Routine Antenatal Care

Question 1

The booking appointment should ideally be completed by when?

Answer 1

10 weeks

Question 2

The fundus of a pregnant uterus is usually palpable by when for a singleton pregnancy?

Answer 2

12 weeks

Question 3

What urine tests should be performed at the booking visit?

Answer 3

Urinalysis and MSSU for microscopy, culture and sensitivity

Question 4

At booking, what conditions should a mother be screened for?

Answer 4

Anaemia, HIV, hep B, syphilis and rubella

Question 5

When should the early ultrasound scan be performed?

Answer 5

11 - 14 weeks

Question 6

What part of the early ultrasound scan can be used for Down’s syndrome screening?

Answer 6

Nuchal translucency

Question 7

What measurement on the early ultrasound scan can be used to assess gestational age between 10 and 13+6 weeks?

Answer 7

Crown rump length

Question 8

If the crown rump length is > 84mm or if the pregnancy is beyond 14 weeks, what measurement should be used to estimate the gestational age?

Answer 8

Head circumference

Question 9

What are the most important parts of a history that should be discussed at every antenatal visit?

Answer 9

Physical and mental health and foetal movements

Question 10

What investigations should be performed at every antenatal visit?

Answer 10

BP and urinalysis

Question 11

Symphyseal fundal height should be measured at every antenatal visit from what gestation?

Answer 11

24 weeks

Question 12

At what gestation is the foetal anomaly scan performed?

Answer 12

18 - 20+6 weeks

Question 13

When should gestational diabetes screening be done in women who are deemed to be high risk?

Answer 13

24 - 28 weeks

Question 14

When should a second blood test for anaemia and atypical antibodies be performed in routine antenatal screening?

Answer 14

28 weeks

Question 15

When should the first dose of anti-D be offered to Rh negative women?

Answer 15

28 weeks

Question 16

If a woman is found to have a low lying placenta at the anomaly scan, when should they undergo a second scan?

Answer 16

32 weeks

Question 17

When should the second dose of anti-D be offered to Rh negative women?

Answer 17

34 weeks

Question 18

What additional examination should be performed at the 36 week antenatal visit?

Answer 18

Assess position of the baby, and offer external cephalic version if the baby is in breech position

Question 19

What should be offered to women who have not yet given birth by 41 weeks?

Answer 19

Membrane sweep and induction of labour

Question 20

What is the most common cause of anaemia in pregnancy and how can this be treated?

Answer 20

Iron deficiency- treat with iron supplements

Question 21

If an HIV test is decline at booking, it should be offered again to women at which antenatal visit?

Answer 21

28 weeks

Question 22

When can the sex of the baby be determined?

Answer 22

At the 18 - 20+6 week anomaly scan

Question 23

When can the ‘combined test’ for Down’s syndrome be performed?

Answer 23

11 - 14 weeks

Question 24

What are the two areas of the combined test for Down’s syndrome screening?

Answer 24

Ultrasound scan for nuchal translucency and bloods for PAPP-A and HCG

Question 25

When the crown rump length is 45-84mm, what would a normal nuchal translucency be?

Answer 25

< 3.5

Question 26

What happens to concentrations of PAPP-A and HCG in Down's syndrome?

Answer 26

PAPP-A is low and HCG is high

Question 27

At what gestation can second trimester screening for Down's syndrome be done?

Answer 27

15 - 20 weeks

Question 28

What blood tests are measured in second trimester screening for Down's syndrome?

Answer 28

HCG, AFP, unconjugated oestradiol, inhibin-A

Question 29

Which blood tests in second trimester screening will be high in Down's syndrome?

Answer 29

HCG and inhibin-A

Question 30

Which blood tests in second trimester screening will be low in Down's syndrome?

Answer 30

AFP and unconjugated oestradiol

Question 31

An isolated raised AFP is suggestive of what complication?

Answer 31

Neural tube defect

Question 32

The results of both first and second trimester Down's syndrome screening are combined with what other two factors to create a personalised risk?

Answer 32

Gestational age and maternal age

Question 33

Further investigation is required if Down's syndrome screening is deemed high risk. A likelihood of more than what is considered to be high risk?

Answer 33

> 1 in 150

Question 34

What method is used to obtain a sample for Down's syndrome testing from 11-14 weeks?

Answer 34

Chorionic villus sampling

Question 35

What method is used to obtain a sample for Down's syndrome testing > 15 week?

Answer 35

Amniocentesis

Question 36

Which contains a slightly higher risk of iatrogenic miscarriage- chorionic villus sampling or amniocentesis?

Answer 36

Chorionic villus sampling

Question 37

The sample obtained for Down's syndrome testing from CVS or amniocentesis is sent for analysis via what? How soon should the results come back?

Answer 37

PCR, in 48 hours

Question 38

Non-invasive prenatal testing can be used for Down's syndrome screening after what gestation?

Answer 38

10 weeks

Question 39

Foetal growth and wellbeing is assessed at each antenatal visit by assessing what two things?

Answer 39

Foetal movements and symphyseal-fundal height

Question 40

If the foetal growth is less than expected at an antenatal visit, what investigation should be done next?

Answer 40

US assessment of foetal weight and amniotic fluid volume

Question 41

When measuring symphyseal-fundal height, the fundus should reach the umbilicus by what gestation?

Answer 41

20 weeks

Question 42

When measuring symphyseal-fundal height, the fundus should reach the xiphisternum by what gestation?

Answer 42

36 weeks

Question 43

Foetal movements are usually felt from around what gestation?

Answer 43

20 weeks

Question 44

If a change in foetal movements is reported, what further investigation is required?

Answer 44

CTG +/- ultrasound

Question 45

If breech presentation is suspected on abdominal palpation, what investigation should be used to confirm this?

Answer 45

Ultrasound

Question 46

What maternal condition should be being screened for at the foetal anomaly scan?

Answer 46

Placenta praevia

Question 47

What condition is being screened for by doing urinalysis and BP at every antenatal visit?

Answer 47

Pre-eclampsia

Question 48

What are some conditions predisposing to pre-eclampsia?

Answer 48

Hypertension, diabetes, CKD, autoimmune disease

Question 49

Any woman who is deemed high risk for pre-eclampsia should be given what medication?

Answer 49

75mg aspirin daily from 12 weeks onwards

Question 50

What is the screening test for gestational diabetes?

Answer 50

2 hour oral glucose tolerance test

Question 51

All women should take what supplement for the first 12 weeks of pregnancy? What is the purpose of this?

Answer 51

Folic acid, to reduce the risk of neural tube defects

Question 52

What is the normal dose of folic acid?

Answer 52

0.4mg

Question 53

What dose of folic acid is given to women who are deemed high risk of having a baby with neural tube defects?

Answer 53

5mg

Question 54

Other than folic acid, what other vitamin supplement is routinely recommended to pregnant women?

Answer 54

10mcg vitamin D

Question 55

Women who smoke in pregnancy undergo what additional tests?

Answer 55

Carbon monoxide testing and serial growth scans