Antenatal care Flashcards
When does the booking visit typically occur?
Before 12 weeks gestation
What aspects of history should be discussed at the booking visit?
Past medical Obstetric Gynaecological/menstrual Family Social
What aspects of social history/lifestyle should be addressed at the booking visit? (5)
Smoking; alcohol; diet (Vit D, folate) ; exercise; occupation
Which examinations/procedures should be carried out at the booking visit? (5)
BMI Blood pressure Urine dipstick Abdo CVS
Booking bloods (5)
FBC ABO/Rh status Red cell alloantibodies Haemoglobinopathies Serologies
Immunological investigations arranged at booking visit
Syphilis, rubella, HIV, Hep B and C serology
What does the initial ultrasound confirm?
Foetal viability; number of foetuses; gestational age (crown-rump length)
Which routine procedures should be carried out at all subsequent antenatal visits?
Blood pressure proteinuria screen symphysis-fundal height measurement lie and presentation foetal heart auscultation
Four common classes of congenital abnormality
Heart defects; neural tube defects; abdominal wall defects; chromosomal abnormalities
Main risk factors for Downs Syndrome (2)
Maternal age; previous history
How is Downs risk assessed in a) first trimester b) second trimester
a) combined test (nuchal thickness + HCG/PAPP-A)
b) quadruple serum test (HCG, aFP, uE3, inhibin A)
When are further investigations for Downs syndrome warranted?
Likelihood ratio >1:250
What further investigations are carried out for Down syndrome and when?
Chorionic villus sampling (after 12 weeks)
Amnioscentesis (after 15 weeks)
When should the dating scan take place?
10-14 weeks
First-line treatment for nausea and vomiting antenatal
Antihistamines (promethazine)
When should the anomaly scan take place?
18-21 weeks
Nutritional advice in pregnancy:
a) vitamin A
b) vitamin D
c) folic acid
a) avoid excessive intake- teratogenic
b) 10 micrograms/day
c) 400 micrograms/day (5mg in those taking anti-epileptic drugs)
Risks of smoking during pregnancy (3)
Low birth weight
Pre-term birth
Stillbirth
Foods to avoid in pregnancy (three groups)
Soft cheese and pate (listeriosis)
Raw/partially cooked eggs/poultry (salmonella)
Liver (vitamin A)
In low-risk pregnancy, how is surveillance of the fetus achieved? (3)
Maternal vigilance for foetal movements in the latter half of pregnancy
Symphyseal-fundal height charting
Doppler auscultation of the foetal heart
Surveillance of high-risk pregnancies? (4)
Serial measurements of:
Foetal growth (head, abdominal, and estimated foetal weight)
Umbilical artery Doppler
Amniotic fluid volume
Biophysical parameters- HR, movements, tone and breathing
Abnormalities on scan: choroid plexus cysts, clenched hands, rocker bottom feet, small placenta
Edwards syndrome (Trisomy 18)
Trisomy 13
Patau syndrome
Trisomy 21
Downs syndrome
