Antenatal care Flashcards
Booking appointment routine tests
Bloods
- electrophoresis - haemoglobinopathy - sickle cell and beta thalassaemia
- FBC - anaemia
- Rhesus status + ab
- Blood group
STI screening
- HIV, syphilis, Hep B
Urinanalysis - MSU
- glycosuria
- proteinuria
- haematuria
When to do an anomaly scan
USS at 18 - 22wks + 6days
Down syndrome combined test
USS nuchal translucency
PAPP -A
beta - HCG
Down syndrome quadruple test
USS nuchal translucency
Inhibin A
Unconjugated oestradiol
AFP
When to do down syndrome tests
Combined test - 11 - 13wks + 6 days
Quadruple test - 15 - 20wks
Down syndrome results
Increased nuchal translucency
Increased beta HCG
Decreased PAPP-A
Decreased inhibin A
Decreased unconjugated oestradial
When to test for gestational diabetes
24 - 28wks
How to test for gestational diabetes
OGTT
Fasting glucose > 5.6
2 hour post-prandial > 7.8
Risks of gestational diabetes
Macrosomia
Shoulder dystocia
Preterm
Miscarriage
Risk factors for gestational diabetes
Obesity
Previous gestational diabetes
Booking appointment advice
Explain how the baby develops during pregnancy
Exercises including pelvic floor exercises
Ideal place of birth + pregnancy care pathway
Breastfeeding and workshops
Participant led antenatal sessions
Screening
Folic acid and vitamins
Food hygiene
Foods to avoid
Unpasteurised milk
Ripened soft cheese - Camembert, Brie
Pate
Uncooked ready meals
Raw eggs
Mayonnaise
Smoked salmon
Raw meat
Alcohol advice
Stop all alcohol
Refer for alcohol cessation clinic
Risk of fecal alcohol syndrome, preterm birth, small for dates
Booking appointment examination
BMI
general clinical exam
Dating scan
10 - 13 +6 weeks (first trimester)
CRL
When to screen for gestational diabetes
BMI > 30 Previous macrosomia previous gestational diabetes FHx of diabetes Family origin with high incidence rate
Which conditions are screened for
Gestational diabetes Pre eclampsia HIV Hep B Syphilis
How to screen for pre eclampsia
BP
Urinanalysis
Risk factors for pre eclampsia
Previous pre eclampsia Age 40+ Nulliparity Pregnancy interval of 10+ years FHx BMI >30 HTN and pre-existing vascular disease Multiple pregnancy
When is CRL not used
If > 84 mm
Use head circumference instead
What does the combined test screen for
Downs syndrome - trisomy 21
Patau - trisomy 13
Edwards - trisomy 18
If high risk for Down syndrome
Do chorionic villous sampling - 10 weeks
Amniocentesis - 15 weeks
Risk of amniocentesis
0.5 - 1% chance of stillbirth
High risk of Down syndrome
1 in 150
Non invasive parenteral testing
Maternal serum level testing that detects fetal cells
Used as screening tool
Number of appointments for nulliparous mother
9 - 10
Number of appointments parous women
7
At each visit
BP and urine check
24 wks - symphysis - fundal height
36 wks - fetal presentation
28 weeks appointment
FBC
Rhesus antibodies
OGTT if indicated
Routine anti-D prophylaxis
36 weeks appointment
Breastfeeding info Birth plan How to recognise active labour Care for new baby Vitamin K prophylaxis New born screening Postnatal self care Baby blues and MH signs Risk assessment
reasons to scan after 24 weeks
Low lying placenta
Small for dates
Malpresentation
42wks and declining induction
Breech presentation at 36 wks
Offer ECV (external cephalic version) at 36wks
IOL at 38 wks if failed
