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Year Three - Reproductive System > Antenatal Care & Screening > Flashcards

Antenatal Care & Screening Flashcards

(90 cards)

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1
Q

What five general lifestyle advice to we give pregnant women?

A

Folic Acid Supplements

Vitamin D Supplements

Alcohol Cessation

Smoking Cessation

Medication Alteration

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2
Q

How long should folic acid supplements ideally be taken prior to pregnancy?

A

Three months

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3
Q

Why do we promote pregnant patients taking folic acid supplements?

A

They decrease the risk of the baby developing neural tube defects

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4
Q

What dose of folic acid supplements are recommended?

A

400mcg daily

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5
Q

In what three patient groups is a dose of folic acid 5mg daily recommended?

A

Those who have a BMI > 30

Those who take valproate for epilepsy

Those who have had a previous child with spina bifida

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6
Q

What dose of vitamin D supplements is recommended in pregnant patients?

A

A dose of 10mcg daily throughout the whole pregnancy

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7
Q

Why is alcohol cessation recommended to pregnant patients?

A

Alcohol can cross the placenta, enter the foetus, and disrupt fetal development

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8
Q

Is there a safe level of alcohol in pregnancy?

A

No

Women are encouraged not to drink at all

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9
Q

What are the three complications of alcohol during pregnancy?

A

Miscarriage

Preterm Delivery

Fetal Alcohol Syndrome

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10
Q

What are the seven clinical features of fetal alcohol syndrome?

A

Microcephaly

Smooth Flat Philtrum

Short Palpebral Fissure

Thin Upper Lip

Learning Disability

Hearing & Vision Problems

Cerebral Palsy

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11
Q

What are the six complications that can arise due to smoking during pregnancy?

A

Fetal Growth Restriction

Sudden Infant Death Syndrome (SIDS)

Miscarriage

Stillbirth

Preterm Delivery

Pre-Eclampsia

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12
Q

What is the first pregnancy appointment called? When does it take place?

A

Booking clinic

10 weeks gestation

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13
Q

What four investigations take place at the booking clinic?

A

Antenatal Examination

Bloods

Blood Pressure

Urinalysis

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14
Q

What two measurements are taken during the antenatal examination in the booking clinic?

A

Symphyseal Fundal Height (SFH)

Fetal Presentation

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15
Q

What is the SFH?

A

This is the distance between the pubic symphysis to the fundus of the uterus

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16
Q

What is the SFH used to measure?

A

This measurement is then plotted on a chart allowing us to measure the growth of the foetus and whether this is normal or not

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17
Q

In what two circumstances can the SFH measurement not be obtained?

A

High BMI

Uterine fibroids

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18
Q

Why is fetal presentation important?

A

If abnormal, it can have implications for delivery

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19
Q

What is offered when the baby remains in a breech presentation after 36 weeks?

A

External cephalic aversion

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20
Q

What is external cephalic aversion?

A

This is a procedure used to turn a fetus from a breech position into a vertex position before labour begins

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21
Q

What happens if an external cephalic version fails?

A

The baby will be delivered by elective c-section

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22
Q

What seven blood tests taken during the booking clinic?

A

FBC

Blood Group

Antibodies

Rhesus D Status

Alpha Fetoprotein

Infectious Disease Screening

Inherited Blood Disorder (Haemoglobinopathy) Screening

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23
Q

Why is a FBC conducted during the booking clinic?

A

To look for anaemia

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24
Q

What alpha fetoprotein level at the booking clinic indicates further investigation?

