Antenatal Care

Question 1

Outline structure of a pre-pregnancy counselling structure.

Answer 1

• Routine screening for any problems (Hx, Ex, Ix)
• Mx of any problems (Dx, Rx, Px)
• General advice (Pharmacological, behavioural)

Question 2

Pre-pregnancy counselling routine screening for what?

Answer 2

Rubella ab, Varicella ab, Pap smear

Question 3

Pre-pregnancy counselling mx of problems e.g. DM, epilepsy, anticoag?

Answer 3

DM use insulin, not oral hypoglycemics.
Epilepsy, dial back on the drugs (valproate v. bad)
Anticoag: NO WARFARIN

AND no pregnancy if appalling prognosis (e.g. renal failure creatinine > 0.3 or pulm HT)

Question 4

General advice: Pharmacological and Behavioural

Answer 4

Pharmacological: Foalte 0.5mg, avoid teratogens
Behavour: get pregnant sex frequently before and after ovulation, alcohol, smoking

Question 5

Outline structure of first antenatal visit

Answer 5

• confirm pregnancy
• gestational age
• screening for problems
• mx of any problems
• general advice
• booking

Question 6

First antenatal visit: Confirmation of pregnancy?

Why is urinary Bhcg less reliable compared to serum?

Answer 6

Hx: missed period, nausea, breast tender, urinary f
Ex: uterine enlargement abdo 12wks/vaginal 8wks
Ix: serum B hCG v. reliable, urinary CG not as good as reacts with LH.

Question 7

First antenatal visit: Determination of gestational age by?

Answer 7

Ultrasound scan most accurate (6-12wks CRL)
12-20wks BPD

Menstrual Dates: Naegele’s Rule is LNMP-3months+1yr 1 wk + (cycle days - 28)

Question 8

First antenatal visit: Screening for potential problems

Answer 8

Hx: age POH, PGH etc.
Ex: gen appearance, gynae (speculum, bimanual)
Ix: haematology (Hb, Platelets, MCV; anaemia thalassaemia), blood bank (Gp, Ab; red cell iso immunisation), microbiology (Rubella, Varicella, Syphyllis, HepB, HepC, HIV, MSU), cytology (Pap Smear), biochem (serum screen T21), imaging (12wk nuchal translucency, 19sk morphology).

Question 9

First antenatal visit: General advice

Answer 9

• diet (nutrition, Listeria)
• Mineral & vitamin supplements (iron,Ca,VitD,folate,iodine,multivitamin)
• exercise (moderate)
• alcohol and smoking (teratogenic, IUGR)
• sex (ok)
• working (usual up to 34 wks)
• medication (paracetamol ok, maxalon nausea, penicillin/amoxy ok)

Question 10

First antenatal visit: Booking

Answer 10

Models of care: public for normal risk = residents midwives, GP shared care, public hospital high risk (specialist obstetrician/registrar). Or private obstetrician.

Question 11

Subsequent antenatal visits - purpose?

Answer 11

Early diagnosis and treatment (preeclampsia, placental insufficiency wk 19)

Question 12

Subsequent antenatal visits - frequency?

Answer 12

36wks (wkly);

Question 13

Subsequent antenatal visits - outline.

Answer 13

hx (gen well being, fetal movements, oedema)

ex (weight gain, BP, fundal height, lie px auscultation, urinalysis)

ix (28wks FBE, OGTT, Rh ab & anti-D administration if Rh -ve) (36wks FBE, GBS swab, antiD administration if Rh-ve)

Question 14

Timing of birth

Answer 14

• spontaneous labour ~40wks
• 1/400 perinatal death or disability as consequence of event after maturity (38wks), no. higher if complications - preeclampsia, placental insufficiency, twins etc.

Question 15

Mode of birth

Answer 15

ideally vaginal