Antenatal Care

Question 1

IVF is associated with an increased risk of what negative outcomes?

Answer 1

Preterm labour and fetal growth problems

Question 2

Women with PCOS have a higher risk of what negative outcomes?

Answer 2

Metabolic conditions during pregnancy such as gestational diabetes

Question 3

Why are uterine fibroids important to know about in pregnant women?

Answer 3

Because the can cause abnormal fetal lie, postpartum haemorrhage and pain + pressure symptoms

Question 4

What are important aspect of family history to know about?

Answer 4

Hypertensive disorders Women with a family history of preeclampsia in female relatives are at an increased risk of preeclampsia themselves

Venous thromboembolism (VTE) elicit as pregnancy is a pro-coagulable state, and all women have a higher risk of VTE in pregnancy

Diabetes more likely to develop gestational diabetes

Other inherited disorders

Stillbirths and neonatal deaths

Psychiatric history Women with a first-degree relative with bipolar affective disorder or schizophrenia have an increased risk of developing postpartum depression or psychosis

Question 5

the fetal heart can be heard with a handheld doppler from about ______ weeks

Answer 5

14-16 weeks

Question 6

Folic acid should be prescribed to all women up until ____ gestation to reduce the risk of________

Women at high risk of _______should take __ folic acid OD

Low risk women should take _____ folic acid OD

Answer 6

Folic acid should be prescribed to all women up until 14 week’s gestation to reduce the risk of neural tube defects (NTDs)

Women at high risk of neural tube defects (e.g. diabetes) should take 5mg folic acid OD until 14 weeks

Low risk women should take 800mcg folic acid OD until 14 weeks

Question 7

What are the three screening tests available in NZ (2 funded and 1 non-funded)

Answer 7

• MSS1: first trimester screening is performed with a blood test (MSS1) and ultrasound for nuchal translucency at 11-13+6 weeks gestation.
• MSS2: Second trimester testing if the MSS1 is not achieved within the timeframe
• NIPT: non funded, from >10weeks of pregnancy, based on the detection of cell free fetal DNA (fragments of fetal DNA) present in maternal blood.

Question 8

Hw does MSS1, MSS2 and NIPT work and what are they testing for?

What happens if its positive?

Answer 8

• MSS1 and MSS2 use ultrasound to assess nuchal translucency
  
  • Downs Syndrome (Trisomy 21), Trisomy 18 and Trisomy 13 respectively, mayalso be increased in other conditions such as neural tube defects such as spina bifida
  • If positive, these women are referred for amniocentesis for diagnostic testing

Question 9

How accurate is MSS1/MSS2 for detection of Trisomy 21?

How does this to compare to NIPT (~$10,000)

Answer 9

Detection rate of 90% with a false positive rate of 5%

NIPT: 99% detection rate, false positive 1 %

Question 10

Whats the differences between the two forms of diagnostic testing for women?

Answer 10

1. Amniocentesis: from 14 weeks, the gold standard, small sample of amniotic fluid is taken with a risk of 0-0.4%
2. Chorionic Villus Sampling: From 10 weeks, taking a sample of chorionic villus. More difficult, miscarriage rate <1%. Can have placental mosaicism.

Question 11

What’s the purpose of the 18-20 week Morphology (Anatomy) Ultrasound

Answer 11

To ensure the fetal anatomy is normal.

Looks for anatomical defects of the fetus, the maternal ovaries and uterus, and the placenta. ~50% accuracy

Question 12

Purpose of the 24-28 week blood tests

Answer 12

• Hb and ferritin: start on iron supplementation if needed
• Antibody status and Blood group
• Diabetic testing

Question 13

What vaccinations are reccomended for pregnant women?

Answer 13

Influenza and Pertussis

Others may be reccommended in high risk women. (Hep B)

Question 14

Signs and Symptoms of Pre Eclampsia

Answer 14

• (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg )
• proteinuria after 20 weeks of gestation
• New-onset cerebral or visual disturbance, such as:
  
  • Photopsia (flashes of light) and/or scotomata (dark areas or gaps in the visual field).
  • Severe headache (ie, incapacitating, “the worst headache I’ve ever had”) or headache that persists and progresses despite analgesic therapy.
  • Altered mental status.
• Severe, persistent right upper quadrant or epigastric pain
• Pulmonary Edema

Question 15

What does smoking increase the risk of ?

