Antenatal care

Question 1

How many appointments should there be in an uncomplicated:

1) nullip pregnancy?
2) multip pregnancy?

Answer 1

1 - 10

2 - 7

Question 2

Preconception advice

Answer 2

Folic acid and vit D supplements
Nutrition, diet and food hygiene
Lifestyle factors
antenatal screening

Question 3

When should booking appointment occur?

Answer 3

8-12 weeks

ideally less than 10

Question 4

What non-invasive tests take place at booking?

Answer 4

Blood pressure, BMI, check for risk factors eg GDM, pre-eclampsia, psych hx, FGM, DV,

Urine checked for proteinuria and asympomatic bacteriuria

Question 5

What are included in booking bloods?

Answer 5

ABO typing, RhD status, red cell alloantibodies FBC (anaemia), haeboglobin electrophoresis (haemoglobinopathies)
HepB, HIV, syphillis, rubella

Question 6

When should dating scan take place? What is checked?

Answer 6

10-14 weeks
Measure CRL, Check intrauterine, check fetal poles, singleton/twins, Check NT and may/may not take bloods for combined test

Question 7

1 When is combined test done?
2 What is included?
3 What is the cut-off for risk?

Answer 7

11-13+6/40
NT, PAPP-A, bHCG
1 in 150

Question 8

What happens at 16wk appointment?

Answer 8

Discuss results of tests,
Measure BP and check for proteinuria
offer iron if anaemic
OGTT if previous GDM

Question 9

When is anomaly scan and what does it look for?

Answer 9

Occurs at 18-20 weeks. Screening for structural anomalies eg cardiac defects, diaphragmatic hernia, check uterine artery flow etc

Question 10

When is SFH measured?

Answer 10

every appointment after 24 weeks

Question 11

When are the additional appointments nullips have and what takes place?

Answer 11

Occur at 25, 31 and 40 weeks
Standard BP, SFH and proteinuria check.
Discuss management of prolonged pregnancy and consider stretch and sweep at 40/40

Question 12

After anomaly scan, when are the routine appointments?

Answer 12

28, 34, 36 and 38 weeks

Question 13

What happens at 28 week appointment?

Answer 13

Discuss anomaly scan results,
Second screening for anaemia and red cell alloantibodies
OGTT if risk factors and no previous history of GDM
Anti-D to Rh neg mothers
Women should be offered acellular Pertussis vaccine between 28-38 weeks
BP, SFH and proteinuria check

Question 14

What happens at 34 week appointment?

Answer 14

Second dose of Anti-D if indicated
Review results of 28-week bloods
BP, SFH and proteinuria check
Info on preparing for labour, discuss pain management etc

Question 15

What happens at 36 week appointment?

Answer 15

Assess fetal presentation. Confirm malpresentation by USS
BP, SFH and proteinuria check
Offer uncomplicated breech singletons ECV
Counsel on breastfeeding, care of newborn, Vit K prophylaxis, newborn screening and postnatal self-care inc baby blues awareness

Question 16

What happens at 38 weeks?

Answer 16

Assess foetal presentation,
BP, SFH and proteinuria check
Planning delivery, discuss options for prolonged pregnancy

Question 17

What happens at 41 week appointment?

Answer 17

If havent given birth:
BP, SFH and proteinuria check
Offer membrane sweep or induction of labour

Question 18

What if woman declines induction past 42 weeks?

Answer 18

Offer increased monitoring - twice weekly CTG and US of amniotic pool depth

Question 19

What antivirals should be given to a woman with HIV?

Answer 19

BIHA says zidovudine and lamivudine
if 3rd agent needed, give nevirapine or efavirenz
IV zidovudine infusion during labour and delivery if presented late