Antenatal screening

Question 1

_____ is the process of identifying apparently healthy people who may have an increased chance of a disease or condition.

Answer 1

Screening

Question 2

Antenatal

Answer 2

Anytime during pregnancy up until delivery

Question 3

Puerperium

Answer 3

6 week period after delivery

Question 4

Liquor

Answer 4

Amniotic fluid around the baby

Question 5

Lochia

Answer 5

Normal blood loss after delivery

Question 6

Intrapartum

Answer 6

Delivery of the baby

Question 7

What are some infectious diseases screened for in pregnancy?

Answer 7

HIV
Heb B
Syphilis

Question 8

Why are blood tests conducted in antenatal appointment?

Answer 8

Screening for sickle cell and thalassaemia screening.

Question 9

What are some risks that could be identified and acted on during pregnancy?

Answer 9

Venous thromboembolism
Pre-eclampsia and hypertension
Gestational diabetes
Foetal growth
Pre-existing medical conditions
Mental health

Question 10

What are some important risks of smoking to pregnancy?

Answer 10

Premature birth
Increased miscarriage
(affects blood flow through placenta)

Question 11

What is response to pregnant smokers?

Answer 11

Smoking cessation advice
Growth scans

Question 12

How is pre-eclampsia or Pregnancy Induced Hypertension (PIH) managed?

Answer 12

Aspirin throughout pregnancy
Expedited delivery (37 weeks) if pre-eclampsia diagnosed.

Question 13

How is gestational diabetes managed?

Answer 13

Growth scans
Diabetes team

Question 14

What are risk factors for Post-Partum Haemorrhage?

Answer 14

High BMI
Previous PPH

Question 15

When are the routine dating scans done?

Answer 15

11+2 to 14+1 weeks
Nuchal translucency done here

Question 16

When are anatomy scan done?

Answer 16

18+0 to 20+6 weeks
Screens for 11 crucial structurally visible conditions

Question 17

What is the most common cause of death in maternal mortality in the UK?

Answer 17

VTE

Question 18

What is maternal death defined as?

Answer 18

Death of a patient while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by pregnancy or its management.

Question 19

Stillbirth rate increases according to the level of _____

Answer 19

deprivation

Question 20

True or false: both progesterone and oestrogen spike just before childbirth and then drop down.

Answer 20

True

Question 21

Immediately following delivery, uterus contracts to what level?

Answer 21

The level of umbilicus

Question 22

Fundal height decreases in size by _cm per day post birth

Answer 22

1cm

Question 23

The uterus returns to pre-pregnancy size at _ weeks

Answer 23

6

Question 24

the muscle layer of the uterus reduces to normal thickness post-birth through ischaemia, a_____ and p_____

Answer 24

autolysis
phagocytosis

Question 25

Decidua is shed as ____

Answer 25

lochia

Question 26

GP checks up postnatally at _ weeks

Answer 26

6 weeks

Question 27

Sepsis red flags

Answer 27

Supplemental oxygen required High heart rate High resp rate High lactate Purpuric rash Low systolic bp V or less on AVPU

Question 28

What are the Give 3, Take 3 of managing sepsis?

Answer 28

Give Fluids Give Oxygen Give antibiotics Take cultures Take lactate (blood tests) Take fluid balance (accurate hourly monitoring)

Question 29

Primary PPH is over 500ml blood loss within what time frame?

Answer 29

24 hours of delivery of the baby

Question 30

Minor PPH is estimated blood loss (EBL) or less than _____mls and no clinical signs of shock

Answer 30

1000mls

Question 31

Major PPH definition

Answer 31

EBL of 1000mls + and continuing to bleed or clinical shock

Question 32

For patients of 70kg, blood loss of more than __% of their total blood volume is generally regarded as life threatening

Answer 32

40%

Question 33

Secondary PPH is abnormal or excessive bleeding between 24 hours and __ weeks postnatally

Answer 33

12

Question 34

Causes of Primary PPH

Answer 34

4 Ts: Tone - uterine atony Tissue - retained placental tissue Trauma - damage to reproductive tract eg tears Thrombin - coagulopathies

Question 35

Managing Primary PPH

Answer 35

A to E approach IV access (2 wide bore cannulae) Identify and treat cause Lab bloods Crossmatch at least 2 units.

Question 36

How to manage primary PPH caused by tone

Answer 36

Bimanual compression, oxytocin analogues Surgical measures

Question 37

Common Causes of Secondary PPH

Answer 37

Endometriosis (uterine infection) Retained placental fragments Abnormal involution of placental site Arteriovenous malformations

Question 38

Managing secondary PPH

Answer 38

A to E approach if haemodynamically unstable. Assess blood loss and full examination Send swabs Pelvic USS

Question 39

Risk factors of VTE are scored using...

Answer 39

TRAF system

Question 40

TRAF system allows risk stratification to guide whether to give prophylactic _____

Answer 40

dalteparin

Question 41

How long is dalteparin given for in those with high TRAF score?

Answer 41

6 weeks

Question 42

How long is dalteparin given for in those with an intermediate TRAF score?

Answer 42

10 days

Question 43

How long is dalteparin given for in those with lowTRAF score?

Answer 43

No dalteparin prescription

Question 44

What is definition of pre-eclampsia?

Answer 44

Hypertension Significant proteinuria (> 300mg in 24 hours) > 20 week gestation

Question 45

What is eclampsia?

Answer 45

Seizure that occurs if pre-eclampsia worsens

Question 46

What is monitored in those identified with pre-eclampsia?

Answer 46

Blood pressure

Question 47

What medication is commonly used for blood pressure in those with pre-eclampsia

Answer 47

labetalol

Question 48

What medication is given if eclampsia develops?

Answer 48

MgSO4

Question 49

What are Baby Blues?

Answer 49

Brief period of feeling emotional/ tearful 3-10 days after giving birth. Very common.

Question 50

What is post-natal depression?

Answer 50

A depressive episode within first 12 months postpartum Less common Severity various

Question 51

What is Puerperal psychosis?

Answer 51

Severe form of mental illness which usually starts days to weeks following delivery Presentation variable About 1 in 1000 Rate of recurrence is about 50%