Antenatal Care Flashcards
What is the purpose of antenatal care?
-Identify existing problems that may be worsened by pregnancy or may affect pregnancy development
-Optimise maternal health in pregnancy
-Assess risk of pregnancy complications and institute appropriate monitoring
-Build therapeutic relationship
Physiological changes of pregnancy
-Cardiac output increased by 40%
-Stroke volume increased
-Heart rate increased by 10-20 bpm
-Blood pressure reduced
-Systemic vascular resistance reduced by 25-30%
-Hypercoagulable state
-Oxygen consumption increased by 20%
-Glomerular filtration rate increases by 50%
Frequency of antenatal care
-Nulliparous, uncomplicated
-10 app
-Parous – uncomplicated 7 app
-Hand held record
-Appropriate environment
What is discussed in the booking visit?
-PMH
-FHx
-Screening
-Risk factors (diabetes, epilepsy, hypertension, medications, alcohol, drugs)
-Problems
-Contacts
-Advice about supplements – folic acid (400mcg for 12 weeks), vitamin D
-Foods to avoid
-Working advice
-Prescribed and OTC medication
-Exercise
-Sex
-Alcohol (CAGE questionnaire screens for dependence)
-Smoking (nicotine constricts blood vessels in placenta, miscarriage, delayed conception, club foot and cleft lip)
-Cannabis
-Air travel/ car/abroad (Zika?)
-Domestic violence and child protection issues
What investigations are done in routine antenatal care?
-Gestational age USS offered between 10 and 13+6weeks
-Calculate BMI
Common symptoms presenting to antenatal care
-Nausea and vomiting
-Fatigue, metallic tastes, dizziness, mood swings, swollen and tender breasts
-Heartburn (increasing fundus, more stomach acid)
-Constipation
-Haemorrhoid
-Varicose Veins
-Vaginal discharge (increased secretions)- may be implantation bleed
-Backache (loose joints due to progesterone)
What screening is done for the mother?
-Haematological conditions
1. Anaemia, 11g.ml booking, 10.5g.ml 28 weeks
=Iron studies
=Supplement/ transfusion
2. Blood grouping and red cell alloantibodies
=Rhesus status, anti-D prophylaxis
3. Haemoglobinopathies
=FOQ
=Ideally screening by 10 weeks
-High prevalence – lab screening of all women to identify carriers of sickle/thalassaemia
-Low prevalence
-FOQ questionnaire
Routine screening for infections
-Asymptomatic Bacteriuria
-Hep B
-Hep C
-HIV
-Rubella
-Syphilis
What infections are not screened for?
-Asymptomatic bacterial vaginosis
-Chlamydia
-CMV
-Hep C
-GBS
-Toxoplasmosis
Screening for clinical conditions
-Gestational diabetes
-Pre-eclampsia (criteria, low dose aspirin)
-Pre-term birth
-Placenta Praevia
-Foetal growth and well-being
-Foetal presentation
Screening for Down’s syndrome
-Pre-screening probability
=1 in 1500 aged 20
=1 in 270 aged 35
=1 in 100 aged 40
-Combined test ( NT, beta-HCG, PAPP-A) between 11+0 – 13+6
-Quadruple test between 15+0-20+0 weeks
-Screen positive/ Screen negative / implications
-CVS < 13 weeks 1-2%/ amnio 15 weeks 0.5%
What is the 12-14 week scan?
-Pregnancy dating and viability confirmation
-Counting the babies and determining chorionicity in multiples (T and lunar sign in 1st trimester)
-Anatomy assessment – head/brain, abdominal wall, bladder, limbs
-Combined screening for T13, T18 and T21
=Heart beat
=Twins?
=Abnormalities (anencephaly, Exomphalos, Gastroschisis)
=EDD
=Image
=Nuchal translucency
=Arrange fetal anomaly scan for 20 weeks
What is NT?
Nuchal translucency
=Hollow black space
=Altered by fetal position: Chin in relaxed position
=Down’s
=Normal= less than 3.5mm?
Screening for foetal abnormalities
-Structural
=18+0 – 20+6
=Reproductive choice
=Parents to prepare
=Managed birth in specialist centre
=Intrauterine therapy
What happens at the 18-22 week scan?
-Placental site
-Cervical length
-Anatomy screening- FASP conditions
-FA scan
Foetal conditions screened for as a minumum
-Anencephaly
-Open spina bifida
-Cleft lip
-Diaphragmatic hernia
-Gastroschisis
-Exomphalos
-Cardiac abnormalities
=Transposition of the Greta Arteries
=Atrioventricular Septal Defect
=Tetralogy of Fallot
=Hypoplastic Left Heart Syndrome
-Bilateral renal agenesis
-Lethal skeletal dysplasia
-Edward’s syndrome (Trisomy 18)
-Patau’s syndrome (Trisomy 13)
New and emerging screening
-NIPT
-Pre-eclampsia screening
What is NIPT?
?
Limitations of NIPT
-Affected by mosaicism, multiple pregnancy
-Possibility of no result
-Screening NOT diagnosis
-Cannot detect single gene conditions, aneuploidies not affecting chromosomes 13, 18, 21, X or Y
-Can’t use with donor egg pregnancies
Describe pre-eclampsia screening
-Use risk factors to identify women at risk and suitable for treatment with aspirin
How to work out expected date of delivery
EDD= LMP + 9 months + 7 days (based on 280 day pregnancy, 28 day cycle)
What neural tube defects does folic acid prevent
-Spina bifida (an incomplete closure of the spinal cord and spinal column)
-Anencephaly (severe underdevelopment of the brain)
-Encephalocele (when brain tissue protrudes out to the skin from an abnormal opening in the skull)
Blood screening at booking
-FBC
-Glucose
-Trisomy 13.18.21 (PAPPA bHCG)
-Group and save
-Antibody screen
-Syphilis
-Hepatitis B/HIV
What is measured in ultrasound?
“crown-rump-length” (CRL)
“bi-parietal diameter” (BPD)
=Check size of baby
=EDD
