Antenatal Care and Screening in Pregnancy Flashcards
(93 cards)
1
Q
what is aneuploidy
A
an abnormal number of chromosomes
2
Q
what are the tests for aneuploidy in pregnancy
A
First trimester screening
- Combined ultrasound and biochemical screening (CUBS)
Second trimester serum screening
Non-invasive pre-natal testing (NIPT)
3
Q
what is the formula for sensitivity
A
true positive / (positive + false negative)
4
Q
what is formula for specificity
A
true negative / (negative + false positive)
5
Q
how sensitive is the first trimester screening for downs syndrome and what is the false positive rate
A
90%
FP 5%
6
Q
how may women who are high risk in down syndrome first trimester screening will have a baby NOT affected by the conditions
A
in on 20
7
Q
what are the green and red pathways
A
green= low risk pregnancies, midwife led
red= obstetric led care, higher risk pregnancies
8
Q
what do you start if patient is at higher risk of a VTE
A
fragmin
9
Q
is FGM illegal in UK
A
yes and illegal to facilitate someone leaving country to do it
have to involve social work if think mother will do it to daughter
10
Q
what tests are done at the booking visit (12 weeks)
A
BMI BP cardio exam abdo exam Hb ABO, Rhesus syphilis, HIV, Hep B+C urinalysis USS offer down syndrome screening anencephaly, gastroschisis, absent limbs blood group and rhesus status
11
Q
how do you predict due date from LMP
A
ass on nine months and 7 days- 280 days
12
Q
what do you look for the booking USS
A
viability singleton/ multiple pregnancy gestational age major structural anomalies molar pregnancy estimated date of delivery (CRL)
13
Q
is there a yolk sac in an ectopic pregnancy
A
no
14
Q
what is needed to confirm a pregnancy is viable
A
heart beat
15
Q
how do you differentiate a non continuing or ectopic pregnancy if USS is inconclusive
A
hCG
16
Q
what is a dichorionic twins
A
twins that have own placenta and yolk sac
17
Q
when should screening for sickle cell disease and thalassaemia should be offered
A
before 10 weeks
18
Q
what is assessed at the follow up visits (20 weeks)
A
history - physical and mental health, fetal movements BP urinalysis symphysis- fundus height lie and presentation engagement of presenting part (shouldnt be there <36 weeks) fetal heart auscultation gender cleft lip heart defects placenta praevia talipes spina bifida anecephaly (neural tube defect, skull doesnt form)
19
Q
when should be be worried about a babies lie
A
36 weeks onwards
20
Q
what are the objectives of USS foe feral anomaly
A
Reduction in perinatal mortality and morbidity
Potential for in utero treatment
Identification of conditions amenable to neonatal surgery
21
Q
why do you screen for cleft lip
A
needs surgical correction, sometime SL therapists or NG tubes, generally no long term complications.
- to prevent shock to mother if not expecting it, so she can meet surgeons
- Also can be associated with trisomy 13 and 18 and other genetic syndromes that cause structural abnormalities- do extended scan to look for other abnormalities and if found genetic testing
22
Q
what anomalies are USS screened for at 20 weeks
A
cleft lip cardiac anecephaly gross abnormalities- limbs, hands, feet abdominal waal defects- gastoschisis and omphaloceole spina bifida diaphragmatic hernia exomphalos bilateral renal agenesis lethal skeletal dysplasia trisomy 13 and 18
23
Q
are trisomy 13 and 18 compatible with life
A
generally no
24
Q
what is pataus syndrome
A
trisomy 13
25
what is edwards syndrome
trisomy 18
26
what is placenta praevia
when the placenta is low lying in the womb and covers all or part of the entrance (the cervix). In most women, as the womb grows upwards, the placenta moves with it so that it is in a normal position before birth and does not cause a problem.
