Antenatal care

Question 1

pre-pregnancy care

Answer 1

advice regarding lifestyle issues particularly diet, substance abuse, start folic acid, cease smoking
aim for ideal BMI
check immunity for rubella/varicella
check thyroid function
essential for women with medical conditions and on medication
pre-pregnancy counselling eg. hereditary conditions

Question 2

Hx of pregnancy

Answer 2

Question 3

pregnancy screening

Answer 3

Question 4

Rh D negative mother

Answer 4

if mother is Rh D negative and baby is positive some baby blood can enter maternal blood stream (veto-maternal haemorrhage)
mothers immune system can produce antibodies to the baby’s red blood cells and destroy them
the rhesus antibodies remian
next pregnancy if there is a rhesus positive baby, the mother’s antibodies may cross the placenta and destroy the babys rbcs (haemolytic disease of the newborn)

Question 5

first antenatal visit actions

Answer 5

audit-C for alcohol use and level of risk
edinborough post-natal epression scale
FDV screening
commence pregnancy handheld record
weight and BMI

Question 6

first visit bloods

Answer 6

M – measles and mumps
R – rubella
S – syphilis (TPHA)
A – antibody ABO
B – blood group
C – chlamydia (FVU and SOLV)
D – Vitamin D
E – entertain pap smear
F – FBC
G – Globinopathy
H – Hepatitis B and C and HIV
I – Iron and other bloods

+MSU MC&S

Question 7

dating scan

Answer 7

8-10 weeks

Question 8

first trimester ultrasound screen

Answer 8

11-14 weeks
combine test to obtain calculated risk using US for nuchal translucency, maternal blood (PAPP-A and free b-HCG)
may also want NIPT, not covered by medicare
‘high’ risk indicates >1:300

Question 9

NIPT

Answer 9

screens for fetal aneuploidy
from ten weeks
uses cell-free DNA
routine anatomy scan still required to check for multiple pregnancy and major fetal abnormalities eg. aneuploidy
99% accurate

Question 10

anatomy scan

Answer 10

18-20 weeks
placental location
fetal size
cervix length (if thinning early - consider progesterone pessary, cervical cerclage, cervical suture etc. to prevent pre-term brth due to cervical incompetency)
identfication of fetal abnormalities

Question 11

if the cervix is thinning early

Answer 11

consider progesterone pessary, cervical cerclage, cervical suture etc
to prevent preterm birth due to cervical incompetancy

Question 12

diagnostic tests in the vent of positive FTS or NIPT

Answer 12

chorionic villus sampling (placenta)
- 11-14 weeks, transvaginal or transabdominal, sample of chorionic villi is tested for chromosomal abnormalities and hereditary conditions
Amniocentesis (fetus)
- 15-16 weeks, amniotic fluid sample containing fetal cells is tested for chromosomal abnormalities and hereditary conditions

Question 13

antenatal visit timings

Answer 13

If nulliparity – 4 weekly until 28, then 2 weekly until 36, then weekly
If multiparty – 4 weekly until 36, the 2 weekly
If >40 – need biweekly from 36

Question 14

anti D administration timings

Answer 14

28-32 weeks – one dose
34-36 weeks – another dose
Blood product can have side effects

Question 15

examination for antenatal visits

Answer 15

height/weight
BP
urinalysis
abdominal palpationn
oedema
fetal movements from 24 weeks
general wellbeinng

Question 16

how to do an abdominal palpation

Answer 16

Examine for linear nigra, stretch marks, previous caesarean scar
Identify fundus and lie, identify is twin pregnancy
Presentation – cephalic or breach, head will feel firm, hard and round
Engagement – most babies don’t engage until near term
Auscultation – normal is between 110-160 BPM
To complete examination – help the patient up

Question 17

what sorts of things to look for depending on how old the pregnancy is

Answer 17

To 28 weeks – fundal height, fetal heart rate
FBC, antibodies (if RhD neg), pertussis, diabetes screen
28-36 weeks – plus lie, presentation
36 weeks onwards: plus position and descent of fetal head
FBC, LVS and rectal swab for screening of GBS

Question 18

when in OGTT done

Answer 18

between 24-28 weeks or earlier if at high risk