Antenatal screening and care Flashcards
(73 cards)
1
Q
What is meant by the term gravidity?
A
Number of pregnancies a woman has had regardless of outcome
2
Q
What is mean by the term parity?
A
Pregnancies that resulted in delivery beyond 28 weeks gestation
3
Q
What is meant by para 2+1?
A
2 Pregnancies beyond 28 weeks, 1 terminated prior to 28 weeks
4
Q
If a woman had had 3 full term children and was pregnant with another, what gravidity would she be?
A
Gravida 4
5
Q
How long does pregnancy normally last?
A
40 weeks from LMP
6
Q
How would you roughly calculate the expected delivery date?
A
EDD = Approximately 1 year and 7 days after LMP - 3 months
7
Q
What is crown/rump length used to calculate?
A
Gestation between 8 and 13 weeks
8
Q
How is crown/rump length measured?
A
On USS, measurement from one foetal pole to the other along its longitudinal axis
9
Q
When should booking visit take place?
A
8-12 weeks gestation
10
Q
What weeks of pregnancy are the first trimester?
A
1st day since LMP to 12 weeks
11
Q
What weeks of pregnancy are the 2nd trimester?
A
13-28
12
Q
What weeks of a pregnancy are the 3rd trimester?
A
Weeks 29 - 40
13
Q
What aspects of the history would you wish to obtain at first booking?
A
- Gravidity/Parity
- Usual cycle length
- LMP
- Drugs/contraception
- PMH
- Any fertility probems/oucomes of past pregnancies
- History of diabetes/HTN/foetal abnormality/Twins
- Concurrent illness
- Past mental illness
- Education/Social status - poor, unsupported, substance abuser etc.
14
Q
What key things are screened for in antenatal surveillance
A
- Gestational hypertension/pre-eclampsia
- BP and urinalusis checked every visit
- Fetal growth restriction/SGA
- Below 10th centile
- Screened by USS/symphysis fundal height
- IGTT
- For those with risk factors eg BMI >30, oerv baby >4.5kg, first degree relative diabetes
- Haemolytic disease
- Breech presentation
- Anaemia
- Polyhydramnios
15
Q
What levele is diagnostic of gestational diabetes
A
- Fasting >5/6mmol/L
- 2hour >7/8
16
Q
What is breech presentation associated with?
A
Multiple preg, firboids, placenta praevia, polyhydramnios
17
Q
What is polyhydramnios assocaited with?
A
Placental abruption
18
Q
General overview of booking visit
A
- General information eg deit, aclohol, smoking, folic acid, vit D, antenatal classess
- BP, urine dipstick and BMI checked
- FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
- Heb B, syphillis, rubella
- HIV test offered to all women
- Urine culcutre to detect asymptomatic bacteriuria
19
Q
How would you describe the gravidity and parity of a woman who is pregnant for the 4th time with 1 previously normal delivery at term, 1 termination at 9 weeks and 1 miscarriage at 16 weeks?
A
Gravida 4, Para 1+2
20
Q
What are the basic aims of antenatal care?
A
- Provide evidence based information
- Advise on minor problems and symptoms
- Assess foetal and maternal risk factors at onset of pregnancy
- Facilitate prenatal screening and subsequent management of abnormalities (screening is offered but is NOT compulsory)
- Monitor foetal and maternal wellbeing
- Determine timing and mode of delivery
21
Q
What bedside tests should be performed at every antenatal visit?
A
BP and urine dipstick
22
Q
What should be covered at first antenatal appointment?
A
- Calculate BMI
- Measure BP
- Dipstick
- US for gestational age and gross abnormalities
- Blood tests
- Give information - folic acid, lifestyle, screening, AN classes, diet and supplementation
23
Q
What screening tests are done when looking for anaemia and isoimmunisation?
A
- FBC
- Anti-D
- Anti-C
- Anti-Kell
24
Q
What is involved in an antenatal examination?
A
- Routine enquiry - feeling well, foetal movements
- BP
- Urinalysis
- Abdominal examination
25
What tests are done when screening for infection in a pregnant woman?
Consent required to screen for infection
* **Rubella**
* **Hep B**
* **HIV**
* **Syphillis**
* **HIV**
* **MSSU**
26
What is rubella syndrome?
Microcephaly
Congenital cataracts
Heart defects (PDA)
Hearing loss
27
When is first scan done?
10-13+6 weeks
28
What is looked for on first visit scan?
* **Ensure pregnancy viable**
* **Multiple pregnancy**
* **Identify abnormalities incompatible with life**
* **Can offer down's screening**
29
How would you describe the following lie?
Longitudinal lie
30
How would you describe the following lie?
Longitudinal lie
31
What presentation is the following?
Breech
32
What lie is the following?
Transverse lie
33
What presentation is the following?
Vertex presentation
34
What are the main aspects of pre-pregnancy councelling?
* **General health management** - diet, BMI, alcohol, Smoking
* **Folic acid**
* **Risk assessment** - Age, Parity, occupation, Substance misuse, psych history
* **Medication review**
35
What alterations should be made to diet?
* Reduce vit A (fetotoxic if \>700mg) (spinach, mangos, carrots, sweet potatoes)
* Increased vit D
* Iron supplement
* Folic acid 400mg from before contraception to 12 weeks
36
What food should be avoided?
