Antenatal Care 2 Flashcards
How many conceptions are there in the UK each year?
900,000
Increasing in women >25
How many of these conceptions are to under 18s?
22,700 to under 18s
What is the purpose of the booking visit?
First appointment should be before 10 weeks’ gestation
Purpose – screen for possible complications
Decisions about type + frequency of antenatal care + delivery
Gestation of pregnancy checked
Appropriate prenatal screening discussed
General health check
Health advice
Assess risk using history/examination
What history should be taken at the booking visit?
Age <17 and >35
History of present pregnancy: LMP
Past obs history: inc preterm labour, small-for- dates + IUGR, stillbirth, haemorrhages, congenital anomlaies, rhesus disease, pre-eclampsia + diabetes
Past gynae history: inc history of subfertility, fertility drugs or assisted conception,
cervical smear
PMH: hypertension, diabetes, autoimmune disease, haemoglobinopathy,
thromboembolic disease, cardiac or renal disease or other serious illnesses
DH: change drugs contraindicated in pregnancy to those considered safe
FH: diabetes, hypertension, thromboembolic, autoimmune + pre-eclampsia
Immigration + language issues
SH: smoking, alcohol + drug, domestic violence
What examination should be done at the booking visit?
BMI
Baseline BP
No need for abdo palpation/vaginal examination/clinical assessment of pelvic cavity
What are the routine investigations needed in the booking visit?
US – between 11 and 13+6, date using crown-rump length <14 weeks, detect
multiple pregnancy and chromosomal abnormalities with nuchal translucency/blood
levels of beta hCG/PAPPA
Bloods – FBC (anaemia), anti-D, GTT (planned for 28 weeks), syphilis, HIV, hep B,
haemoglobin electrophoresis, sickle-cell anaemia
Screening for infections – chlamydia, BV
Urine microscopy + culture – asymptomatic bacteruria can lead to pyelonephritis
Urinalysis for glucose (diabetes) protein (renal disease) nitrites (infection)
What are the normal weight changes in pregnancy?
10-15kg increase
What are the blood volume changes in pregnancy?
50% increase
What happens to red cell mass during pregnancy?
increases
What happens to haemoglobin in pregnancy?
haemoglobin decrease
What happens to WBC in pregnancy?
increases
What happens to cardiac output in pregnancy?
40% increase
What happens to peripheral resistance in pregnancy?
50% decrease
What happens to BP in pregnancy?
small mid pregnancy fall
What happens to tidal volume in pregnancy?
40% increase
How is the gastro system affected during pregnancy?
delayed gastric emptying
constipation
What happens to they thyroid during pregnancy?
enlarges
How is pregnancy dated?
Use due date which is originally calculated from the first day of last period
Ultrasound used to confirm gestation based on crown-rump length at dating scan (8-14
weeks) or head circumference used between 14-20 weeks if no earlier scan and LMP not
known
How is estimated delivery date worked out?
subtract 3 months from date of LMP, add 7 days and 1 year (or use wheel)
What maternal blood tests can be used to assess for fetal abnormalities?
alpha fetoprotein - raised in NTD or gastrochisis
beta-HCG, PAPPA, AFP, oestriol and inhibin A - trisomy’s 21 (downs), 18 and 13
How is USS used to assess for fetal abnormalities?
Confirm dates, pregnancy site + multiple pregnancy
Nuchal translucency at 11-14 weeks – larger the nuchal translucency, higher risk of
trisomy + other abnormalities
What is the combined test for Downs?
Screening test for trisomies inc Down’s syndrome
Sensitivity 75%
Risk from maternal age, with PAPP-A and beta-hCG blood tests + nuchal translucency
measurement by US (11 weeks – 13+6)
What are the legal rights of a pregnant employee?
Paid time off for antenatal care (inc classes if necessary)
Maternity leave
Maternity pay or maternity allowance
Protection against unfair treatment, discrimination or dismissal
What are the health and safety risks at work?
Heavy lifting or carrying
Standing or sitting for long periods without adequate breaks
Exposure to toxic substances
Long working hours
How is US used to diagnose fetal abnormalities?
anomaly scan at 18-21 weeks
detect congenital malformations of all organs and systems
repeat US is increased liquor volume and polyhydramnios
How is fetal MRI used to diagnose fetal abnormalities?
diagnosis of intracranial lesions
How is amniocentesis used in diagnosing fetal anomalies?
Removal of amniotic fluid using fine-gauge needle under US guidance
Safest from 15 weeks’ gestation
Diagnosis of chromosomal abnormalities, CMV, toxoplasmosis, sickle-cell,
thalassaemia, CF
How is CVS used to diagnose fetal anomalies?
Biopsy of the trophoblast by passing fine-gauge needle through abdo wall/cervix into placenta
After 11 weeks
Diagnosis of chromosomal problems and autosomal dominant and recessive conditions
When is there genetic diagnosis preimplantation?
in IVF
Ethical dilemmas
Diagnosis of sex linked disorders, trisomies and dominant and recessive conditions
