Ante-natal care

Answer 1

Ante-natal timeline

1. <10 weeks
   - Booking appt
   - BMI, BP, Urine dip
2. 11-14
   - USS (g. age, multiple pregnancy)
3. 14-17
   - Quadruple test (anomaly )
4. 18-20
   - USS Anomalies
   - Placental location
5. 24 weeks
   - Symphysis-fundal height
   - Fetal movements
6. 28 weeks
   - Rhesus Anti-D
   - FBC, blood group, antibody
7. 36 weeks
   - Abdominal palpation (position)
   - USS confirmation
8. 37+ weeks
   - Induction for high risk
9. 41+
   - Induction

Question 2

Rhesus D
- Sensitising events
- Antibody Test
- Prophylaxis

Answer 2

Rhesus D

• Sensitising events
  1. Amniocentesis
  2. Antepartum bleed
  3. Abdominal trauma
• Antibody Test
  1. Kheilhauer-Betke
• Prophylaxis
  1. 28 weeks
  2. 34 weeks

Question 3

Fetal growth
- SFH measurement

Answer 3

Fetal growth
- SFH measurement

1. Each appointment after 24 wks
2. USS instead:
   - multiple pregnancy
   - BMI >35
   - Fibroids (large/multiple)

Question 4

Pregnancy advice

• Food
• Exercise
• Smoking
• Alcohol
• Recreational drugs
• Travel

Answer 4

Pregnancy advice

• Food
  1. Avoid raw meat, fish, eggs, dairy
  2. Wash fruit and veg (toxoplasmosis)
• Exercise
  1. Same level as pre-pregnancy
  2. Not vigorous or high risk (sfga)
• Smoking
  1. Cessation
  2. Limited evidence on NRT
• Alcohol
  1. FAS
  2. Avoid completely
• Recreational drugs
  1. Cocaine especially
  2. Most misuse has consequences
  3. Methadone programme for heroin
• Travel
  1. VTE stockings/ prophylaxis
  2. Active daily and well hydrateed

Question 5

Reduced fetal movements
- Recognition

Answer 5

Reduced fetal movements

• Recognition
  1. No change after 28 weeks
  2. Lie on left side
• focus for 2 hours
• 10 or more movements

3. If not 10 in 2 hours, USS or delivery

Question 6

Pregnancy N&V
1. Timing
2. Remedies

Answer 6

Pregnancy N&V

1. Timing
   - Wk 4-7 starts
   - Wk 20 settles
2. Remedies
   - Ginger and acupuncture
   - Antiemetics
   - Hyperemesis gravidarum

Question 7

MBRRACE Report
- Maternal risk

Answer 7

MBRRACE Report
- Maternal risk

1. Substance misuse
2. Teen pregnancy
3. Asylum seeker/recent migrant/ refugee
4. Domestic abuse
5. Ethnic minority backgrounds