* Listerosis
* Avoid unpasturised milk, ripened soft cheeses, pate or undercooked meat
* Salmonella
* Avoid raw or partially cooked eggs and meat esp poultry
37
What previous pregnancy problems increase maternal risk?
* **C-section**
* **DVT**
* **Pre-eclampsia**
38
What previous pregnancy problems increase foetal risk?
* **Pre-term delivery**
* **Intrauterine growth restriction**
* **Foetal abnormality**
39
What are important maternal factors for increasing risk of down's syndrome in a baby?
* **Increasing age**
* **Family history**
40
What is the risk of a neonate exposed to maternal Hep B becoming a carrier?
90% - can progress to liver cirrhosis and HCC
41
What is recommended for treatment of a neonate whos mother is Hep B core antigen +ve?
Active and passive immunisation
42
When is screening for down's syndrome commonly carried out?
11-14 weeks gestation
43
How is down's syndrome screened for?
* **Assess Maternal risk factors** - age, FH
* **B-HCG**
* **PAPP-A -** pregnancy assocaited plasma protein A
* **Foetal nuchal translucency**
* **Inhibin A**
* **Unconjugated oestriol**
44
What is the combined test?
NT + BHCG + PAPPA
45
What elevates the alpha-fetoprotein?
NTDs
Downs
Incorrdect gestational age
Multiple pregnancy
Bleeding in pregnancy
Foetal death
Abdominal wall abnormalities
46
Where is the nuchal transluceny measurement tacken from?
Between crown/rump length of 45-84 mm
47
How is nuchal translucency related to chromosomal/other abnormalities?
Related to size - increased size increases risk of there being an abnormality
48
How can risk of vertical transmission of HIV be reduced?
* **Anteretroviral treatment**
* **Pregnancy**
* **Labour**
* **Neonataly** - 6 weeks
* **C-section**
* **Avoidance of breastfeeding**
49
How is B-HCG and PAPP-A related to trisomy 21?
Increased B-HCG and PAPP-A - Increased risk
50
What options are available if screening tests for downs syndrome come back as high risk?
Diagnosis by karotyping -
* **Chorionic Villous Sampling**
* **Amniocentesis**
* **Non-invasive Prenatal testing**
51
What is involved in chorionic villous sampling?
It entails sampling of the chorionic villus (placental tissue) and testing it for chromosomal abnormalities, usually with FISH or PCR.
52
When is CVS performed?
Weeks 10-14
53
What is the risk of miscarriage from chorionic villous sampling?
1-2%
54
What is inovled in amniocentesis?
Sampling a small amount of amniotic fluid through a transabdominal needle aspiration
55
When is amniocentesis most commonly performed?
\>15 weeks gestation
56
What is the risk of miscarriage in someone having an amniocentesis?
Approximately 1%
57
If someone had a family/personal history of neural tube defect, how should they be managed?
5mg folic acid
58
What abnormalities are incompatible with life on first US?
Anencephaly
59
What is the main purpose of 20 week scan?
**Used to detect foetal abnormality** - more sensitive for structural rather than chromosomal abnormalities
60
What proportion of NTDs will be detected on first scan?
\<10%
61
What proportion of NTDs will be seen on 20 week scan?
\>90%
62
How would you measure the fundal height?
Estimated in centimetres from the upper border of the fundus to the pubic symphasis
63
How does the height of the fundus correlate with gestational age?
Height in cm correlates with gestational age in weeks
64
How many appointments do nulliparous and multiparious women have?
Nulliparous - 10 appointments
Multiparous - 7 appointments
65
When is first dose of anti-D fiven to rhesus negative women?
When is second dose given?
First = 28 weeks
Second = 34 weeks (when info on labour and birth plan also discussed)
66
What is first sign of pregnancy on US
Thickening of lining of womb
67
When does the gestational sac appear?
4.5 weeks
68
When does the yolk sac appear in the uterus?
5 weeks
69
When is the FHR pulsation visible
6 weeks
70
When is cephalic version offered if indicated?
36 weeks. Information on breast feeding, vit K and baby blues also discussed.
71
Who recieves low dose asprin?
75mg from 12 weeks for those with
1 of
* Hypertension during previous pregnancy
* Chronic hypertension
* CKD
* SLE/Antiphosphylipid syndrome
* Diabetes
2 of
* First pregnancy
* 40=/\>
* Pregnancy interval \>10 years
* BMI of 35
* FH of preeclampsia
* Multiple pregnancy
72
Indications for C section
Cephalopelvic disproportion
Foetal distress
Breach
Multiple pregnanyc
Failued induction
73
How is foetal wellbeing assessed?
* **Foetal movement counting**
* ****Mum records how long it takes to feel 10 separate movements
* **Foetal cardiotocography**
* ****CTG - foetal well bing at particular moment in time
* **Foetal biphysical profile**
* ****5 paramaters assessed and each scored out of 2:
* CTG
* Foetal breathing
* Foetal movements
* Foetal tone
* Liquor \>3cm depth in 2 plants
* **Doppler flow velocity**
* Examination of umbillical arteries
* Useful in pregnancies at risk of hypocia due to impaired placental function
