Obstetrics - antenatal care

Question 1

Booking appointment

Answer 1

8-10 weeks
Full maternal history
BMI
Bloods - rhesus status of mother, Hep B, Syphilis

Question 2

Anomaly scan and what tests for

Answer 2

18-22 weeks (20 weeks) - identifies structural abnormalities e.g. exomphalos, NT defects, gastroschisis, congenital cardiac abnormalities

Question 3

Dating scan/combined screening - and what tests for

Answer 3

Between 11 and 13 weeks

USS takes two measurements (crown-rump length, nuchal translucency)

Increased nuchal translucency can indicate Down’s, Edward’s, Patau’s (21, 18 13 respectively)

CRL allows dating
Can assess if multiple foetuses are present

Blood tests - beta HCG (high in Downs etc) and PAPPA (low in Downs etc)

Question 4

Routine anti-D injections

Answer 4

28 and 34 weeks

Question 5

Combined test elements and time conducted

Answer 5

Nuchal translucency
PAPP-A
Beta-HCG

Between 11 and 14 weeks

Question 6

Things tested at routine antenatal appointments

Answer 6

• Symphysis fundal height (from 24 weeks)
• Foetal presentation (from 36 weeks)
• Urine dipstick and blood pressure (for pre-eclampsia)
• Urine for microscopy and culture for asymptomatic bacteriuria
• Plans for delivery and remainder of pregnancy

Question 7

Vaccines offered

Answer 7

Whooping cough (pertussis) from 16 weeks gestation

Flu vaccine (in autumn/winter)

Live vaccines e.g. MMR - avoid in pregnancy

Question 8

What test is done if the woman hasn’t had the combined test and is past 13+6 weeks?

Answer 8

Quadruple test - between 15 and 20 weeks

Question 9

Options for invasive diagnostic testing in high risk pregnancies identified for Trisomies and the details

Answer 9

• Chorionic villus sampling - between 10 and 13 weeks usually, risk of miscarriage just over 1% and slightly more likely to get an inconclusive result and need repeat sampling
• Amniocentesis - after 15 weeks, slightly safer (<1% miscarry), less chance of inconclusive result

Question 10

Women at risk of gestational diabetes get

Answer 10

Oral glucose tolerance test (between 24 and 28 weeks)

Question 11

Women with placenta praevia also get

Answer 11

Ultrasound scan at 32 weeks

Question 12

Women at increased risk of intrauterine growth restriction also get …

Answer 12

serial growth scans