Antenatal care

Question 1

Routine antenatal testing

Answer 1

1. FBE
2. Blood group and antibodies
3. Syphilis, HBV, HCV, HIV serology
4. Rubella immunity
5. Midstream urine culture

Question 2

Routine ultrasound investigations

Answer 2

1. First trimester screening at 12 week’s gestation

2. Fetal morphology and placental ultrasound at 18-20 weeks’ gestation

Question 3

Booking visit (first antenatal consultation) - examination

Answer 3

History is followed by examination

1. BMI, BP
2. CVS ex
3. Thyroid ex
4. Breast ex
5. Abdominal ex, and if possible, auscultation of fetal heart (after first trimester)

Question 4

First trimester (1-12 weeks) (3)

Answer 4

1. Booking visit hx and ex
2. Routine blood and other ix (5 points)
3. First trimester U/S

Question 5

Second trimester (12-28 weeks)

Answer 5

1. Monthly check ups
2. U/S at 18-20 weeks
3. Test urine for proteinuria (screen for infection and preeclampsia)
4. Screen for gestational diabetes with OGTT
5. Check FBE for anaemia, screen for antibodies in Rh-negative women (if no anti-D detected, these women should receive 650IU of anti-D IgG)

Question 6

Third trimester (28 weeks to birth) (3)

Answer 6

1. Fortnightly visits from 28 to 36 weeks, and then weekly to 41 weeks
2. FBE at 28 weeks’ gestation
3. Antibody at 36 weeks if woman Rh-negative

Question 7

Multiple pregnancy - antenatal care

Answer 7

1. Consultation with an obstetrician
2. Book into a hospital with appropriate neonatal care
3. Increased risks = GDM, gestational diabetes, preeclampsia, placenta previa, postpartum haemorrhage

Antenatal U/S surveillance fetal growth.

4. DCDA = 4-weekly U/S
5. Monochorionic = fortnightly U/S

Question 8

Antenatal care - social considerations

Answer 8

1. Seatbelts - wear lap belt low under abdomen (bc if accident, may have trauma to uterus -> abruption, fetal death)
2. Air travel - no reason for restricting air travel (if uncomplicated pregnancy) prior to 32 weeks for international flights and 36 weeks for domestic flights
3. 30 mins moderate exercise/d in the absence of medical/obstetric complications
4. Occupation - avoid exposure to toxic chemicals and radiation
5. Sex - not contraindicated unless APH or PROM

Question 9

Aneuploidy screening (3, 5)

Answer 9

First trimester (combined test at 11-13 weeks):

1. U/S (nuchal translucency)
2. Free beta hCG
3. Pregnancy-associated plasma protein A (PAPP-A)

Second trimester (triple and quadruple tests at 16 weeks):

1. Dating scan (but not nuchal scan)
2. Estriol
3. hCG
4. Alpha fetoprotein (AFP)
5. Inhibin A (not if triple)

Question 10

Aneuploidy dx

Answer 10

Chorionic villus sampling

• 10 to 13 weeks
• 1% miscarriage

Amniocentesis

• 15 to 18 weeks
• 0.5% miscarriage