Antenatal Care Screening

Question 1

What is the definition of antenatal care?

Answer 1

Care provided by health care professionals to preganant women to ensure the best health outcomes for the mother and the foetus during pregnancy.
Aims to prevent maternal mortality, still birth and neonatal death.

Question 2

What is included in antenatal care?

Answer 2

Risk identification
Prevention and managementnof pregnancy related or concurrent diseases
Health education
Health promotion

Question 3

What influences the decisions in antenatal care?

Answer 3

Research-based evidence
Practitioner availability
Family experience and insight

Question 4

What are some statistics regarding the amount of women who die during childbirth?

Answer 4

10.9 per 100,000 died whilst giving birth
27 babies dies and 366 motherless children remained.
Most women die in the postnatal period.
Post natal suicide rates are increasing

Question 5

What are some inequaltiies in natal outcomes?

Answer 5

1 in 9 mothers to die had severe and multiple disadvantages
Black women are 3.7 x more likey to die during childbirth and asian women are 1.8x more likley to die during childbirth.

Question 6

What is the thought behind preconceptual care?

Answer 6

Opportunity to assess perspective parents health and provide information to help them make informed decisions.
This can inlcude managing diabetes and anemia before pregnancy.
Often given folic acid.
However, this is often not the case as most pregnancies are unplanned.

Question 7

What are the seven principles of decisions making and consent?

Answer 7

1. All patients have the right to be involved in decision-making and should be supported to make informed decisions.
2. Decision making is ongoing, information should be exchanged continously with the patient
3. All patients should be listened to, provided with appropriate information and time.
4. Doctors should talour information and options to what the patient regards as the most important
5. All adults should be presumed to have the capacity to consent until evidence otherwise
6. It a patient does not have the capacity to consent all decision making should be in their best interest, and in consultation with those who know them best
7. Patients laking capcity by law, should still be involved and exercise choice where possible.

Question 8

How broad is the team involved in antenatal care?

Answer 8

Interprofessional and multiagency - including private and public decisions

Question 9

How can you be referred to antenatal care?

Answer 9

Self referral
Midwife
GP
Early Pregnancy Assessment
Direct Access to treatment centre (walk in)
Fertility clinic

Question 10

What is an Early Pregnancy Assessment?

Answer 10

Centre that treats women between 6 and 13 weeks pregnant,
Must be experiencing bleeding or pain
Is ran by nurses but aided by gynecologists.
Often recieve a scan by a radiologist to identify the problems.

Question 11

Where can antenatal care happen?

Answer 11

Midwife at patients home
Obstetric unit
Health centre
Childrens Centre
A midwifery unit

Question 12

What is meant by universal care or additional care?

Answer 12

Universal Care is offered to every pregnant woman
Additional care is only offered to select at risk groups, such as diabetics or if it is your first pregnancy

Question 13

How does your level of required additional care affect the team you work with?

Answer 13

Normal level care is often led by midwifery team and focuses on universal care screening and diagnostic testing
Intermediate care is shared
High level care is consultant led care, often in a obsteric unit/ specialist unit, this includes additional monitorting such as glucose levels or renal system function.

Question 14

What maternal characteristics may require additional antenatal care?

Answer 14

BMI > 30
BMI < 18
Smoking or substance misuse
Age >40
Teenage mothers

Question 15

What previous medical conditions may require a patient to have additional antenatal care?

Answer 15

Cardiac disease
Renal disease
Endocrine disease
Diabetes
Haematological disorders
Autoimmune disorders

Question 16

What obstetric issue may require a patient to have additional antenatal care?

Answer 16

Recurrent miscarriage
Preterm birth
Pregnancy induced hypertension Eclampsia
Rhesus Isoimmuniszation
APH/PPH antepartum haemorrhage and postpartum haemorrhage
Still birth/ neonatal death
If child is identified as small or large for gestational discharge.

Question 17

What are the WHO screening needs?

Answer 17

Respons to a recognised need
Objectives defined
Target population
integrate education, testing, services and management
Quality assurance
Ensure informed choice, confidentiality and autonomy
Promote equity and ensure access
Benefits outweight the harm.

Question 18

What is the deal with screening in antenatal care?

Answer 18

To detect potential risk factors and disease indicators.
Looks at a large population of at risk but asymptomatic individuals
Simple and safe tests
Generally accepted as low risk
Results indicate the suspicion but not diagnose theactual presence of a disease
Cheap to access

Question 19

What is the deal with diagnostic tests in antenatal care?

Answer 19

To determine if a disease is or is not present
Often symptomatic individuals who have already been identified as at risk by screening programmes
May be invasive, expensive and more high risk.
More complex decisions to decide to take a diagnostic test
Gives a definite result.