27
what should you be offered If an earlier ultrasound scan (usually between 18 weeks 0 days and 20 weeks 6 days) showed that your placenta extends over the cervix
another abdo scan at 32 weeks
if this unclear vaginal scan
if still low then strongly suggest CS
28
do all women get offered down syndrome screening
yes
29
what increases the risk of downs syndrome
maternal age
30
what is included in the risk assessment for downs syndrome in the first trimester
```
nuchel thickness
HCG (goes up in DS)
PAPP-A (goes down in DS)
maternal age
AFP (alpha feta protein) (goes down)
```
31
what is the nuchel thickness
Measure of skin thickness behind fetal neck using ultrasound done at 11+3-13+6 weeks
32
what is a normal NT value
< 3.5 mm (when the CRL is between 45 and 84mm)
33
what is a diagnostic test offered for downs syndrome
when 1st trim screening result less than 1 in 250
34
what is the risk of amniocintesis causing miscarriage
1%
35
what should be done before downs syndrome screening
counselling
| dating US before blood taken to establish gestation
36
when should you use CRL up until
13 weeks gestation
| after this head circumference
37
who gets 2nd trim screening for aneuploidy (15 to 20+6 weeks)
For those women who miss first trimester screening
| For those women in whom CUBS is unsuccessful
38
what is included in 2nd trim aneuploidy screening
```
Alpha-fetoprotein (AFP)
human Chorionic Gonadotrophin (hCG)
unconjugated oestradiol (UE3)
inhibin A
maternal weight,
smoking status, and if applicable, previous affected pregnancy and assisted conception
```
39
what does 2nd trim aneuploidy screening
risk of downs syndrome
40
what is NIPT
non invasive prenatal testing
can identify pregnant women who are at higher risk of having a baby with certain genetic and chromosomal conditions, such as Down’s syndrome (also known as Trisomy 21), Edwards’ syndrome (Trisomy 18) and Patau’s syndrome (Trisomy 13)
detects fetal DNA fragments in a sample of blood taken from the mother
41
what is FASP
Fetal Anomaly Screening Programme
42
when is an amniocentesis done
after 15 weeks
maternal choice
if high risk of DS
43
what are the specific diagnostic tests for DS
amniocentesis
| chorionic villus sampling
44
when is chorionic villus sampling done
after 12 weeks
45
what is the miscarriage rate of chorionic villus sampling
2%
46
is LA needed for amniocentesis and CVS
only CVS (bigger needle that samples placenta)
47
what are haemoglobinopathies screened for
booking appointment
48
what are haemoglobinopathies
autosomal recessive RBC disorders that result in abnormal haemoglobin
49
what are the main types of haemoglobinopathies
thalassemias and sickle cell anaemia
50
how are haemoglobinopathies inherited
AR
| 50% risk of carrier, 25% not affected, 25% affected
51
what is thalassemia characterised by
low haemoglobin and RBCs
52
what can happen in sickle cell anaemia in pregnancy
sickle cell crisis
| lot of other complications
53
what can cause maternal anaemia
Iron deficiency
Folate deficicy
B12 deficiency
54
when are mothers screened for anaemia
booking and 28 weeks
55
what is the aim for anaemia treatment
optimise Hb prior to birth
56
when are rhesus incompatabilities a problem
negative mum
positive baby
worry about mum being previously sensitised and acquiring anti D antibodies
57
when should all pregnanct women have their blood group and antibody status (e.g. O- is o group and rh -ve) determined
at booking and again at 28 weeks
58
which type of HDN is more severe
ABO is more common but less severe
| Rhesus is more severe but less common
59
when is jaundice of a newborn pathological
if within 1st day of life
60
what mental health screening questions should you ask all pregnant women
Do you have new feelings and thoughts which you have never had before, which make you disturbed or anxious?
Are you experiencing thoughts of suicide or harming yourself in violent ways?
Are you feeling incompetent as a mother, as though you can’t cope, or feeling distanced or estranged from your baby? Are these feelings persistent?
Do you feel you are getting worse
61
what are the risk factors for gestational diabetes
BMI above 30 kg/m2
previous macrosomic baby weighing 4.5 kg or above
previous gestational diabetes
family history of diabetes (first‑degree relative with diabetes)
minority ethnic family origin with a high prevalence of diabetes
62
what should you offer women with any one of these risk factors for gestational diabetes
testing for gestational diabetes;
| 2‑hour 75 g oral glucose tolerance test (OGTT) to test for gestational diabetes in women with risk factors
63
what result = gestational diabete
in a 2‑hour 75 g oral glucose tolerance test (OGTT)
a fasting plasma glucose level of 5.6 mmol/litre or above or
a 2‑hour plasma glucose level of 7.8 mmol/litre or above.
