Antenatal Care ☺️

Question 1

What are the key appointment dates

Answer 1

1st contact before 10wks

Question 2

What would you do at the booking appointment

Answer 2

Sickle cell, thalassemia before 10wks

Folate supplementation
Nutrition
Smoking, alcohol

Offer US for dating scan (8-14wks), anomaly scan (18-20wks)

Question 3

When is the dating scan

What would you do

Answer 3

8-14wks (gen 12wks)

US for birthday, number

• combined blood test for Downs, Edwards, Patau
• nuchal translucency scan

May do blood test for
-syphyllis, HepB, HIV, Rubella

Question 4

When is the anomaly scan?

What do you do?

Answer 4

18-21wks (normally at 20wks)

US scan for 11 congenital issues

• anencephaly
• open spina bifida
• cleft lip

Question 5

Describe the combined test for Downs, Edwards and Pataus

Answer 5

12wks
PAPPA, bhCG, nuchal translucency + maternal age
-Downs - low PAPPA, high bhCG, high NT

Question 6

How would you use CRL?
-important landmarks
How would you use fundal height?

Answer 6

Most accurate estimation of gestational age in early pregnancy between 6-13wks
After 13wks => head circumference, biparietal, femur length

Cardiac activity present with CRL > 7mm

Fundal height in cm corresponds to gestational age in wks between 24-36wks

Question 7

When would amniocentesis/CVS/NIPT be offered?

-method

Answer 7

Screening suggests Downs, Edwards, Pataus
Past pregnancy affected
FHx

Amniotic fluid removed
-genetic analysis of fetal cells

Chorionic villus sampling
-genetic analysis of placental cells

Both have a 1% risk of miscarriage

NIPT
-fetal DNA found in maternal blood for chromosomal abnormalities

Question 8

Supplements

• dosage
• reasoning

Answer 8

Folate 
Preconception - 400mcg
PC+obesity - 5mg
Reduce NTD incidence by wk12
  *FHx/PMH
  *diabetic
  *obese
  *on antiepileptic meds

VitD
Pregnant -10ug
-Fetal skeleton accumulates Ca from maternal stored
-requires vitamin D from sun and diet (fish, egg, meat)

Question 9

VTE prophylaxis

-risk factors

Answer 9

35+
BMI 30+
Smoker

Parity 3+
Multigravid
Current PET
Past VTE
IVF

Gross varicose veins
Immobility
FHx of unprovoked VTE
Low risk thrombophilia

3 = heparin from 28wks - 6wk postnatal
4+ = heparin now - 6wk postnatal
DVT before delivery = continue heparin for 3months

Question 10

Cervical cancer screening

Answer 10

Sample tested for high risk strains of HPV

• if positive => cytological examination
• if positive => colposcopy

25-49 = every 3 years
50-64 = every 5 years