Question 20

What may be the care outcomes after a screening test?

Answer 20

May be recommended diagnostic testing
Information
Further tests
Treatment

Question 21

What type of tests may be involved in diagnostic testing?

Answer 21

History taking
Clincal observations
Laboratory test results
Imaging studies

Question 22

What are the 6 different NHS antenatal and newborn screening programmes?

Answer 22

Fetal anomlay screening (FASP)
Infectious disease in pregnancy screening (IDPS)
Sickle cell and thalassaemia screening (SCT)
Newborn and infant physical examination (NIPE)
Newborn blood spot screening (NBS)
Newborn hearing screening (NHSP)

Question 23

What are some limitations of screening programmes?

Answer 23

Does not give a difinitive results only indicates risk - this can confuse patients
If not highly selective may give false positives and false negatives.
Women expect all tests to have good/normal results, isnt really an informed choice.

Question 24

When should different screening tests occur?

Answer 24

0-12 weeks infectious disease screening (HIB, hepatitis B and syphilis. - test can be reoffered ar 20 weeks
preconceptions - 12 weeks - sickle cell anemia and thalassemia
11 weeks and 2 days to 13 weeks and 6 days = T21, T18, T13
11 to 12 weeks - baby blood group (rhesus)
FBC may be done at booking scan and at 28 weeks for mum
A MSU or midstream speciement of urine - is taken regularly from mum, often first as dating scan, indicates, for UTI or preenclampsia and HCG levles

Question 25

What is a booking appointment in antenatal care?

Answer 25

Ideally held before week 10. This is the first appointment with the midwife. Book later tests and scans Midwife colects general health infromation and history Chance to tell midwife of any concerns that may affect yours or your babies safety during pregnancy including domestic abuse or FGM. Bloos test is completed for infectious diseases and hCG levels. Start to develop maternity notes Health education on how to encourage a healthy pregnancy and good labour.

Question 26

What happens in a sickle cell and Thalassemia screening?

Answer 26

Happens from preconception to 10 weeks gestation All women are offered thalassaemia but not all are offered sickle cell anemia but it can be requested Sickle cell may be offered if you are in a high risk area. Done by a famliy origin questionnaire (genetic pedigree) May have a blood test.

Question 27

What is the combined test?

Answer 27

A blood test and scan between 11 weeks and 14 weeks Measures the nuchal translucency (part of anomaly scan) Results combined with the mother's age to calculate the risk of DS. ES and PS. imaging test may also look at the shape of the babys nose, DS are more likely to flat a flat nose bridge, will have a greater presnasal thickness to nasal bone ratio. Mothers blood test to identify hormones from the placenta and levels of DNA from the placenta relating to chromosome T21 T18 and T13..

Question 28

How does the nuchal transluency test relate to down syndrome?

Answer 28

Measures the thickness of the tissue at the back of the unborn babies neck using ultrasound imaging An increases thickness indicates a risk of downsyndrome At eleven weeks low risk id below 2mm and 13 weeks and 6 days low risk is below 2.8mm

Question 29

What is the quadruple test in antenatal screening?

Answer 29

Is offered if the gestation is over 14 weeks at the first routine scan Blood test only between 14 and 20 weeks for the risk of Down Syndrome Screening for Edwards and Pataus takes place later at the anomaly scan Is less accurate than the combined test.

Question 30

What are the short hand genetric term mutations for Down Syndrome, Edwards Syndrome and Pataus Syndrome?

Answer 30

DS is T21 ES is T18 PS is T13

Question 31

What are the different screening tests for trisomy condition options?

Answer 31

Down Syndrome Only Edwards and Pataus Syndrome Only All three.

Question 32

When is the anomaly ultrasound scan? What does it do?

Answer 32

Is between 18 weeks and 21 weeks of pregnancy Nuchal translucency measurement Abnormalities and birth defects Open spins bifida Gastrochises Cleft Clip Placenta position. More complex diagnosis may require a sonographer

Question 33

What are some indications that there is an increased risk of an underlying foetal chromosomal disorder?

Answer 33

Echogenic bowel (brighter then usual), often transient Shortened feotal long bones in trimester 3 single Umbilical cord artery Clenched fists indicate T13 and T18 Rocker bottom feet T13 and T18 Sandal Gap T21 Choroid plexu cysts Absent Nasal bone Ventriculomegaly >10mm (brain ventricles)

Question 34

What are some features of T21 on ultrasound?

Answer 34

Reduced or no nasal bone Sandal Gap Increased Nuchal Transluceny

Question 35

What are some fatures of Edwards and Pataus syndrome on ultrasound?

Answer 35

Rocker bottom Feet Clenched First Still born (no heart beat).

