Antenatal Care

Question 1

Preconceptual care

Answer 1

• Rubella status
• Cervical smear
• Strict glucose control in diabetes
• Optimising medication (eg epilepsy drugs)
• 0.4mg/day folic acid
• Smoking, alcohol and diet
• Drugs: cocaine, ecstasy and benzos cause defects; opiates associated with preterm delivery, IUGR, stillbirth, developmental delay and SIDS; cannabis may cause IUGR and affect later childhood development.

Question 2

Routine US scans

Answer 2

12 week ‘dating scan’ +/- Down’s screen

20 week ‘anomaly scan’

Question 3

Booking visit

Answer 3

• Before 12 weeks
• Give info on antenatal care
• Genetic disorders
• Preexisting conditions
• LMP
• Social situation incl domestic violence
• Smoking cessation
• Past obstetric hx
• Past gynae hx/past medical hx
• BMI
• Blood pressure
• VTE risk
• Bloods (see other card)
• STI and other infections check
• Urinalysis and urine microscopy and culture

Question 4

Bloods at booking visit

Answer 4

• FBC - underlying anaemia
• Serum antibodies
• Glucose
• Syphilis
• Rubella immunity
• HIV
• HBV
• Haemoglobin electrophoresis

Question 5

Spina bifida screening

Answer 5

• The 18-20-week fetal anomaly screening ultrasound scan allows detection and diagnosis of neural tube defects
• When amniocentesis is done, amniotic fluid AFP and acetylcholinesterase concentrations can be used to differentiate between open ventral wall defects (gastroschisis and omphalocele) and open neural tube defects.
• Raised levels of maternal serum alpha fetoprotein (AFP) at 16-18 weeks of gestation are found in neural tube defects.

Question 6

Down’s syndrome screening

Answer 6

SERUM betaHCG and and pregnancy-associated plasma protein A (PAPP-A)at 10-14 weeks
USS nuchal fold thickness at 11-14 weeks
Maternal factors (age, weight, ethnicity)
>1/150 = +ve, offered diagnostic testing with CVS/amniocentesis

Question 7

Who should take Vit D? And how much?

Answer 7

10 micrograms of vitamin D per day should be taken by women at risk. These include:
• Women of South Asian, African, Caribbean or Middle Eastern family origin.
• Women who have limited exposure to sunlight, such as women who are predominantly housebound, or who usually remain covered when outdoors.
• Women who eat a diet particularly low in vitamin D, such as women who consume no oily fish, eggs, meat, vitamin D-fortified margarine or breakfast cereal.
• Women with a pre-pregnancy body mass index (BMI) above 30 kg/m2

Question 8

Which vitamin can be teratogenic

Answer 8

Vit A