Antenatal Care and Screening Flashcards Preview

Y3 OBS AND GYNAE > Antenatal Care and Screening > Flashcards

Flashcards in Antenatal Care and Screening Deck (34)
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1
Q

How many antenatal meetings are normally made prior to 20 weeks gestation?

A

4

2
Q

When assessing screening test, what is meant by ‘sensitivity’?

A

True positive (positive and false negative)

3
Q

When assessing screening test, what is meant by ‘specifity’?

A

True negative (negative and false positive)

4
Q

List points in the history and examination carried out at booking visit

A

HISTORY: menstrual, medical, obstetric, family, social
EXAM: height, weight, BP, CVS, abdomen

5
Q

What is Naegele’s rule?

A

Estimate due date based in onset of women’s LMP (add 9 months and 7 days)

6
Q

What tests are usually done in an antenatal booking appointment?

A
Hb
Antibodies (Rhesus)
Syphilis, HIV, Hep B+C
Urinalysis, MSSU C+S
Ultrasound
7
Q

What markers are used to estimate gestational age?

A

Biparietal diameter

Femur length

8
Q

What sign suggests a pregnancy is viable on ultrasound?

A

Fetal heart present

9
Q

List points in the history and examination carried out at a follow up antenatal visit

A

HISTORY: physical and mental health, fetal movements
EXAM: BP, urinalysis, symphysis (fundal height), lie and presentation, engagement of presenting part, fetal heart auscultation

10
Q

What common clinical maternal condition is characterised by high BP and proteinuria on urinalysis?

A

Preclampsia

11
Q

What is “foetal lie”?

A

Relation of foetal spine to maternal spine
Longitudinal lie: parallel to maternal spine
Transverse lie: horizontal to maternal spine

12
Q

What is “foetal engagement”?

A

Relation of foetal head to pelvic rim

13
Q

Which scan is used to screen for foetal anomaly? When is this carried out?

A

Ultrasound

20 weeks

14
Q

High AFP and low HCG is associated with increased risk of what particular foetal anomaly?

A

Spina bifida

15
Q

List fetal anomalies screened for during pregnancy

A
Cleft lip
Anencephaly
Spina bifida
Diaphragmatic hernia
Cardiac abnormality
Renal agenesis
Edward's syndrome
Patau's syndrome
16
Q

State the chromosomal mutation found in Edward’s Syndrome

A

Trisomy 18

17
Q

State the chromosomal mutation found in Patau’s Syndrome

A

Trisomy 13

18
Q

What is ‘placenta praevia’? How is this managed?

A

A low-lying placenta, overlying the cervical os, after 20 weeks of pregnancy
32 week ultrasound scan followed by a vaginal scan

19
Q

State the chromosomal mutation found in Down’s Syndrome

A

Trisomy 21

20
Q

What tests can be used to detect the risk of Down’s syndrome in 1st trimester?

A

Skin thickness behind foetal neck (Nuchal translucency)

bHCG and PAPP-A levels

21
Q

What tests can be used to detect the risk of Down’s syndrome in 2nd trimester?

A

Blood sample

HCG and AFP levels

22
Q

Low AFP and high HCG increases/decreases risk of Down’s syndrome

A

Low AFP and high HCG increases risk of Down’s syndrome

23
Q

What is a normal ‘Nuchal translucency’ of a fetus?

A

<3.5mm when CRL is between 45 and 84mm

24
Q

Low risk on Down’s syndrome screening excludes Down’s syndrome. True/ False?

A

False

25
Q

A risk >1:250 of Down’s Syndrome is classed as high risk and requires further investigation. What is recommended as the next best test?

A

Amniocentesis

26
Q

List biochemical markers screened for in second trimester

A

AFP
HCG
Unconjugated oestradiol (UE3)
Inhibin A

27
Q

What are the 2 main specific diagnostic tests that can be done for foetal karyotyping?

A

Amniocentesis

Chorionic villus sampling

28
Q

Which two major haemaglobin disorders are screened for during pregnancy?

A

Sickle cell anaemia (distorted shape of red blood cells)

Thalassemias (abnormal form or low amount of Hb)

29
Q

Describe how Rhesus disease can be acquired in the foetus.

A

Rh+ father and Rh- mother have a Rh+ baby –>
Blood cells enter mother’s bloodstream –>
Invading blood cells produce Rh Igs at delivery –>
In a later pregnancy, Rh Igs attack baby’s blood cells causing Rh disease

30
Q

List risk factors indicating further testing in women for gestational diabetes

A
BMI >30
Previous macrosomic baby
Previous gestational diabetes
FHx of diabetes (1st degress relative)
Minority ethnic family origin with high rates of DM
31
Q

What measurement of symphysis fundal height would require referral for US measurement of fetal sixe?

A

Below 10th centile

Slow or static growth, e.g. crossing centiles

32
Q

List factors relating to high risk of maternal preclampsia. How should this be managed?

A
Previous preclampsia
Hypertension during previous pregnancy
CKD
Autoimmune disease (SLE, APS)
Diabetes (type 1 or type 2)
Chronic hypertension

75mg aspirin daily from 12 weeks until birth

33
Q

What clinical conditions can urinalysis pick up during antenatal screening?

A

UTI
Asymptomatic bacteriuria
PET (Preclampsia)
Diabetes

34
Q

How is Rhesus disease prevented in the pregnant women?

A

Anti-D prophylaxis throughout pregnancy