A

> 2MoM

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25
What is rhesus?
It refers to various types of rhesus antigens on the surface of red blood cells
26
What is the most relevant antigen within the rhesus blood group system?
Rhesus-D antigen
27
How do we manage pregnant women who are rhesus-D positive?
There is no need for any additional treatment during pregnancy
28
Explain why rhesus-D negative pregnant women need to be managed
There is a possibility that her child will be rhesus positive. It is likely that at some point during the pregnancy that the blood from the baby will find a way into the mother’s bloodstream. When this happens, the baby’s red blood cells display the rhesus-D antigen. The mother’s immune system will recognise these antigens as foreign and produce antibodies against them. The mother has then become sensitised to rhesus-D antigens. This sensitisation process doesn’t cause problems during the first pregnancy. However, in subsequent pregnancies, the mother’s rhesus-D antibodies can cross the placenta into the fetus. If that fetus is rhesus-D positive, these antibodies attach themselves to the red blood cells of the fetus and causes the immune system of the fetus to attack them. The red blood cell destruction (haemolysis) caused by the antibodies of the mother is called haemolytic disease of the newborn.
29
How do we manage rhesus-D negative women during pregnancy?
All women are given intramuscular anti-D injections
30
How does anti-D medication work to prevent sensitisation?
It works by attaching to the rhesus-D antigens on the fetal red blood cells in the mother’s circulation, causing them to be destroyed This prevents the mother’s immune system recognising the antigen and creating its own antibodies to the antigen
31
When do we give anti-d injections - three circumstances?
28 weeks’ gestation Sensitisation events At birth (if the baby’s blood group is found to be rhesus-positive)
32
What is the Kleihauer test?
It checks how much fetal blood has passed into the mother’s blood during a sensitisation event
33
When is the Kleihauer test conducted? Why?
It is used after any sensitising event past 20 weeks’ gestation To assess whether further doses of anti-D are required
34
How is the Kleihauer test conducted?
This test involves adding acid to a sample of the mother’s blood Fetal haemoglobin is naturally more resistant to acid, therefore it persists in response to the added acid, whilst the mother’s haemoglobin is destroyed The number of cells still containing haemoglobin can then be calculated
35
What three infectious diseases are screened during the booking clinic? In which women do we screen these diseases?
Hepatitis B HIV Syphilis This is part of the routine antenatal screening, which is recommended for every pregnancy
36
What two inherited blood disorders are screened during the booking clinic? In which women do we screen these diseases?
Sickle cell disease - only those that are at high risk are screened Thalassaemia -all pregnant women are offered screening
37
Why is blood pressure measured at the booking clinic?
It is conducted to screen for hypertension A hypertensive pregnancy can be indicative of pre-eclampsia
38
Why is a urinalysis investigation conducted at the booking clinic?
It is used to screen for excess protein and bacteria This can then allow diagnosis of a UTI or pre-eclampsia
39
After the booking clinic what is the next pregnancy appointment? When is this conducted?
Dating scan 10-14 weeks
40
What investigation is conducted at the dating scan?
Ultrasound scan
41
What are the six things screened for at the dating scan?
It is used to check the baby’s heartbeat, growth and development It is used to estimate the stage of the pregnancy and the due date It confirms whether there is a multiple pregnancy It allows screening for trisomy abnormalities. These screening tests only provide a risk of their baby being affected however cannot provide a confirmed diagnosis It is used to measure the nuchal translucency (NT) It screens for neural tube defects
42
What measurement is used to calculate the gestational age?
Crown rump length
43
What are the three types of trisomy abnormalities?
Down’s syndrome (trisomy 21) Edward’s syndrome (trisomy 18) Patau’s syndrome (trisomy 13)
44
Can screening for trisomy abnormalities confirm a diagnosis?
No, they can only estimate a risk
45
What is the first line antenatal screening for Down's syndrome?
Combined test
46
At what gestation is the combined test conducted?
11-14 weeks gestation
47
What is the combined test?
It involves combining results from ultrasound and maternal blood tests
48
What does the ultrasound scan in the combined test measure?
Nuchal translucency
49
What is the nuchal translucency?
This is the sonographic appearance of a collection of fluid under the skin behind the fetal neck
50
What two things increase the nuchal translucency?
Gestational age Chromosomal abnormalities
51
What nuchal translucency thickness is indicative of Down's syndrome?
> 6mm
