocytogenes/listeriosis

What causes increased alpha feto protein?

Neural tube defects * Meningocele * Myelomeningocele * Anencephaly Abdominal wall defects * Omphalocele * Gastroschisis Multiple pregnancy

What causes decreased alpha feto protein?

Down's syndrome Trisomy 18/Edward's syndrome Maternal diabetes mellitus

Give risk factors for neural tube defects

Previous child with NTD Diabetes mellitus Women on antiepileptic Obese HIV +ve taking co-trimoxazole Sickle cell

What causes increased nuhal translucency?

Down's syndrome Congenital heart defects Abdominal wall defects

What tests are used in down syndrome screening?

Increased serum b-human chorionic gonadotrophin (b-hCG) Decreased pregnancy associated plasma protein A (PAPP-A) Increased fetal nuchal translucency (NT) measurement

What are the air travel rules in pregnancy?

Women over 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel Women with uncomplicated, multiple pregnancies should avoid travel by air over 32 weeks

How does fetal alcohol syndrome present?

Microcephaly (small head) Thin upper lip Smooth flat philtrum (the groove between the nose and upper lip) Short palpebral fissure (short horizontal distance from one side of the eye and the other) Learning disability Behavioural difficulties Hearing and vision problems Cerebral palsy

What vaccinations are offered to pregnant women?

Pertussis and influenza

Give complications of CVS

Foetal limb abormalities if performed before 11 weeks gestation

Antenatal Care and Screening Flashcards

(43 cards)