Antenatal Flashcards
Anaemia, bloods, weight gain, nutrition, screening
What is the recommended iodine supplementation dose for pregnancy?
150mcg PO a day
When should a woman take iodine supplementation?
When pregnant and breastfeeding
Why should a woman take iodine supplementation during pregnancy?
To help the fetal body grow and development, especially the brain
What are the consequences of low iron in pregnancy?
Can lead to hypothyroidism that can cause congenital anomalies and decreased fetal intelligence
What is the recommended folic acid supplementation in pregnancy?
800mcg PO a day
When should a woman take folic acid supplementation?
Four weeks before pregnancy through to 12 weeks gestation
Why is folic acid supplementation recommended in pregnancy?
To help prevent neural tube defects like spina bifida
What are the consequences of low folic acid in pregnancy?
Increases the risk of neural tube defect e.g. spina bifida
What is the recommended iron supplement dose in pregnancy?
27 mcg / 200mg PO once or twice a day depending on ferritin levels
The purpose of ordering Ferritin level in early pregnancy is to establish the baseline indication of:
Iron stores
Why is iron supplementation recommended in pregnancy?
For growth and development as the baby uses the maternal iron to make haemoglobin
What are the consequences of low iron in pregnancy?
Anaemia. Increased risk of low birth weight and premature delivery. Increased maternal tiredness, reduced milk production and depression
Within the midiwifery scope of practice, what does preconception advice cover?
Suggesting taking folic acid and maternal screening. Also may include referring to obstetrician for genetic counselling
When are bloods taken in pregnancy?
Booking visit (before 12 weeks)
26 - 28 weeks
36 weeks
What is tested for in the booking bloods?
- Ferritin
- FBC
- Antibody screen (Rh factor, white and red blood tells, hb level)
- STI’s (HIV, syphilis)
- Rubella antibodies
- HbA1c diabetes
- Blood group
What is tested for in the 26 - 28 week bloods?
- Ferritin
- Antibody screen
- FBC
- Polycose
What is tested for in the 36 week bloods?
- Ferritin
- Antibody screen
What is the healthy weight gainer singleton pregnancy with BMI <18.5
12.5 - 18kg
What is the healthy weight gainer singleton pregnancy with BMI 18.5 - 24. 9?
11.5 - 16kg
What is the healthy weight gainer singleton pregnancy with BMI 25.0 - 29.9
7kg - 11.5kg
What is the healthy weight gainer singleton pregnancy with BMI >30
5 - 9 kg
What are risk factors for the mama with increased BMI?
- Gestational diabetes
- Failed IOL
- C-section
- Delayed lactogenesis
What are risk factors for the baby with a mama with an increased BMI?
- LGA
- Birth injury
What are the three types of diabetes testing?
- HB1AC at booking (average BSL over last 6 - 8 weeks)
- GCT - Glucose Challenge Test (1 hour)
- GTT - Glucose Tolerance Test (diagnostic - 2 hour test - fasting)
Low BMI and GWG risks
- Miscarriage
- SGA
- Premature birth
How is iron deficiency anaemia diagnosed?
Hb <100g/l and Fe <15umol/L
What is the haemoglobin normal range?
100 - 145g/L
What is the normal serum ferritin normal range?
30 - 170 umol/L
What treatment would you give for hb>100 and fe >30
No treatment
What treatment would you give for hb <100 and fe >30
Diagnosis with anaemia, could commence low dose iron therapy
What treatment would you give for hb <100 and fe <30
Discuss dietary options and consider low dose iron supplementation
What treatment would you give hb >100 and <15
Low dose iron supplementation = 1x ferrotab (ferrous fumarate 200mg tab) and retest in 4 weeks = if haven’t improved = high dose iron supplementation
What treatment would you give for hb <100 and fe <15
Diagnosis with iron deficiency anaemia. Start high dose iron supplementation = 2x ferrotab or 1 ferrogradument (325mg controlled release). Give advice on how to avoid constipation. Refer for IV iron therapy if hb <70g/L or can’t take tablets
What sources of food can you get folic acid from?
Leafy green vegetables (spinach, silver beet, broccoli, cabbage, whole grains)
What sources of food can you get iodine from?
Fish
Seafood
Seaweed
What sources of food can you get iron from?
Red meat
Fish/Seafood
Eggs
Wholegrain or fortified breads
Green leafy vegetables (spinach)
Dried fruits
Nuts
Seeds
Marmite/Vegemite
What sources can you get vitamin d from?
90% from sunlight
coffee, liver,
oily fish (salmon)
Fortified dairy products (butter, milk ,eggs)
What food can you get calcium from?
Milk
Cheese
Butter
Yoghurt
Dried apricots
Tinned fish with bones (salon, sardines)
What is vitamin D important for in pregnancy?
For general fetal growth and development
Muscle function, formation of the fetal skeleton
Bone health and aids in calcium absorption
What is calcium important for in pregnancy
For healthy bones and teeth
Is often used to regulate blood pressure and can be preventative in hypertension disorders (used in combination with LDA)
What are risk factors for having low folic acid?
- Relevant family history
- Obese
- Diabetic
- Anticonvulsant therapy
What is the recommended dose of folic acid for those at high risk of being deficient?
5mg PO daily
What aids iron absorption?
Vitamin C
Once commencing iron supplementation how long should you wait to recheck levels?
4 weeks
Who is at high risk of being vitamin D deficient?
Dark skin
Covered skin
Higher BMI
What is the recommended dose of vitamin D?
10 - 15mcg PO daily
Should also be taking calcium
Who is at risk of needing calcium supplementation?
Preeclampsia
Hypertension
Preterm birth
Low birth weight
What is the recommended dose of calcium?
1g daily (2x 500mg calcitab)
When should pregnant mama be taking calcium?
Use between 12 -16 weeks up until 36 weeks gestation
What is required for mss1 screening?
Blood test and nuchal translucency scan in the first trimester
What is the recommended timeframe for MSS1 screening - blood test and scan
Blood test: 9 - 13 + 6 weeks
NT scan: 11 - 13 + 6
What is required for MSS2 screening?
NT scan
When can MSS2 screening be completed?
Between 14 and 20 weeks
When can NIPT be completed?
A blood test after 10 weeks gestation
When should aspirin be commenced if needed?
Between 12 - 16 weeks and stopped at 36 weeks
What category referral is required for hb <90 and not responding to treatment?
Consultation
What is haematocrit (HCT)
Percentage of RBCS relative to the portion of plasma
What is mean cell volume?
Size of RBC’s
What is mean cell haemoglobin?
Average amount of hb in RBCs
Who should have high dose folic acid supplementation?
- Previous history of NTD
- Family history of NTD
- High BMI >30
- Coelic disease
- Anticonvulsants
Morag’s haemoglobin is 70g/L and Ferriting 6ug/L at 36 weeks of gestation. Your plan would be to:
Refer Morag for a consultation so she can be prescribed IV Iron therapy (Ferinject).