Question 36

What is a NIPT (Non invasive prenatal screening test)?

Answer 36

Often done is a previous combined or quadruple screening test indicates an increased risk Has very high specificity for T21, T18 and T13. Analyses mothers smal cell free DNA fragments in the blod from the placenta.

Question 37

What is chorionic villous sampling?

Answer 37

A diagnostic test, that removes and samples a small amount of DNA from the placenta either transabdominally or transcervically. Done ideally between 11 and 14 weeks of preganancy. Has a 1 in 200 (monozgotic) and 1 in 100 (dizygotic) risk of miscarriage, and a risk of infection Done if a screening test indicates an increased risk.

Question 38

What is amniocentesis?

Answer 38

A diagnositc test done if a screening test indicates an increased risk of a genetic condition. Occurs between week 15 and week 20. A thin needles is inserted transabdominally to sample amniotic fluid from the amniotic sac. Risk of miscarriage and infection (1 in 200 for a monozygotic pregnancy).

Question 39

What additional tests are offered for a diabetic mother?

Answer 39

Pre-pregnancy are offered diabetic eye screening annually. (high blood sugar can damage the retina) 0-12 weeks pregnant, type 1 and type 2 diabetic mothers are offered a diabetic eye screening 16-20 weeks are offered a follow up retina scan if retinopathy was seen at the first scan 28 weeks Offered a further eye test for daibetic retinopathy Diabetic eye screening is not offered to women who develop gestational diabetes.

Question 40

What is gestational diabetes screening?

Answer 40

Offered to women who have gestational diabetes, often occurs during the first pregnancy and resolves after delivery. At 24 to 18 weeks (or earlier if increased risk) will recieve an oral glucose tolerance test, given a glucose drink in the morning after fasting, blood test two hours later to see how glucose was handled Regular blood glucose monitoring, adivce on exercise and diet

Question 41

What are some of the long term efffects of gestational diabetes on the mother?

Answer 41

Increased risk of gestation diabetes in future preganancies Increased risk of developing type 2 diabetes in the future. Increased risk of cardiovascular disease, chronic kidney disease and cancer.

Question 42

What are some of the long term effects of gestational diabetes on the foetus?

Answer 42

Increased risk of still birth Increased risk of type two diabetes or obesity in later life.

Question 43

What are the NICE criteria of an increased risk of gestational diabetes?

Answer 43

BMI > 30 Previous baby over 4.5kg Ethnic origin - south asian, black caribbean, middle eastern are at increase risk Previous gestational diabetes Glycosuria First degree relative with diabetes

Question 44

What are the main problems that antenatal care aims to indentify?

Answer 44

Foetal congential or genetic abnormalities Pregnancy induced hypertension and eclampisa Gestation diabetes Restricted interuterine growth Mental health and wellbeing Prematurity UTI APH - antepartum hemmorrhage.

Question 45

What tests are done at almost all antenatal care appointments?

Answer 45

Blood pressure urinalysis Abdominal palpitation Odema Mood/emotional wellbeing.

Question 46

What additional antenatal appointments are offered to women who are pregnancy for the first time?

Answer 46

25 weeks appointment - with doctor of the midwife to measure the size of the uterus, measure the blood pressure and urine. 31 weeks appointment - discuss any previous screening results, uterus size and urine. 40 weeks appointment - info about what happens in the pregnancy lasts longer than 41 weeks, uterus size and urine.

Question 47

What should happen at the first appointment with the midwife or doctor?

Answer 47

Information about folic acid, nutritional information, lifestyle factors and antenatal screening Tell the doctor of any risks or complications from any previous pregnancies. Genetic risk of conditions.

Question 48

What tests and screening should be given to a newborn baby?

Answer 48

Newborn physical examination within 72 hours. Newborn hearing screen - between 0 and 5 weeks Newborn blood spot scans ideally day 5 for metabolic, blood and infectious disease. Infant physical examination at 6-8 weeks.

Question 49

What is the infectious disease in pregnancy screening?

Answer 49

IDPS Is a routine screen, a blood test is offered at the dirst antenatal appointment Blood test form arm for HIV, Syphylis and Hepatitis B.

Question 50

What happens in a newborn and infant physical examination?

Answer 50

Ask about baby alterness, feeding and wellbeing Baby is undressed Examine the eyes for the pupil reflex using the light Exam the hip joints. Listen to the babies heart. In male examine to see if the testes have extended into the scrotum

Question 51

What happens during a newborn hearing screening?

Answer 51

An automated otoacoustic emission An ear piece plays gentl clicking sounds into the babies ear Used to identify permanent hearing loss, unclear results are offered another appointment at 8 weeks pregnancy.