52
What investigation should be conducted when individuals have a high nuchal translucency and a low trisomy risk? Why?
Cardiac scan This is due to fetal cardiac abnormalities are associated
53
What two maternal blood tests are included in the combined test?
Beta-Human Chorionic Gonadotrophin (beta-hCG) Pregnancy-Associated Plasma Protein-A (PAPPA)
54
What beta-hCG result indicates a greater risk of Down's syndrome?
Higher
55
What PAPPA result indicates a greater risk of Down's syndrome?
Lower
56
When is the triple test conduced?
14-20 weeks gestation This investigation is only conducted if it is not possible to obtain a nuchal translucency measurement or the patient is over 14 weeks pregnant
57
What three maternal blood tests are included in the triple test?
Beta-Human Chorionic Gonadotrophin (beta-hCG) Alpha-Fetoprotein (AFP) Serum Oestriol
58
What AFP result indicates a greater risk of Down's syndrome?
Lower
59
What serum oestriol result indicates a greater risk of Down's syndrome?
Lower
60
When is the quadruple test conducted?
14-20 weeks gestation This investigation is only conducted if it is not possible to obtain a nuchal translucency measurement or the patient is over 14 weeks pregnant
61
What is the quadruple test?
It is identical to the triple test, but also includes maternal blood testing for inhibin-A
62
What inhibin-A result indicates a greater risk of Down's syndrome?
Higher
63
What three investigations should be offered to individuals when individuals have a Down's syndrome risk score greater than 1 in 150?
Non-Invasive Prenatal Testing Chronic Villus Sampling (CVS) Amniocentesis
64
What is the first line investigation used for high nuchal translucency?
Non-invasive prenatal testing
65
What is non-invasive prenatal testing?
It involves sampling maternal blood, which will contain fetal cell free DNA that has been released from the placenta
66
Does non-invasive prenatal screening carry a risk of miscarriage?
No
67
What happens if the risk of chromosomal abnormalities is determined low from non-invasive prenatal screening?
No further investigations are required
68
What happens if the risk of chromosomal abnormalities is determined high from non-invasive prenatal screening?
These parents are offered amniocentesis and chronic villus sampling to further investigate this
69
When is CVS conducted?
10-14 weeks gestation
70
What is CVS?
It involves a fine needle being guided through the abdomen to take a small sample of tissue from the placenta The chromosomes from the placenta can be counted from the sample
71
What is the % risk of miscarriage with CVS?
1-2%
72
When is amniocentesis conducted?
15 weeks gestation
73
What is amniocentesis?
It involves a fine needle being guided through the abdomen to take a small sample of amniotic fluid The chromosomes from the fluid can be counted from the sample
74
What is the % risk of miscarriage with amniocentesis?
1%
75
What is the routine screening test offered to women for Down's syndrome?
Combined ultrasound/biochemical (CUB) investigation
76
What are the two types of neural tube defects?
Anencephaly Spina Bifida
77
What is ancephaly?
It is characterised by an absence of cortical tissue and cranial vault
78
What are the three features of ancephaly on the dating scan?
The presence of no parenchymal tissue A low crown-rump length A “frog eye” appearance due to absent cranial bone and bulging orbits
79
What is spina bifida?
It is characterised by incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy
80
What are the three features of spina bifida on the dating scan?
The presence of dorsal ossification centres or lateral pedicles are being splayed apart The lemon sign, which is when the shape of the fetal skull appears flattened and inwardly scalloped The banana sign, which is the appearance of the cerebellum wrapped around the medulla
81
What next pregnancy appointment occurs after the dating scan?
Anomaly scan
82
When is the anomaly scan carried out?
18 and 21 weeks gestation
83
What does the anomaly scan screen for?
Neural tube defects
84
What are the three neural tube defects screened for on the anomaly scan?
Hypoplastic Left Heart Exomphalos Cleft Lip
85
What is hypoplastic left heart syndrome?
It is a birth defect in which the left side of the heart is critically underdeveloped and affected individuals have profound cyanosis and cardiac failure
86
What are the three features of hypoplastic left heart syndrome on an anomaly scan?
A small ascending aorta A thick-walled left ventricle An enlarged right heart chamber
87
What is exomphalos?
It is an abdominal wall defect in which the baby’s intestines protrude inside the umbilical cord
88
What is exomphalos associated with?
Trisomy chromosome abnormalities
89
What is cleft lip?
An opening or split in the upper lip
90
What is the cause of a cleft lip?
It results when facial structures that are developing in an unborn babe don’t close completely

Year Three - Reproductive System (52 decks)

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