Antenatal Care Flashcards
Why are rubella, varicella, and pertussis vaccines recommended preconception?
To ensure immunity before pregnancy due to risks to fetus; they are live attenuated vaccines.
After receiving live attenuated vaccines (e.g., rubella), how long should conception be deferred?
At least 28 days with contraception.
What is the recommended folic acid dose for low-risk women preconceptionally?
400 micrograms daily for 1 month before conception and during the first trimester.
Which women need high-dose folic acid (5 mg)?
Obese women, those on antiepileptic drugs, diabetics, or with a history of NTDs (Neglected Tropical Diseases)
What other vitamin is recommended preconceptionally?
Vitamin D.
Why review maternal medications preconceptionally?
To assess impact on pregnancy and consider specialist referral.
What obstetric history should be taken?
Previous pregnancies, gestation duration, complications, mode of delivery, infant condition.
What personal/family history is relevant in antenatal care?
Maternal medical conditions (mental health, FGM), FHx of diabetes, pre-eclampsia, VTE.
Why inquire about smoking and alcohol in history?
To assess teratogenic and pregnancy risks.
When is the booking appointment ideally scheduled?
Around 8 weeks gestation.
What are key screenings in the first trimester?
FBC, blood group, rubella, haemoglobin electrophoresis, Hep B, HIV, syphilis.
What is the role of the 1st trimester scan?
Confirm intrauterine pregnancy, viability, number of fetuses, chorionicity, gestational age.
How is gestational age estimated?
By measuring crown-rump length (CRL).
What is the “lambda sign”?
Indicates dichorionic twins on ultrasound.
What is the “T-sign”?
Indicates monochorionic twins on ultrasound.
What is the cut-off risk for Down syndrome in the combined test?
1:150.
What does the combined test screen for besides T21?
Trisomy 18 and 13 (~90% detection rate).
What is the 2nd trimester screen called and when is it done?
Quadruple test; 14+2 to 20+0 weeks.
What are the components of the quadruple test?
AFP, HCG, Inhibin A, unconjugated oestriol.
Detection rate of quadruple test for Down syndrome?
Around 65%; 5% false-positive.
What does Non-invasive prenatal testing (NIPT) test for?
Trisomy 21, 18, 13 using cell-free fetal DNA in maternal blood.
When is the fetal anomaly scan performed?
Between 18+0 and 20+6 weeks.
What anomalies can be detected in anatomy scan? 6
CNS (85%), cardiac (50%), renal agenesis (84%), cleft lip (75%), abdominal wall defects, skeletal dysplasia.
What maternal assessments are done in second trimester?
BP, urinalysis, assess PV bleeding/pain, vaccinations, fetal movements, plan OGTT if indicated.
Key components of 3rd trimester visits?
Fetal growth, presentation, movements, amniotic fluid, complications (HTN, PET, anemia, GDM), prolonged pregnancy.
How to perform abdominal palpation?
Use two hands to feel from fundus down baby’s back to head.
How is fetal engagement assessed?
Palpate to check if fetal head is free from pelvis.
How is symphysis-fundal height measured?
Patient semi-recumbent with empty bladder.
