Antenatal Care

Question 1

What elements are important in the first antenatal visit?

Answer 1

• Confirm pregnancy
• Confirm gestational age
• Screen for problems
• Manage problems
• General advice
• Booking hospital/shared-care etc.

Question 2

How might you confirm a pregnancy?

Answer 2

• Hx - missed period, urinary frequency, nausea, breast tenderness
• Ex - uterine enlargement only palpable around 12 weeks
• Ix - serum bHCG (more reliable than urine)

Question 3

How can you determine gestational age?

Answer 3

• Ultrasound (most accurate)
  
  • 6-12 weeks by crown-rump length (3 days accuracy)
  • 12-20 weeks by biparietal diameter (1 week accuracy)
• Menstrual dates
  
  • Naegele’s/Parikh’s rule (LNMP + 9 months - 21 days + cycle length)

Question 4

What investigations might be appropriate to order at a first antenatal visit?

Answer 4

• Hb, FBE (anaemia, thalassaemia)
• Blood group and antibodies (alloimmunisation)
• Rubella/VZV/syphilis (need for vaccination)
• HBV/HCV/HIV (treatment)
• MSU + MCS (asymptomatic bacteruria)
• Pap smear (generally after 12 weeks)
• Others based on presentation (TFTs, 28week OGTT)

Question 5

What tests are generally used antenatally in the detection of genetic abnormalities? When?

Answer 5

• T1 antenatal screening (10+3 to 13+6)
  
  • Age, ultrasound (nuchal) and 2 x bloods
• T2 antenatal screening
  
  • Age, 4 x bloods
• CVS (11 weeks), amniocentesis (15 weeks) if high risk
• New tests

Question 6

What general advice might you provide a woman at the first antenatal visit?

Answer 6

• Diet - avoid sprouts, deli meats, raw milk and soft cheese, smoked seafood
• Vitamins - folate and multivitamin, Vit D, Fe if required
• Exercise - moderate okay
• Smoking, EtOH cessation
• Sex - okay
• Working - most until 34 weeks unless high risk
• Medication - penicillin, paracetamol, maxilon okay
• Minor maladies - nausea, stretch marks etc.

Question 7

What are the models of care a pregnant woman may be eligible for?

Answer 7

• Public hospital (residents and midwives) - low risk
• GP obstetrician (shared care)
• Public hospital (obstetrician led) - high risk
• Private obstetrician

Question 8

After the first antenatal visit, how often should a pregnant woman return for check-up?

Answer 8

• < 28 weeks - 4 weekly
• 28-36 weeks - 2 weekly
• > 36 weeks - weekly

Question 9

What should be covered in antenatal visits after the first one?

Answer 9

• Hx - general wellbeing, foetal movements, oedema
• Ex - weight, BP, fundal height, lie, presentation, urinalysis
• Ix - time determined (FBE, antibodies +/- OGTT at 28 weeks, FBE, antibodies + GBS swab at 36 weeks)

Question 10

If a woman is Rhesus negative, when is anti-D globulin administered pre-partum?

Answer 10

28 and 36 weeks

Question 11

If a pregnant woman is GBS positive, how is this aspect of her pregnancy managed peripartum?

Answer 11

• Perilabour IV benzylpenicillin