1: Antenatal risk and the booking visit

Question 1

What is the role of the first trimester scan?

Answer 1

• Dating scan (before 14 weeks): foetal viability, pregnancy location, EDD
• Nuchal translucency (11-13+6): combination with blood test screening for down’s syndrome.

Question 2

What lab tests are recommended at the booking visit?

Answer 2

Bloods: FBC, HbA1c, Group and screen, rubella, HIV, syphilis, hepatitis B

Urine: protein, glucose, bacteria

Swabs: vulvovaginal (chlamydia/gonorrhoea)

Smear: cervical

Question 3

What is the role of the 20 week scan? Advantages and disadvantages?

Answer 3

• Check foetal and maternal anatomy is normal
• Advantages: very accurate for some e.g. neural tube, urinary system
• Disadvantages: some systems difficult to detect/not developed at this time

Question 4

How might BMI influence pregnancy and health outcomes?

Answer 4

Antenatal

• Maternal: Pre-eclampsia, VTE, GDM, OSA, miscarriage
• Foetal: stillbirth, pre-term birth, neonatal death, congenital abnormalities, abnormal growth

Intrapartum

• Induction, prolonged labour, failure to progress
• Instrumental + failed instrumental
• Caeserean section
• Anaesthetic and issues with pain medication
• PPH
• Difficulties with foetal monitoring
• Shoulder dystocia

Postpartum:

• Maternal: VTE, delayed wound healing, issues with breastfeeding
• Infant weight gain, obesity

Question 5

What are some of the common symptoms of pregnancy?

Answer 5

CVS/haem: anaemia, varicose veins, increased cardiac output

GIS: nausea and vomiting, constipation, haemorrhoids, heartburn

GUS: increased vaginal discharge, urinary symptoms

MSK: Back/pelvic pain, cramps and numbness

Breast tenderness

Question 6

What are the two components of diet counselling in pregnancy?

Answer 6

• Nutrition

- Food safety

Question 7

What is the recommended weight gain for a woman with normal BMi?

Answer 7

11-16kg

Question 8

What are the risks associated with smoking in pregnancy?

Answer 8

• Miscarriage, placental abruption/praevia, ectopic, preterm labour, infertility
• Congenital malformations, stillbirth, SGA/IUGR, congenital abnormalities, long term developmental issues, susceptibility to infection, abnormal growth, stillbirth

Question 9

What are the risks of a subsequent pregnancy after a caeserean section?

Answer 9

Uterine rupture
Antenatal stillbirth
Abnormal placenta e.g. placenta praevia, placenta accreta