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Obstetrics Junior > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

Definition of Antenatal Care?

A
  • A planned program
  • of observation, education, and medical management of pregnant women
  • directed towards making pregnancy and delivery a safe and satisfactory experience.
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2
Q

Aims of Antenatal Care?

A
  1. Antenatal Education
  2. Common Symptoms in Pregnancy
  3. Screening for Maternal Complications
  4. Screening for Fetal Complications
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3
Q

How antenatal education implemented in ANC?

A
  1. Provision of information (involved in decision making)
  2. Lifestyle concerns (advices)
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4
Q

Common symptoms of pregnancy

A
  1. Extreme tiredness
  2. Nausea & vomiting
  3. Constipation
  4. Heartburn
  5. Backache
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5
Q

At what Hb levels is anemia diagnosed during pregnancy?

A

Hb < 11g/dL up to 12 weeks gestation
or
Hb < 10.5g/dL at 28 weeks.

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6
Q

What risks are associated with a low Hb level of 8.5-9.5g/dL during pregnancy?

A
  1. Preterm labor
  2. Low birth weight baby.
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7
Q

When should routine anemia screening be performed in pregnancy?

A

At the booking visit and at 28 weeks gestation.

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8
Q

What is the most common cause of anemia in pregnancy?

A

Iron deficiency

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9
Q

What test is the best way to assess maternal iron stores?

A

Serum ferritin

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10
Q

Should routine iron supplementation be given to pregnant women with normal Hb?

A

No, it has not been shown to improve maternal or fetal outcomes.

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11
Q

Why is maternal blood grouping important during pregnancy?

A
  1. To identify atypical antibodies
  2. Prevent hemolytic disease (Rh alloimmunization)
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12
Q

When should antibody screening be performed in pregnancy?

A

At the booking visit and again at 28 weeks gestation.

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13
Q

What is the management for RhD-negative pregnant women?

A

Offer anti-D prophylaxis

  1. After potentially sensitizing events (e.g., amniocentesis, APH)
  2. Routinely at either
    a) 28 and 34 weeks
    b) once at 32 weeks.
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14
Q

When should maternal blood be screened for infections during pregnancy?

A

At booking

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15
Q

What infections should maternal blood be screened for during pregnancy?

A

Hepatitis B, HIV, syphilis, and rubella

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16
Q

How is chronic hypertension in pregnancy defined?

A

Hypertension that pre-dates pregnancy or appears in the first 20 weeks.

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17
Q

How is pregnancy-induced hypertension (PIH) defined?

A

Hypertension that develops during pregnancy, resolves after delivery, and is not associated with proteinuria.

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18
Q

What is the definition of pre-eclampsia?

A
  1. Hypertension of at least 140/90 mmHg
    - recorded on at least two separate occasions
    - and at least 4 hours apart
  2. In the presence of at least 300 mg protein
    - in a 24-hour collection of urine
  3. arising de novo after the 20th week of pregnancy
    - in a previously normotensive woman
    - and resolving completely by the sixth postpartum week.
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19
Q

Risk factors for pre-eclampsia.

A
  1. Nulliparity
  2. Advanced maternal age (>40 years)
  3. Family history of pre-eclampsia
  4. History of pre-eclampsia in previous pregnancy
  5. BMI >35
  6. Multiple gestation
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20
Q

What routine checks should be performed to monitor for pre-eclampsia in low-risk pregnancies?

A

Blood pressure measurement and urine analysis for protein at each antenatal visit.

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21
Q

What symptoms should mothers be warned about as signs of advanced pre-eclampsia?

A
  1. Frontal headache
  2. Epigastric pain
  3. Vomiting
  4. Visual disturbances
22
Q

Risk factors of GDM?

A
  1. Previous pregnancy with GDM
  2. Family history of diabetes mellitus
  3. Advanced maternal age (>35 years)
  4. Maternal obesity
  5. Previous macrosomic baby
23
Q

What test is used to diagnose gestational diabetes?

A

Oral glucose tolerance test (OGTT)
- 2 hours
- 75g

24
Q

When should the OGTT be performed for women at risk of gestational diabetes?

A

At 16 weeks of gestation and repeated at 28 weeks.

25
Q

What is placenta praevia, and how is it detected?

