Antenatal Care

Question 1

25yo G1P0 presents at 10weeks gestation to ANC counsel lifestyle changes and discuss Ix to assess fetal wellbeing

Answer 1

Impression
From this presentation, most pertinent components are the assessment of 1st trimester pregnancy, would want to conduct thorough assessment, provide appropriate patient education and counselling, establish appropriate review/referral.

Question 2

Antenatal Care - History

Answer 2

History:

• PC: planned vs unplanned, wish to proceed, method of conception (if IVF, important to know age of eggs)
• sx: N/V/D, pain, fetal movements (unlikely at this age)
• REDFLAGS: fever, bleeding, discharge
• O&G history: CST results, STI screening, details of previous pregnancies
• antenatal care: supplements taking y/n, any scans completed and findings?
• medical and surgical history
• psychosocial history

Question 3

Antenatal Care - Examination

Answer 3

Examination

• general observation + vitals + anthropometric
• Antenatal: fundal height, abdo palp (presentation, lie), BP, FHR doppler
• pelvic examination (can be deferred to later date)

Question 4

Antenatal Care - Investigations

Answer 4

Investigations

• bedside: vitals, UA + MCS, STI screen
• bloods: TORCH serology, other (varicella, HIV, Syphilis), iron studies, FBC, blood group & Rh status, TFTs,
• Imaging: abdo ultrasound: dating scan, then later have structural scan, screening for DS

inform on future scan protocol:

• morphology scan in 2nd trimester,
• OGTT for GDM

Question 5

Antenatal Care - Management/Counselling

Answer 5

Management/Counselling
Counselling:
- patient education: assess current understanding, explain testing regimes and timing of, education re Down syndrome,
- address any concerns
- discuss lifestyle adjustments:
- psychosocial: avoid smoking, drinking, dietary considerations, exercise, risks of obesity

Medications

• conduct medications review, checking for teratogenic
• seek advice re cessation/switching meds if concerns

Vaccinations

• MMR and Varicella are live vaccines and can’t be given during pregnancy
• administer influenza and pertussis fosters

Arrange appropriate follow-up (4-weekly until 28 weeks gestation, fortnightly till 36, weekly till birth)