7- Normal pregnancy and labour ( Antenatal care: appointments, screening, lifestyle advice, medication)) Flashcards
antenatal care for uncomplicated pregnancies is ……. led and involves how many appointments
Midwife led
- first pregnancy: 10 appointments
- second pregnnacy: 7
antenatal care for complicated pregnancies is ……. led
obstetrician led
higher risk pregnancies include
- includes all the midwidery appointments plus joint clinics to cover mental health, haematological issues, diabetes etcs
- multiple pregnancy
- maternal health problems
how is gestation age describe
In weeks and days. For example:
5 + 0 refers to 5 weeks gestational age (since the LMP)
13 + 6 refers to 13 weeks and 6 days gestational age
trimesters of pregnancy: first
from start of pregnnacy until 12 weeks gestation
trimesters of pregnancy: second
from 13 weeks until 26 weeks gestation.
trimesters of pregnancy: third
is from 27 weeks gestation until birth.
when do fetal movements start
20 weeks gestation
key milestone of the antenatal period
additional antenatal milestones
Additional Milestones
There may be additional appointments necessary if the woman fits certain criteria:
- Additional appointments for higher risk or complicated pregnancies
- Oral glucose tolerance test in women at risk of gestational diabetes (between 24 – 28 weeks)
- Anti-D injections in rhesus negative women (at 28 and 34 weeks)
- Ultrasound scan at 32 weeks for women with placenta praevia on the anomaly scan
- Serial growth scans are offered to women at increased risk of fetal growth restriction
what happens in the booking appointment
1) Education
- How baby develops during pregnancy
- What to expect at different stages of pregnancy
- Lifestyle advice in pregnancy (e.g. not smoking)
- Food hygiene
- Supplements (e.g. folic acid and vitamin D)
- Plans for birth
- Screening tests (e.g. Downs screening)
- Antenatal classes
- Breastfeeding classes
- PFMT
- Discuss mental health
- Smoking cessation, drug use and alcohol consumption
2) Planning
- Place of birth and pregnancy care pathway
2) Other measures
* Weight, height and BMI
* Urine for protein and bacteria (asymptomatic bacteriuria)
* Blood pressure
* Discuss female genital mutilation
* Discuss domestic violence
3) Booking bloods (see other flashcard)
4) Risk assessment
* Rhesus negative (book anti-D prophylaxis)
* Gestational diabetes (book oral glucose tolerance test)
* Fetal growth restriction (book additional growth scans)
* Venous thromboembolism (provide prophylactic LMWH if high risk)
* Pre-eclampsia (provide aspirin if high risk)
Clinical examination at booking
blood tests done in the booking appointment
- FBC for anaemia
- Blood group
- antibodies and rhesus D status
- screening for thalamssaemia (all women) and sickle cell (women at higher risk)
- offer screening for HIV, HepB and syphilis
Routine Antenatal Appointments
Several things are covered at each routine antenatal appointment:
- Discuss plans for the remainder of the pregnancy and delivery
- Symphysis–fundal height measurement from 24 weeks onwards
- Fetal presentation assessment from 36 weeks onwards
- Urine dipstick for protein for pre-eclampsia
- Blood pressure for pre-eclampsia
- Urine for microscopy and culture for asymptomatic bacteriuria
Symphysis–fundal height measurement
- taken from 24 weeks onwards (and at each antenatal appointment)
- fundal height will match number of weeks of pregnancy +- 2 cm
- e.g. if you are 27 weeks pregnant, fundal height should be about 27cm
remember when measuring to use blank side of tape first and then turn over to prevent bias
if concerns with foetal growth (detected using sympohysis fundal height) then what should happen
Send women for USS assessment
Other indications for regular USS
* Multiple pregnancy
* BMI >35
* Large or multiple fibroids
This is because these mothers are unsuitable for SFH measurements, as abdominal palpation is unlikely to be accurate in these instances.
what can be given to women who are high risk of having a small for gestational age foetus
Consider low dose aspirin at night from 12 weeks gestation
vaccines for all pregnant women
- Whooping cough (pertussis) from 16 weeks gestation
- Influenza (flu) when available in autumn or winter
LIVE VACCINES SUCH AS MMR AVOIDED IN PREGNANCY
vitamins in pregnancy
- Folic acid - all women trying to get pregnant should take 400mcg (ug) daily and for the first 12 weeks of pregnancy
- Vitamin D (10mcg) - reduce risk of rickets
women at higher risk of neural tube defects should be given
5mg of folic acid in the first trimester. Women at risk include:
* Epilepsy
* Previous baby with neural tube defects
* Obesity with BMI over 35
* Diabetes (Type 1 and 2)
* Sickle cell disease
* Thalassemia
* Malabsorption disorders (e.g. Crohn’s disease)
* Those taking folate antagonist drugs (HIV anti-retroviral drugs, methotrexate, sulphonamides)
describe rhesus disease
- Causes Haemolytic disease of the foetus and newborn
- Rhesus disease only happens when the mother has rhesus negative blood (RhD negative) and the baby in her womb has rhesus positive blood (RhD positive).
- The mother must have also been previously sensitised to RhD positive blood.
describe rhesus disease
- Causes Haemolytic disease of the foetus and newborn
- Rhesus disease only happens when the mother has rhesus negative blood (RhD negative) and the baby in her womb has rhesus positive blood (RhD positive).
- The mother must have also been previously sensitised to RhD positive blood.
when can sensitisation to rhesus antigens occur
Sensitisation happens when a woman with RhD negative blood is exposed to RhD positive blood
- usually during a previous pregnancy with an RhD positive baby.
- amniocentesis
- abdominal trauma
A rhesus negative woman’s body responds to the RhD positive blood by producing
Antibodies (infection-fighting molecules) that recognise the foreign blood cells and destroy them.
If sensitisation occurs, the next time the woman is exposed to RhD positive blood, her body produces antibodies immediately. If she’s pregnant with an RhD positive baby, the antibodies can cross the placenta, causing rhesus disease in the unborn baby. The antibodies can continue attacking the baby’s red blood cells for a few months after birth.
what is given to rhesus negative women
Anti- D AB
when is Anti-D given
- Sensitising events (amniocentesis, antepartum bleed and abdominal trauma)
- Check the dose of Anti D required with the Kleihauer-Betke test after a sensitising event.
- Routinely offer prophylaxis at 28 and 34 weeks.
lifestyle advice in the antenatal period
antenatal screening involves what sort of tests
USS or blood tests or a combination of both
USS scan can screen for conditions such as
spina bifida
what do the USS part of the combined test for DS measure
Measures nuchal translucency, which is the thickness of the back of the neck of the fetus.
Down’s syndrome is one cause of a nuchal thickness greater than 6mm.
Amniocentesis
involves ultrasound-guided aspiration of amniotic fluid using a needle and syringe. This is used later in pregnancy (>15 weeks) once there is enough amniotic fluid to make it safer to take a sample.
- 15-20ml aspirated using 22G needle
-
screening for gestational diabetes?
not for everyone
screening for pre eclampsia
management of pre-eclampsia if diagnosed