64
what does monitoring symphysis fundal height prevent
undetected intrauterine growth restriction
65
what are the major risk factors for small for gestational age of babies
```
maternal age > 40
smoker >11/ per
paternal/paternal SGA
cocaine
daily vigorous exercise
previous SGA/ still birth
chronic hypertension
diabetes with vascular disease
renal impairment
```
66
when should you measure SFH
each antenatal appointment from 24 weeks
67
why might FSH be inaccurate
BMI > 35, large fibroids, hydramnios
68
what should you do if a FSH is below the 10th percentile/ inaccurate
USS to measure fetal size
69
what should women at risk of pre eclampsia take a prevention
75 mg of aspirin daily from 12 weeks until the birth of the baby
70
who is at high risk for pre eclampsia
hypertensive disease during a previous pregnancy
chronic kidney disease
autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
type 1 or type 2 diabetes
chronic hypertension
71
what are contraindications to aspirin
asthma, previous gastric ulcer
72
who is at moderate risk for pre eclampsia
```
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m2 or more at first visit
family history of pre-eclampsia
multiple pregnancy
```
73
what is look for in urinalysis
UTI
Asymptomatic bacteriuria- may not have any urinary symptoms, associated with pre term labour
PET- proteinuria
Diabetes
74
what is screened for at 28 weeks
Glucose tolerance test if they are high risk based on their history
Repeat haemoglobin- haemorrhage is biggest cause of maternal death world wide, want to correct anaemia before surgery/ birth
Repeat antibodies
Intra uterine growth restriction
Macrosomia
Urine: pre eclampsia, UTI (higher risk of preterm labour if untreated)
75
what can cause increased NT
chromosomal abnormalities (trisomy 13, 18 and 21, turners), cardiac abnormalities
76
what is MSAFP
maternal serum AFP - produced by liver of developing foetus
77
what can cause raised MSAFP
twins (more placenta, more AFP)
spina bifida
gastoschisis
(organs in contact with amniotic fluid)
78
what does hypertension and proteinuria in pregnancy suggest
pre eclampsia
79
what systems can pre eclampsia affect
any
80
what is the treatment of pre eclampsia
```
labetalol orally/ IV (nifedinpine or methyldopa if others not suitable) (to reduce BP)
betamethasone IM (to reduce brain inflammation, prevent haemorrhage, help fetal lungs develop, prevent necrotising enterocolitis)
hydrasalazine oral (peripheral vasodilators, relaxes vascular smooth muscle)
magnesium sulphate IV (peripheral + cerebral vasodilator, membrane stabiliser, anti convulsant to prevent eclamptic seizures, prevent eclampsia)
```
81
what is meant by Rhesus -ve
no d antigen on RBCs
82
what would you expect to find in a Rhesus sensitised mother
she will be rhesus -ve (no anitgen on RBCs) but will have develop anti body
83
what happens to Hb and bilirubin and coombs test in a Rh +ve affected baby
Hb down
haemolysis up
coombs test +ve (is a measure of haemolysis)
84
when can anti D be given to prevent immunisation following event of fetal maternal transfusion
ideally within 72 hours, can be within 10 days
85
how does anti D work
mops up D antigen covered RBCs from fetus, stops them interacting with maternal antibodies
86
what is the ideal route and dose of anti D
```
after sensitising event 500 IU IM
IV if in large foetal maternal haemorrhage
prophylaxis
<20 weeks 250 IU
>20 weeks 500 IU
```
87
what events in pregnancy would you administer anti D after
```
miscarriage
TOP
amniocentesis
trauma
surgical intervention for ectopic pregnancy
after delivery
```
88
```
would you give anti D to:
Rh -ve mother
ABO compatible
Rh +ve baby
coombs test -ve
infant bilirubin level normal
```
yes- at delivery RBCs will mix and cause sensitisation, problems for later pregnancies
89
```
would you give anti D to:
Rh -ve mother
ABO incompatible
Rh -ve baby
coombs test -ve
infant bilirubin level normal
```
no
| not high risk as baby Rh -ve
90
```
would you give anti D to:
Rh -ve mother
ABO compatible
Rh +ve baby
coombs test +ve
infant bilirubin level increased
```
yes- probably already sensitised though
91
```
would you give anti D to:
Rh +ve mother
ABO incompatible
Rh -ve baby
coombs test +ve
infant bilirubin level increased
```
no - haemolysis will be due to ABO incompatability
92
is anti D given in all pregnancies
yes at 28 weeks
93
if both parents are Rh -ve what will the baby be
Rh -ve