A

Placenta praevia occurs when the placenta covers the internal cervical os, detected via ultrasound in the second trimester (13w - 27w)

26
Q

What should be done if placenta praevia is detected in the second trimester?

A

Offer a follow-up scan, preferably transvaginal, at 32 weeks to check the placental site.

27
Q

When should women be screened for significant psychiatric illness during pregnancy

A

At booking

28
Q

What confirms fetal viability in antenatal care?

A
  • Auscultation of the fetal heart
  • can typically be detected from 14 weeks of gestation.
29
Q

What is the significance of measuring symphysis-fundal height (SFH)?

A

SFH measurement in centimeters from the uterine fundus to the symphysis pubis helps detect SGA fetuses.

30
Q

When is a dating scan offered during antenatal care?

A
  • At 10–13 weeks gestation
  • 2 weeks after booking
  • to determine gestational age using crown-rump length.
31
Q

What is used for dating scans if the fetus is presented after 14 weeks?

A

Biparietal diameter (BPD) or head circumference (HC) is used for dating scans if presented after 14 weeks.

32
Q

When is screening for Down’s syndrome typically performed?

A

Screening is usually done between 11–14 weeks of gestation.

33
Q

What are the risk factors for Down’s syndrome?

A
  1. Advanced maternal age (above 35 years).
  2. Previous baby with Down’s syndrome.
34
Q

Why is screening for fetal structural abnormalities important?

A
  1. In-utero therapy for certain conditions.
  2. Planning for delivery, especially in cases like major congenital heart disease.
  3. Parental preparation.
  4. The option of termination if a severe problem is diagnosed.
35
Q

Who traditionally provides antenatal care?

A
  1. General practitioners.
  2. Community midwives.
  3. Hospital midwives and obstetricians.
36
Q

When should the first antenatal visit occur?

A

The first antenatal visit should be early in pregnancy, preferably before 12 weeks.

37
Q

What is the aim of the early antenatal visit?

A
  1. Provide general information about pregnancy.
  2. Identify high risk pregnancy women.
  3. Arrange UFEME and a dating scan.
  4. Perform screening blood tests.
  5. Discuss Down’s syndrome screening with written information and plan follow-up appointments.
38
Q

What general information is provided during the first antenatal visit?

A
  1. Diet.
  2. Smoking cessation.
  3. Alcohol avoidance.
  4. Folic acid supplementation.
39
Q

What screening blood tests are included in the first antenatal visit?

A
  1. Blood grouping.
  2. Red-cell antibodies.
  3. Anemia screening.
  4. Syphilis, HIV, and hepatitis B screening.
40
Q

When should the next appointment after the first visit be scheduled?

A

At 16 weeks gestation

41
Q

When should the next appointment after the first visit be scheduled?

A

At 16 weeks gestation

42
Q

Purpose of the next appointment after the first visit.

A
  1. Discuss screening test results.
  2. Provide information about antenatal classes.
  3. Plan future antenatal visits, including timing and care providers.
43
Q

What checks should be done at every antenatal visit?

A
  1. Blood pressure measurement.
  2. Urine testing for proteins and sugar.
  3. Plotting the symphysis-fundal height.
44
Q

What should be discussed and arranged at 20 weeks gestation?

A

The anomaly scan should be discussed and arranged if indicated.

45
Q

What tests are performed at 28 weeks gestation?

A
  1. Blood tests for hemoglobin estimation and atypical red-cell antibodies.
  2. Anti-D prophylaxis offered to rhesus-negative women.
46
Q

What happens at the 34-week appointment?

A
  1. Discuss the results of blood tests.
  2. Offer a second dose of Anti-D to Rh-D negative women.
47
Q

What is assessed at 36 weeks gestation?

A
  1. Assess fetal lie.
  2. If uncertainty, arrange an ultrasound to exclude breech presentation.
  3. Counsel about external cephalic version (ECV) if breech is confirmed.
48
Q

What is discussed for women who have not delivered by 41 weeks?

A
  1. Membrane sweep.
  2. Induction of labour.
49
Q

What additional appointments are proposed for nulliparous women?

A

At 25, 31, and 40 weeks gestation.

50
Q

How many antenatal appointments are recommended for nulliparous and multiparous women?

A

Nulliparous women: 10 appointments.

Multiparous women: 7 appointments (assuming uncomplicated pregnancies)

Obstetrics Junior (7 decks)

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