Antenatal Appointments Flashcards
what is done at first contact with preg women (4)
identify high risk pt - BMI, PMH, smoker
review meds for preg safety
check VTE risk
advise folic acid & vit D
folic acid dose
400ug OD low risk or 5mg OD high risk
when is booking visit
8 to 12 weeks
what is done at booking visit (6)
RFs for pre-eclampsia
USS
Bloods - foetal screen for Downs, group, anaemia, RC ABs, HB-opathies, hep B, HIV, syphillis
Height / weight / BP / proteinuria
given hand held notes
what is given to prevent pre eclampsia
aspirin
when is OGTT done and what is it
75g 2hr OGTT at 24-28wks
cut offs for GDM tests
fasting 5.6
2hr 7.8
if OGTT is positive, what is the follow up and when is it
1 week joint diabetes and obs clinic
contrast LGA and macrosomia
LGA is proportional
macrosomia has large abdo circumference
what is done at 16wk visit
review all screening tests
pertussis / influenza vaccines
BP & proteinuria
discuss scan
who gets a 25wk scan and what does it sho
Primip
SFH - USS if <10 or >90 centile
28wk visit
2nd screening for anaemia and red cell alloantibodies
offer first anti D if neg
measure SFH
BP & proteinuria
who gets a 31wk visit and what happens
Primip
measure SFH
BP & proteinuria
34wk visit
offer 2nd anti D if neg
BP & proteinuria
SFH
birth plan preparation
36wk visit
BP & proteinuria
SFH
check presentation - offer ECV if breech
give info on breastfeeding, newborn care, Vit K etc
38wk visit
BP & proteinuria
SFH
give info on risks of prolonged preg after 42wks & Mx
who gets 40wk visit and what happens
Primip
BP & proteinuria
SFH
offer membrane sweep
41wk visit
BP & proteinuria
SFH
offer membrane sweep & induction
at which appts are blood tests done
8-12 wks
28 wks
when is anti D given
28 and 34 wks
when is BP and proteinuria checked
EVERY appt
when are the scans done
12wk
20 wk
how many appts do multips vs primips get
multips 7, primips 10
when is the dating scan
10 to 13 weeks
what is the dating scan for
gestational age and EDD
viability & location
detect multiple pregs
detect gross foetal abnormalities
NUCAL TRANSULENCY for downs
what is nuchal translucency
lymph fluid accumulates behind neck
radiological signs of multiple pregs & meaning
lamba sign = DC twins
T sign = MC twins
when is anomaly scan
18 to 20 weeks
what is the purpose of anomaly scan
locate placenta
CRL, BPD, femur length, AC
detect major abnormalities
- if present, allow for TOP, preparation, Mx in birth centre
best and worst type of twins & what they mean
best = dichorionic / diamniotic - 2 bags, 2 placentas
worst = monochorionic / monoamniotic - one bag, one placenta
why is MCMA twins the worst
risk of twin to twin transfusion syndrome
- necrosis of one twin, increased inflammation, early labour
how is twin twin transfusion syndrom treated
intrauterine laser therapy
when is the combined downs screening done
11 to 13+6 weeks
what is the combined downs screening
nuchal translucency on USS
high serum hCG
low PAPPA
if the booking is later in preg, when is downs screening done
15 to 20wks
what is in the triple test
plasma bHCG
unconjugated estriol
AFP
what is in the quad test
plasma bHCG
unconjugated estriol
AFP
inhibin A
results of Downs screen for Downs / Turners
high HCG
high inhibin
(HIgh)
results of downs screen for edwards
low HCG
low estriol
(HE is low)
results of downs screen for patau
high AFP
(P in patau and AFP)
