Antenatal Care

Question 1

What is the purpose of the booking visit?

Answer 1

8-12 weeks → ideally <10 weeks

• General information → diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
• BP
• Urine dipstick
• Check BMI

Booking bloods/urine

• FBC
• Blood group and rhesus status
• Red cell alloantibodies
• Haemoglobinopathies
• Hepatitis B, syphilis, HIV
• Urine culture to detect asymptomatic bacteriuria

Question 2

What is the purpose of the 10-13+6 week visit?

Answer 2

• Confirm dates
• Exclude multiple pregnancy
• Down’s syndrome screening - Nuchal scan

Question 3

What is the purpose of the 16 week visit?

Answer 3

• Information on the anomaly and the blood results
  
  • If Hb < 11 g/dl consider iron
• Routine care
  
  • BP
  • Urine dipstick

Question 4

What is the purpose of the 18-20+6 week visit?

Answer 4

• Anomaly scan

Question 5

What is the purpose of the 25 week visit?

Answer 5

• G1 only
• Routine care
  
  • BP
  • Urine dipstick
  • Symphysis-fundal height

Question 6

What is the purpose of the 28 week visit?

Answer 6

• Second screen for anaemia and atypical red cell alloantibodies
  
  • If Hb <10.5 g/dl consider iron
• First dose of anti-D prophylaxis to rhesus negative women
• Routine care
  
  • BP
  • Urine dipstick
  • Symphysis-fundal height

Question 7

What is the purpose of the 31 week visit?

Answer 7

• G1 only
• Routine care
  
  • BP
  • Urine dipstick
  • Symphysis-fundal height

Question 8

What is the purpose of the 36 week visit?

Answer 8

• Information on breastfeeding, Vit K and baby blues
• Check presentation - offer ECV if indicated
• Routine care
  
  • BP
  • Urine dipstick
  • Symphysis-fundal height

Question 9

What is the purpose of the 38 week visit?

Answer 9

• Routine care
  
  • BP
  • Urine dipstick
  • Symphysis-fundal height

Question 10

What is the purpose of the 40 week visit?

Answer 10

• G1 only
• Discussion about options for prolonged pregnancy
• Routine care
  
  • BP
  • Urine dipstick
  • Symphysis-fundal height

Question 11

What is the purpose of the 41 week visit?

Answer 11

• Discuss labour plans and possibility of induction
• Routine care
  
  • BP
  • Urine dipstick
  • Symphysis-fundal height

Question 12

What are the signs of Down’s antenatal findings?

Answer 12

• Low AFP
• Low oestriol
• Low PAPP-A
• High b-HCG
• Thickened NT

Question 13

What are the differentials of increased alpha-fetoprotein?

Answer 13

• Neural tube defects
• Abdominal wall defects
• Multiple pregnancy

Question 14

What are the differentials of decreased alpha-fetoprotein?

Answer 14

• Down’s syndrome
• Trisomy 18 - Edward’s
• Maternal DM

Question 15

What is the prophylaxis for women who are high-risk for pre-eclampsia?

Answer 15

• 75mg aspirin OD from 12 weeks to delivery
• Screened at every antenatal visit with BP and urinalysis

Question 16

What is checked for in the 18-21 week anomaly scan?

Answer 16

• Spina bifida
• Major congenital anomalies (heart defects)
• Diaphragmatic hernia
• Renal agenesis

Question 17

What supplementation should all women take?

Answer 17

• Folic acid (400mcg or 5mg)
• Vit D (10mcg)
• Usually done through Pregnacare

Question 18

What are the indications for high-dose folic acid?

Answer 18

5mg

• Previous child with NTD
• Diabetes mellitus
• Epileptic woman
• Obesity
• HIV +ve on co-trimoxazole
• SCD
• IBD
• Thalassaemia

Question 19

When can first movements be felt?

Answer 19

• Primigravida = 20w
• Multiparous = 16-18w
• Latest = 24 weeks)

Question 20

Describe antenatal corticosteroid administration.

Answer 20

• 2x 12mg IM Betamethasone (given 24hrs apart)
• Optimal benefit is seen 24 hours after initiation of therapy and lasts for about 7 days
• Alternative = 4 doses of 6 mg IM dexamethasone 12 hours apart