Antenatal Care Flashcards
Definition of Antenatal Care?
- A planned program
- of observation, education, and medical management of pregnant women
- directed towards making pregnancy and delivery a safe and satisfactory experience.
Aims of Antenatal Care?
- Antenatal Education
- Common Symptoms in Pregnancy
- Screening for Maternal Complications
- Screening for Fetal Complications
How antenatal education implemented in ANC?
- Provision of information (involved in decision making)
- Lifestyle concerns (advices)
Common symptoms of pregnancy
- Extreme tiredness
- Nausea & vomiting
- Constipation
- Heartburn
- Backache
At what Hb levels is anemia diagnosed during pregnancy?
Hb < 11g/dL up to 12 weeks gestation
or
Hb < 10.5g/dL at 28 weeks.
What risks are associated with a low Hb level of 8.5-9.5g/dL during pregnancy?
- Preterm labor
- Low birth weight baby.
When should routine anemia screening be performed in pregnancy?
At the booking visit and at 28 weeks gestation.
What is the most common cause of anemia in pregnancy?
Iron deficiency
What test is the best way to assess maternal iron stores?
Serum ferritin
Should routine iron supplementation be given to pregnant women with normal Hb?
No, it has not been shown to improve maternal or fetal outcomes.
Why is maternal blood grouping important during pregnancy?
- To identify atypical antibodies
- Prevent hemolytic disease (Rh alloimmunization)
When should antibody screening be performed in pregnancy?
At the booking visit and again at 28 weeks gestation.
What is the management for RhD-negative pregnant women?
Offer anti-D prophylaxis
- After potentially sensitizing events (e.g., amniocentesis, APH)
- Routinely at either
a) 28 and 34 weeks
b) once at 32 weeks.
When should maternal blood be screened for infections during pregnancy?
At booking
What infections should maternal blood be screened for during pregnancy?
Hepatitis B, HIV, syphilis, and rubella
How is chronic hypertension in pregnancy defined?
Hypertension that pre-dates pregnancy or appears in the first 20 weeks.
How is pregnancy-induced hypertension (PIH) defined?
Hypertension that develops during pregnancy, resolves after delivery, and is not associated with proteinuria.
What is the definition of pre-eclampsia?
- Hypertension of at least 140/90 mmHg
- recorded on at least two separate occasions
- and at least 4 hours apart - In the presence of at least 300 mg protein
- in a 24-hour collection of urine - arising de novo after the 20th week of pregnancy
- in a previously normotensive woman
- and resolving completely by the sixth postpartum week.
Risk factors for pre-eclampsia.
- Nulliparity
- Advanced maternal age (>40 years)
- Family history of pre-eclampsia
- History of pre-eclampsia in previous pregnancy
- BMI >35
- Multiple gestation
What routine checks should be performed to monitor for pre-eclampsia in low-risk pregnancies?
Blood pressure measurement and urine analysis for protein at each antenatal visit.
What symptoms should mothers be warned about as signs of advanced pre-eclampsia?
- Frontal headache
- Epigastric pain
- Vomiting
- Visual disturbances
Risk factors of GDM?
- Previous pregnancy with GDM
- Family history of diabetes mellitus
- Advanced maternal age (>35 years)
- Maternal obesity
- Previous macrosomic baby
What test is used to diagnose gestational diabetes?
Oral glucose tolerance test (OGTT)
- 2 hours
- 75g
When should the OGTT be performed for women at risk of gestational diabetes?
At 16 weeks of gestation and repeated at 28 weeks.
What is placenta praevia, and how is it detected?
Placenta praevia occurs when the placenta covers the internal cervical os, detected via ultrasound in the second trimester (13w - 27w)
What should be done if placenta praevia is detected in the second trimester?
Offer a follow-up scan, preferably transvaginal, at 32 weeks to check the placental site.
When should women be screened for significant psychiatric illness during pregnancy
At booking
What confirms fetal viability in antenatal care?
- Auscultation of the fetal heart
- can typically be detected from 14 weeks of gestation.
What is the significance of measuring symphysis-fundal height (SFH)?
SFH measurement in centimeters from the uterine fundus to the symphysis pubis helps detect SGA fetuses.
When is a dating scan offered during antenatal care?
- At 10–13 weeks gestation
- 2 weeks after booking
- to determine gestational age using crown-rump length.
What is used for dating scans if the fetus is presented after 14 weeks?
Biparietal diameter (BPD) or head circumference (HC) is used for dating scans if presented after 14 weeks.
When is screening for Down’s syndrome typically performed?
Screening is usually done between 11–14 weeks of gestation.
What are the risk factors for Down’s syndrome?
- Advanced maternal age (above 35 years).
- Previous baby with Down’s syndrome.
Why is screening for fetal structural abnormalities important?
- In-utero therapy for certain conditions.
- Planning for delivery, especially in cases like major congenital heart disease.
- Parental preparation.
- The option of termination if a severe problem is diagnosed.
Who traditionally provides antenatal care?
- General practitioners.
- Community midwives.
- Hospital midwives and obstetricians.
When should the first antenatal visit occur?
The first antenatal visit should be early in pregnancy, preferably before 12 weeks.
What is the aim of the early antenatal visit?
- Provide general information about pregnancy.
- Identify high risk pregnancy women.
- Arrange UFEME and a dating scan.
- Perform screening blood tests.
- Discuss Down’s syndrome screening with written information and plan follow-up appointments.
What general information is provided during the first antenatal visit?
- Diet.
- Smoking cessation.
- Alcohol avoidance.
- Folic acid supplementation.
What screening blood tests are included in the first antenatal visit?
- Blood grouping.
- Red-cell antibodies.
- Anemia screening.
- Syphilis, HIV, and hepatitis B screening.
When should the next appointment after the first visit be scheduled?
At 16 weeks gestation
When should the next appointment after the first visit be scheduled?
At 16 weeks gestation
Purpose of the next appointment after the first visit.
- Discuss screening test results.
- Provide information about antenatal classes.
- Plan future antenatal visits, including timing and care providers.
What checks should be done at every antenatal visit?
- Blood pressure measurement.
- Urine testing for proteins and sugar.
- Plotting the symphysis-fundal height.
What should be discussed and arranged at 20 weeks gestation?
The anomaly scan should be discussed and arranged if indicated.
What tests are performed at 28 weeks gestation?
- Blood tests for hemoglobin estimation and atypical red-cell antibodies.
- Anti-D prophylaxis offered to rhesus-negative women.
What happens at the 34-week appointment?
- Discuss the results of blood tests.
- Offer a second dose of Anti-D to Rh-D negative women.
What is assessed at 36 weeks gestation?
- Assess fetal lie.
- If uncertainty, arrange an ultrasound to exclude breech presentation.
- Counsel about external cephalic version (ECV) if breech is confirmed.
What is discussed for women who have not delivered by 41 weeks?
- Membrane sweep.
- Induction of labour.
What additional appointments are proposed for nulliparous women?
At 25, 31, and 40 weeks gestation.
How many antenatal appointments are recommended for nulliparous and multiparous women?
Nulliparous women: 10 appointments.
Multiparous women: 7 appointments (assuming uncomplicated pregnancies)
