Antenatal Care

Question 1

What do you screen for?

Answer 1

Rubella
Varicella
Pap smear

Question 2

How do you manage diabetes in pregnancy?

Answer 2

Switch from oral hygo’s to insulin

Question 3

How do you manage epilepsy in pregnancy?

Answer 3

If well controlled, switch from poly to mono, stop very teratratogenic like valproate

Question 4

What do you do in the first visit?

Answer 4

Confirm pregnancy
Gestational age
Screening for problems
Mx of any problems
General advice
Booking: planning a model of care

Question 5

How do you confirm pregnancy?

Answer 5

Hx - missed period, urinary frequency, nausea, breast tenderness

Ex - uterine enlargement

Ix - serum bHCG - very reliable
- urine bHCG - high false positives and false negatives

Question 6

How do you determine gestational age??

Answer 6

Ultrasound
- most accurate 6-12 weeks - crown rump length-
- 12-20 weeks - biparietal diameter
Menstrual dates

Question 7

What is the Naegele’s rule?

Answer 7

Determining the due date:

9 months + 1 week from the first day last normal menstrual period, adjust up/down if cycle longer/shourter than 28 days

Question 8

How do you screen for problems on hx?

Answer 8

Hx:
Age
PMH, PSH
POH, PGH
Medications and allergies
FH & social Hx - inc alcohol/smoking/illicit, marital, occupation

Question 9

How do you screen for problems on exam?

Answer 9

General appearance
ht, weight
Upper limb, H&N, chest, abdomen, lower limb
Neurology
Gynaecological - external, speculum, bimanual

Question 10

How do you screen for problems on Ix?

Answer 10

Haematology - Hb, platelets, mcv
Blood bank - blood gp, antibody screen
Microbiology - rubella ab, varicella ab, syphilis ab, hepB and C, HIV, MSU mcs
Cytology - pap smear
Biochem - serum screen T21 or NIPT
Imagining - 12 wk nuchal translucency, 19 week morphology

Question 11

Why do you check MCV?

Answer 11

Thalassaemia screen

Haematinics screen

Question 12

What do you do if there is exposure to varicella during preg?

Answer 12

Hyperimmunoglobulin

Question 13

Why do a MSU mcs?

Answer 13

Due to asymptomatic bacteruria

Question 14

What general advice do you give a pregnant woman?

Answer 14

Diet - avoid junk, protein and nutrition, avoid listeria containing foods - poorly cooked chicken, mayonaise, soft serve ice cream

Mineral & vitamin supplementation

• Fe for vegetarians
• Vitamin D supplementation for at risk
• Continue folate during pregnancy - MTHFR mutation is mitigated with folate
• Iodine is needed in melbourne

Exercise
- Strenuous exercise - smaller behaviour

Smoking
- Increases perinatal mortality

Alcohol
- >2 std drinks is teratogenic

Sex
- Okay

Working
- 34 weeks

Medications

• Paracetamol ok
• malaxon ok
• Penicillin ok

Question 15

What are the models of care?

Answer 15

Normal risk - residents and midwives

Question 16

What is preeclampsia?

Answer 16

Hypertension
Proteinuria
Oedema

Question 17

What is placental insufficiency?

Answer 17

Poor foetal movements

Poor growth

Question 18

What do you take on Hx in subsequent antenatal?

Answer 18

Hx

• Oedema
• Movements
• General wellbeing

Question 19

What do you take on Ex?

Answer 19

Weight gain
BP
Fundal height
Lie, presentation, station
Auscultation - baby heart beat - brady and tachy 
Urinalysis - protein

Question 20

Whend oyou do Ix in preg?

Answer 20

28 weeks - FBE, OGTT, +/- Rh ab and anti-D

36 weeks - FBE if low, GBS, +/- anti-D administration

Question 21

What is the timing of birth?

Answer 21

Median onset of spontaneous labour 40 weeks, ~38 weeks’ from fertilisation
But 1/400 will have perinatal death or disability as a consequence of an event after maturity so induction is common

Question 22

Which common drugs must be ceased during pregnancy?

Answer 22

Consider most anti-epileptic - particularly valproate
Methotrexate
Warfarin 
ACE inhibitors
Oral hypos to insulin

Question 23

What do you replace warfarin with?

Answer 23

Low molecular weight heparin

Question 24

What do you replace ACE inhibitors with?

Answer 24

Methyldopa

Labetalol

Question 25

What do you aim for in terms of thyroid function?

Answer 25

TSH less than 2.5