Antenatal care Flashcards
how many routine antenatal appointments do women have
Nulliparous: 10
Parous: 7
What are the indications for consultant-led care
Existing medical problems
High (>30) or low BMI (<18.5)
>40yo at booking
Multiple pregnancy
Complex social factors
Complications in previous pregnancies
Complications develop during current pregnancy
When is the booking visit
8-12 weeks
When is the dating scan
10-13+6 weeks
When is Down’s syndrome testing done
11-13+6 weeks
When is the anomaly scan
18-20+6
When is anti-D prophylaxis given
28 weeks
Second dose at 34 weeks
When are the routine antenatal appointments
28, 34, 36, 38, 41, 42 weeks gestation
Nulliparous: + 25, 31, 40
What is done at the booking appointment
- Clinical history + establish gestation
- Risk assessment
- Examination and investigations
- Medication review
- Screening for conditions
- Lifestyle advice
- Information about pregnancy
- Scans
- Safeguarding screen
What is done at routine antenatal visits
BP measurement
Urine dipstick
Discuss concerns and birth plan
Serial growth scans
>25 weeks: SFH
<28 weeks: handheld doppler heart monitoring
>28 weeks: CTG
What does the risk assessment at the booking visit look for
Gestational diabetes risk
Pre-eclampsia
Foetal growth restriction
Venous thromboembolism
What examinations and investigations should be done at booking visit
BMI (weight and height)
BP
Urine dipstick and culture
Bloods:
- FBC
- Haemoglobinopathies e.g. SCD, thal
- Blood group and rhesus status
- Red cell alloantibodies
- Serology: HIV, hep B, syphillis, rubella
- Chromosome abnormality screening
Give examples of medications contraindicated in pregnancy
ACEi
Statins
Diuretics
Warfarin
Sodium valproate
Vitamin A supplementation
Lithium
When is folic acid given and why
Pre-conception if possible → 12 weeks of pregnancy
normal: 400micrograms
Given to prevent neural tube defects
What is the higher dose of folic acid and when is it indicated
5mg
Diabetes
Epilepsy
BMI >30
Sickle cell disease
Coeliac disease
Previous pregnancy with NTD
When is aspirin given in pregnancy
For those at high risk of pre-eclampsia (aged >40, BMI >35, HTN, previous pre-eclampsia)
Daily aspirin from 12 weeks to birth
When is vitamin D supplementation recommended in pregnancy
Generally recommended to all, particularly darker-skin patients
10 micrograms per day
What dietary advice should be given to pregnant women at booking visit
Eat a variety of foods, including fruit and veg, carbohydrates, proteins, fibre-rich foods, dairy foods
Eat folic acid-rich foods: green leady vegetables, fortified breakfast cereals
Vit D: oily fish, eggs, fortified cereals
Avoid:
* Unpasteurised diary products or mould-ripened cheeses (camembert, brie)
* Raw/uncooked meats
* Liver and liver products (vitamin A)
* All types of pate
* Swordfish/raw shellfish
* Duck/quail eggs
What is the effects of smoking during pregnancy
Miscarriage
Ectopic pregnancy
Stillbirth
Congenital abnormalities
Growth restriction
Abruption
Preterm birth <37 weeks
SIDS
At what point do you advise pregnant women to not sleep on their back
28 weeks: sleep in left lateral position
Consider using a pillow to maintain position
How is gestational age determined
<14 weeks: crown-rump length (CRL)
>14 weeks: abdominal circumference
How is screening for Down’s, Edward’s and Patau’s syndrome carried out
At 11-14 weeks: nuchal translucency + combined test
Down’s syndrome: ↑ HCG, ↓ PAPP-A, thickened nuchal translucency
Edward’s: ↑ HCG (lower than Down’s), ↓ PAPP-A, thickened nuchal translucency
Patau’s: ↑ HCG (lower than Down’s), ↓ PAPP-A, thickened nuchal translucency
When is the quadruple test offered
Instead of the combined test OR the woman books later in pregnancy
offered between 15-20 weeks
What is the quadruple test
Alpha-fetoprotein
Unconjugated oestriol
Human chorionic gonadotrophin
Inhibin A
What are the possible outcomes from a combined/quadruple test
‘lower chance’: 1 in 150 chance or more e.g. 1 in 300
‘higher chance’: 1 in 150 chance or less e.g. 1 in 100
What are the next steps after there is a ‘higher chance’ result from either combined or quadruple test
Either non-invasive prenatal screening (NIPT) or diagnostic (amniocentesis, chorionic villus sampling/CVS)
What is noninvasive prenatal screening
analyses small DNA fragments that circulate in the blood of a pregnant woman (cell free fetal DNA, cffDNA)
cffDNA derives from placental cells and is usually identical to fetal DNA
sensitivity and specificity are very high for trisomy 21 (>99%) and similarly high for other chromosomal abnormalities
private companies (e.g. Harmony) offer NIPT screening from 10 weeks gestation
How is gestational diabetes screened for
Oral glucose tolerance test at 24-28 weeks if there are any risk factors:
- BMI >30
- Prvious macrosomic baby
- GDM in previous pregnancy (should have OGTT earlier)
- FHx diabetes
- South Asian, Black, African-Caribbean, Middle Eastern origin
Urine results of:
- Glycosuria of 2+ or above on 1 occasion.
- Glycosuria of 1+ or above on 2 or more occasions.
What vaccinations are offered during antenatal care
Whooping cough: 16-32 weeks
Influenza vaccine: at any gestation
Covid-19 vaccine
What occurs at the 28 week appointment
Routine care: BP, urine dipstick, SFH
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