Infertility

Miscarriage

Ectopic

Cleft lip

Abruption / placenta praevia

Preterm labour

Small for gestational age(SGA)

Stillbirth

Answer 15

All of them.

Question 16

Whats the safe level to drink during pregnancy?

Answer 16

There is no know safe level to drink during pregnancy.

Alcohol is a teratogen and the susceptibility of the fetus to the adverse effects of alcohol can vary between women and the gestation.

Question 17

What are the clinical features of fetal alcohol spectrum disorder?

Answer 17

• Three characteristic facial features (short palpebral fissures, thin vermillion border, and smooth philtrum)
• Central nervous system (CNS) abnormalities
• Growth retardation

Question 18

Specific Drugs that cause issues in pregnancy

Answer 18

• Amphetamines
• Benzodiazepines
• Cocaine
• Marjuana
• Opiates

Question 19

What is the most common chronic condition in pregnancy and how does this change with pregnancy?

Answer 19

Asthma

It 50% of sufferers there is no change, 25% worsen and 25% improve

Question 20

When are asthma exacerbations the most frequent during pregnancy?

Answer 20

In the third trimester which increase the risk of

• Hospital and ICU admission
• Preterm labour
• SGA
• Preeclampsia
• Perinatal mortality

Question 21

What medical conditions are important to know about in pregnant woman?

Answer 21

• Asthma
• Heart Disease
• Hypertension
• Epilepsy
• VTE
• Thyroid Disease
• Diabetes
• Mental Health

Question 22

How should hypertensive women who get pregnant be managed and what are they at risk for?

Answer 22

First Line: labetolol, nifedipine and methyldopa

Unsafe anti-hypertensives include ACEi, so pregnant women need other management to avoid risks such as

• Pre-eclampsia
• Placental Abruption
• SGA
• Preterm birth

Question 23

Why are women with VTE at an increased risk during pregnancy?

Answer 23

Because pregnancy is a pro-coaguable state

if no prior risk, VTE occurs in <1% during pregnancy and 2% post natal

Question 24

management of pregnant women with VTE is?

Answer 24

LMW and unfractionated heparin can be used safely.

Transition onto Warfarin post birth (can be used safely in breast feeding)

Question 25

Does pregnancy lower your seizure threshold if epileptic?

Answer 25

NOT if epilepsy is well controlled, however in poorly controlled diabetic it worsens seizures * Congenital abnormalities in the fetus (this risk is present even for women who are not taking medication) * Epilepsy in the baby * Sudden death in epilepsy in the mother * Trauma to mother and baby with seizures **\*\*\*labour and birth are the most high risk times**

Question 26

How should seizures be managed?

Answer 26

lower-risk anti-epileptic drugs for congenital malformations eg; carbmazepine or lamotrigine

Question 27

How do thyroid conditions change pregnancy management?

Answer 27

Hypothyroid: thyroxine will need to be increased as the pregnancy progresses

Question 28

When **thyrotoxicosis** occurs for the first time in pregnancy, it is usually a first presentation of .......

Answer 28

**Graves Disease**

Question 29

What shouldbe considered in management of women with preexisting type 1 or 2 diabetes

Answer 29

Glycaemic control around the time of conception and in the first trimester is vital in reducing congenital abnormalities

Question 30

What are the risk factors for developing Gestational diabetes in pregnancy?

Answer 30

* Family history of type 2 diabetes, gestational diabetes or glucose intolerance * Personal history of gestational diabetes or glucose intolerance * Previous LGA baby * Previous poor obstetric history (eg stillbirth) * Belonging to a high risk ethnicity e.g. Polynesian, Indian, Middle Eastern, Asian, Mäori or Australian Aboriginal * Obesity * Maternal age \> 30 years * Previous abnormal glucose tolerance test * Multiple pregnancy * Glycosuria * PCOS

Question 31

What values currently diagnose Gestational diabetes in NZ?

Answer 31

NZ we currently use **≥5.5mmol/L fasting**, **≥9.0 mmol/L at 2 hours** (NSSD).