Antenatal Care Flashcards
Options of care for a pregnant lady
Low risk: midwifes, shared or complete GP care, private obstetrician
High risk: hospital clinic, obstetrician
Typical clinic visits in first pregnancy
Booking visit, 19-20, 24, 28, 32, 36, 38, 40, 41
Typical number of antenatal visits
Approx 8 in first pregnancy
Fewer in subsequent pregnancies if healthy (e.g. 5-8)
Booking visit timing
10 weeks GA
Booking visit things to complete (10)
- Complete SAPR
- Perinatal anxiety/depression screening
- Smoke-free pregnancy assessment
- Calculate EDD
- Medical examination
- Booking bloods
- MSSU
- Offer FTS
- Morphology scan at 18 weeks
- +/- other targeted investigations
Booking bloods (5)
CBE Blood group and antibody screen TORCH viruses Syphilis screen Hepatitis B screen Hepatitis C screen HIV test
Perinatal anxiety and depression screening tools
Edinburgh Postnatal Depression Scale (EPDS)
Antenatal risk questionnaire (ANRQ)
Timing of first trimester screening
11+0 - 13+6
Optional screening tests to offer high risk women at early pregnancy (6)
Haemoglobinopathies Chlamydia Bacterial vaginosis Ferritin Vitamin D Mantoux skin test
Pregnant women recommended to screen for chlamydia
All women under 25y and those from areas with high STI prevalence
Pregnant women who should be screened for bacterial vaginosis
Those with previous preterm birth (treatment before 20 weeks may be beneficial)
Pregnant women who should be screened for vitamin D deficiency
Dark skinned or veiled women
Components of physical examination in booking visit for pregnancy (5)
Booking BP (right arm, seated) Weight and height Cervical smear if overdue Heart and lungs assessment Breast awareness
Components of subsequent antenatal visits
SFH in cm Weight BP (right arm, seated) Presentation and station (after 30 weeks) Foetal heart rate Foetal movements Lab test results
After what gestational age should presentation and station be determined at antenatal visits
30 weeks
Special components of antenatal visit at 19-20 weeks
Morphology ultrasound
Calculate final EDD
What is to be completed at 28 weeks antenatally
CBE OGTT Antibodies Prophylactic anti D to Rh-ve woman Discussion/education re breastfeeding
What is to be completed at 34 weeks antenatally
2nd dose of prophylactic anti D
Repeat CBE if at risk of anaemia
What occurs at 41 weeks antenatal check (in addition to standard)
Discuss induction of labour
Folic acid supplementation in pregnancy (all women and increased risk)
All women 500mcg daily for 1 month pre-conception to 12w
Increased risk of folate def or NTD: 5mg daily throughout pregnancy
Associations with folic acid deficiency in pregnancy
Neural tube defects (+ other birth defects)
Megaloblastic anaemia
Indications for measurement of folic acid in pregnancy
Raised MCV
Poor diet
Prolonged hyperemesis/poor oral intake
GIT pathology (Crohn’s, celiac, bypass)
Highest risk women for folate deficiency or NTD in pregnancy
Women taking liver-inducing anticonvulsatns
Pre-existing DM
Multiple pregnancy
Haemolytic anaemia
BMI higher than 30
Family history of NTD or previous child with NTD
Women with known MTHFR mutation
Vitamin B12 supplementation in pregnancy
Consider for women who are vegetarian or vegan (causes irreversible neurological damage to breastfed infant)
Indications for measurement of vitamin B12 in pregnancy
Raised MCV long-term vegan/vegetarian diet GIT pathology Family history of B12 def or pernicious anaemia Falling PLT count less than 100
General vitamin B12 supplementation for pregnant vegans (not severe symptomatic deficiency)
250-500mcg/day oral
OR 3 monthly IM 1000mcg injections
Vitamin D supplementation for at risk women in pregnancy
ALL high risk women - test at booking visit and begin on 1000 units (25mcg of something) cholecalciferol
IF higher than 60 at booking, discontinue supplement at next visit, otherwise TEST AGAIN
IF still less than 60, increase to 2000 units/day, stay at 1000 units if higher than 60
Indications for vitamin K administration during pregnancy
Women on enzyme-inducing anticonvulsants - to be given at 36 weeks
May be administered to women with proven cholestasis due to reduced vitamin K absorption
Iron supplementation in pregnancy
Not routinely recommended Should be started in women at particular risk e.g. - vegetarians - multiple pregnancy - GIT pathology
Calcium supplementation in pregnancy
Unlikely to be required in absence of vitamin D deficiency
1200mg/day
Iodine supplementation in pregnancy
Recommended for all pregnant or breastfeeding women
150mcg/day (can be taken in form of multivitamin containing RDI of iodine)
Dating a pregnancy
Naegele’s Rule
Ultrasound: crown-rump length
Naegele’s rule
Calculate from FIRST day of LMP
+ 7 days + 9 months (or -3 months + 1 year)
If longer/shorter than 28 day cycle +/- added or lost days
What to do if discrepancy between dates according to LMP and USS
IF menstrual dates are sure and discrepancy in less than 7 days, use dates
PROVIDED: regular, recorded 28 day cycle with no contraception use 3 months before
if over 7 days, use CRL and 8-13 weeks
Nuchal translucency age will go by scanned GA not calculated
Sensitivity of USS in dating pregnancy
Most sensitive in first trimester
CRL at 12w GA will be within 4 days of date in 90%
