Antenatal Care Flashcards
How many visits are recommended in the:
- first pregnancy
- subsequent pregnancies?
- 10 antenatal visits in the first pregnancy if uncomplicated.
- 7 antenatal visits in subsequent pregnancies if uncomplicated.
State all the antenatal visits and when they take place
- Booking visit - 8 to 12 weeks (ideally < 10 weeks)
- Dating Scan - 10 to 13 + 6 weeks
- Down’s syndrome screening - 11 to 13+6 weeks or 15+0 to 20+0 weeks
- 16 weeks
- Anomaly Scan - 18 to 20+6 weeks
- GP review - 25 weeks (only if nulliparous)
- Midwife Review - 28 weeks
- GP review - 31 weeks (only if nulliparous)
- Midwife review - 34 weeks
- Midwife - 36 weeks
- 38 weeks
- Midwife review - 40 weeks (only if nulliparous)
- Midwife review - 41 weeks
What happens at the booking visit?
Booking visit:
- Folic acid supplementation –
- 400μg OD from pre-conception until 12 weeks gestation
- high-dose 5mg OD if high-risk for NTD (e.g. previous NTD, sickle cell disease or on anti-epileptics).
- Memorise these doses!
- Vitamin D supplementation – 10μg OD
- Diet, smoking, alcohol cessation.
- Note: most women will be on Pregnacare®, which already contains 10μg vitamin D and 400μg folic acid (amongst other minerals and vitamins).
PACES TIPS
- Ask in your history if their doctor has given them EXTRA folic acid to demonstrate your knowledge of high risk NTD pregnancies.
- Check BMI, BP, risk factors for gestational diabetes and pre-eclampsia, explore domestic violence risk, FGM and previous mental health Hx.
- At every appointment, you do: BP, BMI, Urine dip.
Vaccinations:
- Flu vaccine straightaway, pertussis vaccine book for @16 weeks.
For the booking appoint do these:
- Blood tests (for blood group, rhesus D status, 1st screening for anaemia, haemoglobinopathies, red cell alloantibodies, hepatitis B virus, HIV, and syphilis)
- Urine dipstick and MC&S (for proteinuria and asymptomatic bacteriuria)
When and what happens at the dating scan?
Viability, gestation, multiple pregnancy and chorionicity, nuchal translucency
When and what happens at the Down’s syndrome screening?
11 to 13+6 weeks Or 15+0 to 20+0 weeks
Down’s syndrome screening
- (using either: ‘combined test’ between 11+0 – 13+6 weeks
- or ‘serum screening test’ (triple or quadruple test) between 15+0 – 20+0 weeks gestation).
What is the combined test?
A screening test for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome is available between weeks 10 and 14 of pregnancy.
It’s called the combined test because it combines an ultrasound scan with a blood test.
Nuchal translucency, beta-human chorionic gonadotrophin, pregnancy-associated plasma protein-A
What is the triple or quadruple test?
If it was not possible to obtain a nuchal translucency measurement, or you’re more than 14 weeks into your pregnancy, you’ll be offered a test called the quadruple blood screening test between 14 and 20 weeks of pregnancy. This only screens for Down’s syndrome and is not as accurate as the combined test.
The triple screening measures the amounts of three substances in a pregnant woman’s blood:
- alpha-fetoprotein (AFP)
- human chorionic gonadotropin (hCG)
- estriol (uE3).
When a test for the hormone inhibin A is added, it’s called a quad screening.
What appointment is on the 16th week?
- If Hb < 11 g/dL, give oral iron tablets.
- At every appointment, you do: BP, BMI, Urine dip.
- Pertussis vaccine give now.
- OGTT if Hx of previous gestational diabetes
When does the anomaly scan take place? What is done?
18 - 20+6 weeks
• Detect structural anomalies, placenta location, amniotic liquor volume, gender and growth of foetus
o If placenta is low, offer another scan at 32 weeks
When do the GP visits take place? What is usually done?
25 weeks and 31 weeks
GP review
At every appointment, you do: BP, BMI, Urine dip
Measure symphysis–fundal height (SFH)
What occurs at the 28 week midwife review?
- 2nd screening for anaemia and red cell alloantibodies.
- If Hb < 10.5 g/dL, give oral iron tablets. (lower threshold than @16weeks)
- At every appointment, you do: BP, BMI, Urine dip, SFH
- First dose of anti-D prophylaxis 250 IU to rhesus negative mothers.
- OGTT if risk factors present now and no Hx of previous gestational diabetes
What occurs at the 34 week midwife review?
- At every appointment, you do: BP, BMI, Urine dip, SFH
- Second dose of anti-D prophylaxis 250 IU to rhesus negatives.
- Give information about labour, birth plan, pain control
What occurs at the 36 week midwife review?
- At every appointment, you do: BP, BMI, Urine dip, SFH
- Assess foetal malpresentation on USS
- Offer ECV at 36 weeks in primip.
- Offer ECY at 37 weeks in multiparous.
- Give specific information on:
- Breastfeeding technique, care of the new baby, vitamin K prophylaxis and newborn screening tests
- Postnatal self-care, awareness of ‘baby blues’ and postnatal depression
What happens on 38 weeks?
At every appointment, you do: BP, BMI, Urine dip, SFH
What occurs at the 40 week midwife review?
(only if nulliparous)
- At every appointment, you do: BP, BMI, Urine dip, SFH
- Further discussion of management of prolonged pregnancy
