Antenatal Care

Question 1

Normal Discomforts in Pregnancy (13)

Answer 1

1. Nausea/vomiting (*hyperemesis gravidarum)
2. Fatigue
3. Dizziness
4. Headaches (*pre-eclampsia)
5. Back aches
6. Heartburn/indigestion
7. Varicose veins
8. Skin changes and stretch marks
9. Mild swelling/fluid retention (*pre-eclampsia)
10. Pica
11. Bleeding gums
12. Constipation
13. Hemorrhoids

Question 2

Smoking in Pregnancy
Risks

Answer 2

Nicotine and carbon monoxide reduce placental blood flow and availability of oxygen.
1. Growth restriction and LBW
2. Preterm birth, miscarriage or still birth
3. Congenital defects
4. Nicotine dependence
5. Decreased lactation
6. Childhood/adult physical and mental comorbidities

Question 3

Smoking in Pregnancy
Advice & Interventions

Answer 3

1. Identify smokers and non-smokers at risk from second-hand exposure
2. Provide education and recommend cessation or reduction
3. Offer behavioural counselling and support services - e.g. QUITLINE
4. Supervised NRT use
5. Monitor for relapse post-birth
6. Advice to partner/family - avoid smoking around pregnant person or infant, smoke outside house/car, illegal to smoke with children in car.

Question 4

Drinking in Pregnancy
Risks

Answer 4

Alcohol passes through the placenta and breast milk to the foetus/infant and can cause:
- Preterm birth, miscarriage or stillbirth
- LBW
- FASD - range of physical, mental and behavioural disabilities:
* Physical - poor growth, facial deformities, poor coordination, heart/kidney/bone conditions, vision/hearing problems.
* Cognitive - poor attention/memory, learning difficulties, speech delays, intellectual disability, poor reasoning/judgement.

Question 5

Drinking in Pregnancy
Advice

Answer 5

1. There is NO safe:
   - Amount of alcohol
   - Type of alcohol
   - Stage of pregnancy to drink
2. Its never too late to stop or reduce drinking
3. Alcohol and Drug support line

Question 6

Safe Sleeping
Advice

Answer 6

1. Safe cot - meets current Australian standards.
   - Avoid second hand cots.
2. Safe mattress - firm, clean, flat, well-fitting.
   - Avoid cot bumpers, water beds, bean bags, couch, pillows/cushions.
3. Safe bedding - safe sleeping bag or lightweight, securely tucked blanket at chest height.
   - Avoid soft bedding, bulky surfaces, electric blankets, hot water bottles/wheat bags,
4. Safe sleeping space - own sleep space in parents room for first 6months.
   - Avoid smoke, handing cords, electrical appliances.
5. Infant:
   - sleep on their back
   - feet at bottom of cot
   - face and head uncovered
   -

Question 7

Advice: Nutrition
Foods to Limit/Avoid

Answer 7

A. Foods to limit
- Caffeine - 200mg/day
- High-energy foods/drinks
- Large fish (mercury)
B. Foods to avoid
- Deli meats, soft cheese and pate (listeria)
- Smoked salmon, raw seafood, precooked prawns/sushi (listeria)
-Unpasteurised milk (lysteria)
- Raw/undercooked meat (toxoplasmosis)
- Raw/undercooked eggs (salmonella)
- Alcohol

Question 8

Advice: Nutrition
General Advice & Foods to Include

Answer 8

General:
1. Eat for you not for two - approx. extra 300cal/day
2. Rainbow plate
3. Healthy swaps
4. Safe food handling

Foods to include:
1. Folic acid - fortified bread, leafy greens, legumes (blood formation/cell building)
2. Iron - meat, fish, poultry, eggs, dairy, fortified cereals (brain development/energy levels)
3. Vitamin D - eggs, oily fish (calcium absorption/bone health)
4. Calcium - dairy, almond/soy products (bone health)
5. Vitamin B12 - meat, fish, poultry, eggs, dairy (nerve/brain development)
6. Protein - meat, fish, poultry, eggs, dairy (blood supply/tissue growth)
7. Iodine - fish, dairy, eggs (brain development)

Question 9

Advice: Weight Gain

Question 10

Maternal Screening Tests

Answer 10

1. Initial blood tests - blood type, RhD factor, FBC (Hb), rubella, varicella, STIs, vitamin D.
2. Combined first trimester screen: MSS + nuchal fold translucency (9-14w) - chromosomal disorders and neural tube defects.
3. Second trimester maternal serum screening (15-17w) - chromosomal disorders and neural tube defects.
4. Non-invasive prenatal test (optional: 10+w) - chromosomal disorders
5. Oral glucose tolerance test (28w) - gestational diabetes
6. Edinburgh post-natal depression scale - PND
7. Group B strep swab (35-37w)

Question 11

Antenatal Assessments

Question 12

Antenatal Interventions

Answer 12

1. Rhogam/Anti-D shot @ 28w, 34w and 72hr post-birth
2. TDaP vaccine @ 30w

Question 13

Antenatal Schedule

Answer 13

0-28 weeks - 4weekly
28-36 weeks - 2weekly
26-40 weeks - 1weekly

Question 14

Safe Co-sleeping
Advice

Answer 14

1. Reinforce safe sleeping principles
2. Tips for safer co-sleeping
   - Create clear space
   - Infant on back NOT tummy
   - Head and face uncovered
   - Use safe sleeping bag
   - Use firm/flat mattress
   - Place on one side of parent away from edge NOT between two people
   - Tie up long hair and remove jewellery
   - Move bed away from wall
   - Prevent infant falling from bed
3. Avoid co-sleeping if:
   - Overly tired or unwell
   - Consumed alcohol, drugs or cigarettes
   - Premature or small infant

Question 15

Maternal Physiological Changes

Answer 15

1. Endocrine - progesterone, oestrogen, relaxin, hCG.
2. CVS - incr. HR, blood volume, CO and clotting ability; decr. SVR; uterine compression of vena cava.
3. Respiratory - URT oedema, diaphragm elevation; incr. RR and O2 consumption.
4. Renal - incr. size, GFR, Na+ retention and frequency of urination.
5. GIT - decr. motility, LES tone; incr. intragastric pressure.
6. Integumentary - incr. pigmentation, stretch marks, decr. hair loss.

Question 16

Foetal Development
Stages

Answer 16

1. Pre-embryonic (0-2w) - fertilisation to implantation.
2. Embryonic (3-8w) - start forming brain, spinal cord, nerves, major organs (incl. heart and sex organs), head/external structures.
3. Foetal (8-40w) - weight gain and elongation, muscle/bone growth, lung formation, hearing, sleep-wake cycle.