Antenatal Care Flashcards
Nutritional supplements
folic acid
vitamin D
iron supplementation should be offered routinely
false
Describe reccomendations for folic acid
folic acid 400mcg should be given from before conception until 12 weeks to reduce the risk of neural tube defects. Certain women may require higher doses (women who take antiepileptics)
indications for more folic acid
MORE folic acid (5mg)
M etabolic diseases (diabetes, coeliac)
O besity (BMI >30)
R elative (family Hx of NTD)
E pilepsy (taking anticonvulsants)
Describe reccomendations regarding vitamin A
vitamin A supplementation (intake above 700 micrograms) might be teratogenic. Liver is high in vitamin A so consumption should be avoided
Describe reccomendations for vitamin D
‘women should be advised to take a vitamin D supplement (10 micrograms of vitamin D per day), as found in the Healthy Start multivitamin supplement. Women who are not eligible for the Healthy Start benefit should be advised where they can buy the supplement’. Particular care should be taken with higher risk women (i.e. those with darker skin or who cover their skin for cultural reasons)
Describe reccomendations for alcohol
the government now recommend pregnant women should not drink. The wording of the official advice is ‘If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.’
Describe reccomendations for smoking
risks of smoking including low birthweight and preterm birth should be discussed
NRT may be used but women must have stopped smoking and risks/benefits need to be discussed
neither varenicline nor bupropion should be offered to pregnant or breastfeeding women
Describe reccomendations for food acquired infections
listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
salmonella: avoid raw or partially cooked eggs and meat, especially poultry
Describe reccomendations for work
inform women of their maternity rights and benefits
for the majority of women it is safe to continue working. Women should be asked whether they work. The Health and Safety Executive should be consulted if there are any concerns about possible occupational hazards during pregnancy
Describe reccomendations for air travel
women > 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel
women with uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks
associated with increased risk of venous thromboembolism
wearing correctly fitted compression stockings is effective at reducing the risk
Prescribed medicines
avoid unless the benefits outweigh the risks
true
Over-the-counter medicines
should be used as little as possible during pregnancy
true
Pregnant women should be informed that few complementary therapies have been established as being safe and effective during pregnancy. Women should not assume that such therapies are safe and they should be used as little as possible during pregnancy
true
Exercise in pregnancy
women should be informed that beginning or continuing moderate exercise is not associated with adverse outcomes
certain activities should be avoided e,g, high-impact sports where there is a risk of abdominal trauma and scuba diving
Sexual intercourse
not known to be associated with any adverse outcomes
true
Nausea and vomiting
natural remedies
ginger and acupuncture on the ‘p6’ point (by the wrist) are recommended by NICE
Nausea and vomiting drugs
antihistamines should be used first-line (BNF suggests promethazine as first-line)
All women should be informed at the booking appointment about the importance for their own and their baby’s health of maintaining adequate vitamin D stores during pregnancy and whilst breastfeeding
true
NICE issued guidelines on routine care for the healthy pregnant woman in March 2008. They recommend:
10 antenatal visits in the first pregnancy if uncomplicated
7 antenatal visits in subsequent pregnancies if uncomplicated
women do not need to be seen by a consultant if the pregnancy is uncomplicated
What is booking visit for?
general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
BP, urine dipstick, check BMI
When is booking visit?
8 - 12 weeks (ideally < 10 weeks)
Booking bloods/urine?
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria
What appointments for first 16 weeks?
8 - 12 weeks (ideally < 10 weeks) Booking visit
10 - 13+6 weeks Early scan to confirm dates, exclude multiple pregnancy
11 - 13+6 weeks Down’s syndrome screening including nuchal scan
16 weeks Information on the anomaly and the blood results.
Routine care: BP and urine dipstick