2 - Obs - Antenatal Care - Later Pregnancy Screening + Continuing Antenatal care

Question 1

what two USS are done later in pregnancy? are they routine? when done?

Answer 1

for structural abnormalities - ‘anomaly scan’ - routine - 20 wks
for risk assessment - not routine - 23wks

Question 2

USS for risk assessment - what is done? screening for? more effective than a Hx at doing what?

Answer 2

doppler of uterine aa - screens for IUGR and preeclampsia

better at predicting major complications

Question 3

NICE recommended appt # for nulliparous and multiparous women?

Answer 3

nulliparous - 10 appts/tests

multiparous - 7 more

Question 4

what is routinely done at an antenatal visit

Answer 4

Hx reviewed
physical and mental state
BP
Urine - glucose, nitrites, protein, leukocytes - culture if abnormal
normally weighed
abdo examination
auscultate fetal heart
reassess risk

Question 5

NICE Recommended Antenatal Schedule

• 16wks?
• 18-21wks?
• 25wks?

Answer 5

review screening tests and bloods at booking visit

anomaly scan - repeat at 32w if low placenta

exclude early onset preeclampsia in nulliparous women

Question 6

NICE Recommended Antenatal Schedule

• 28wks?
• 31wks?
• 34wks?

Answer 6

• fundal height measured. FBC + Abs checked, Anti-D given to rhesus -ve women, GTT if indicated
• fundal height. bloods from wk 28 reviewed (nulliparous only)
• fundal height, FBC rechecked if low Hb

Question 7

NICE Recommended Antenatal Schedule

-36, 38 and 40wks?

Answer 7

fundal height
fetal lie/presentation checked
if breech - refer for external cephalic version (ECV)

pelvic Ex only if contemplating induction or suspect obstruction

exclude placenta praevia

Question 8

NICE Recommended Antenatal Schedule

-41wks?

Answer 8

fundal ht + fetal lie/presentation checked

membrane sweeping offered
as is induction by 42 wks