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Obstetrics & Gynaecology > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

Options of care for a pregnant lady

A

Low risk: midwifes, shared or complete GP care, private obstetrician
High risk: hospital clinic, obstetrician

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2
Q

Typical clinic visits in first pregnancy

A

Booking visit, 19-20, 24, 28, 32, 36, 38, 40, 41

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3
Q

Typical number of antenatal visits

A

Approx 8 in first pregnancy

Fewer in subsequent pregnancies if healthy (e.g. 5-8)

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4
Q

Booking visit timing

A

10 weeks GA

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5
Q

Booking visit things to complete (10)

A
  • 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
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6
Q

Booking bloods (5)

A 
CBE
Blood group and antibody screen
TORCH viruses
Syphilis screen
Hepatitis B screen
Hepatitis C screen
HIV test
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7
Q

Perinatal anxiety and depression screening tools

A

Edinburgh Postnatal Depression Scale (EPDS)

Antenatal risk questionnaire (ANRQ)

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8
Q

Timing of first trimester screening

A

11+0 - 13+6

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9
Q

Optional screening tests to offer high risk women at early pregnancy (6)

A 
Haemoglobinopathies
Chlamydia
Bacterial vaginosis
Ferritin
Vitamin D
Mantoux skin test
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10
Q

Pregnant women recommended to screen for chlamydia

A

All women under 25y and those from areas with high STI prevalence

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11
Q

Pregnant women who should be screened for bacterial vaginosis

A

Those with previous preterm birth (treatment before 20 weeks may be beneficial)

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12
Q

Pregnant women who should be screened for vitamin D deficiency

A

Dark skinned or veiled women

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13
Q

Components of physical examination in booking visit for pregnancy (5)

A 
Booking BP (right arm, seated)
Weight and height
Cervical smear if overdue
Heart and lungs assessment
Breast awareness
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14
Q

Components of subsequent antenatal visits

A 
SFH in cm
Weight
BP (right arm, seated)
Presentation and station (after 30 weeks)
Foetal heart rate
Foetal movements
Lab test results
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15
Q

After what gestational age should presentation and station be determined at antenatal visits

A

30 weeks

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16
Q

Special components of antenatal visit at 19-20 weeks

A

Morphology ultrasound

Calculate final EDD

17
Q

What is to be completed at 28 weeks antenatally

A 
CBE
OGTT
Antibodies
Prophylactic anti D to Rh-ve woman
Discussion/education re breastfeeding
18
Q

What is to be completed at 34 weeks antenatally

A

2nd dose of prophylactic anti D

Repeat CBE if at risk of anaemia

19
Q

What occurs at 41 weeks antenatal check (in addition to standard)

A

Discuss induction of labour

20
Q

Folic acid supplementation in pregnancy (all women and increased risk)

A

All women 500mcg daily for 1 month pre-conception to 12w

Increased risk of folate def or NTD: 5mg daily throughout pregnancy

21
Q

Associations with folic acid deficiency in pregnancy

A

Neural tube defects (+ other birth defects)

Megaloblastic anaemia

22
Q

Indications for measurement of folic acid in pregnancy

A

Raised MCV
Poor diet
Prolonged hyperemesis/poor oral intake
GIT pathology (Crohn’s, celiac, bypass)

23
Q

Highest risk women for folate deficiency or NTD in pregnancy

A

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

24
Q

Vitamin B12 supplementation in pregnancy

A

Consider for women who are vegetarian or vegan (causes irreversible neurological damage to breastfed infant)

25
Q

Indications for measurement of vitamin B12 in pregnancy

A 
Raised MCV
long-term vegan/vegetarian diet
GIT pathology
Family history of B12 def or pernicious anaemia
Falling PLT count less than 100
26
Q

General vitamin B12 supplementation for pregnant vegans (not severe symptomatic deficiency)

A

250-500mcg/day oral

OR 3 monthly IM 1000mcg injections

27
Q

Vitamin D supplementation for at risk women in pregnancy

A

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

28
Q

Indications for vitamin K administration during pregnancy

A

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

29
Q

Iron supplementation in pregnancy

A 
Not routinely recommended
Should be started in women at particular risk e.g.
- vegetarians
- multiple pregnancy
- GIT pathology
30
Q

Calcium supplementation in pregnancy

A

Unlikely to be required in absence of vitamin D deficiency

1200mg/day

31
Q

Iodine supplementation in pregnancy

A

Recommended for all pregnant or breastfeeding women

150mcg/day (can be taken in form of multivitamin containing RDI of iodine)

32
Q

Dating a pregnancy

A

Naegele’s Rule

Ultrasound: crown-rump length

33
Q

Naegele’s rule

A

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

34
Q

What to do if discrepancy between dates according to LMP and USS

A

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

35
Q

Sensitivity of USS in dating pregnancy

A

Most sensitive in first trimester

CRL at 12w GA will be within 4 days of date in 90%

Obstetrics & Gynaecology (22 decks)

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