Antenatal care

Question 1

What must you cover for pre-pregnancy care?

Answer 1

• Pap up to date?
• Medical conditions controlled? – eg HTN/DM/Epilepsy
• Smoking/alcohol/drugs?
• Rubella immunity?
• Varicella immunity?
• Advise folate and iodine supplement
• Weight check & advise to normalise

Question 2

Which routine antenatal tests do you order on the first visit (with consent and counselling)?

Answer 2

• Blood group & antibody screen
• FBC – Hb, platelets and MCV
• Syphilis serology
• Rubella Ig
• Hep B sAg
• Hep C Ab
• HIV Ab
• Chlamydia <30
• MSU C&S- check for asymptomatic bacteriuria (increases pyelonephritis and premature labour)
• USS dating scan

Question 3

When can you give a pregnant woman the rubella vaccination and why?

Answer 3

After the birth of the baby

It’s a live vaccination & has theoretical risks of causing the disease in her or the baby if used whilst pregnant.

Question 4

What are the three major aneuploides tested for with the combined first trimester screen (CFTS)?

Answer 4

Down’s syndrome (21)

Edward’s syndrome (18)

Patau’s syndrome (13)

Question 5

When and how do you screen for Down syndrome?

Answer 5

Week 9-13+6 for blood test
Week 11 - 13+6 for u/s
PAPP-A + nuchal transparency + Free B-hCG

or

Non-invasive prenatal test (NIPT) to detect fetal genetic material in maternal blood

Question 6

Does a negative screen result indicate a normal baby?

Answer 6

Unfortuantely, no.

Serious congenital abnormalities occur in 2-3% of pregnancies. There is no test that can assure a baby is normal

Screening does not:

• Diagnose or exclude trisomy - amnio or CVS needed
• Diagnose or exclude other congenital abnormalities
• Detect other genetic abnormalities than T21, 18, 13

Question 7

What is elevated MSAFP (maternal serum alpha-fetoprotein) associated with?

Answer 7

• Open neural tube defects (anencephaly, spina bifida)
• Abdominal wall defects (gastroschisis, omphalocele)
• Multiple gestation
• Incorrect gestational dating
• Fetal death
• Placental abnormalities (placental abruption)

Question 8

What are the most common pathogens involved in maternal-fetal infections

Answer 8

• Toxoplasmosis (pregnant woman shouldn’t change cats litterbox or work in the garden)
• Other***
• Rubella
• CMV
• Herpes simplex virus
• HIV
• Syphilis
• *** Parvovirus, Varicella, Listeria, TB, Malaria, Fungi.

Question 9

When should pregnant women be offered a GTT screen for gestation diabetes?

Answer 9

26-28 weeks gestation

Plus at booking if risk factors for GDM

Question 10

What do you do in a routine antenatal check?

Answer 10

• BP to check for pre-eeclampsia/gestational HTN
• Weight
• Fundal height to assess fetal growth
• After 34 weeks confirm presentation cephalic
• Clinical assessment of liquor
• Fetal HR via doppler - to check baby still alive
• Assess general wellbeing
• Antenatal education
• Review previously ordered tests

Question 11

1. When do you check Rh antibodies?
2. When do you give Rh negative mothers their first dose of anti D?
3. When do you give the second dose?

Answer 11

1. At booking, plus 28/34 weeks if Rh negative
2. 28 weeks
3. 34 weeks

Question 12

How do you calculate EDD via LNMP?

What is the most reliable way to calculate due date?

Answer 12

1) ONLY IF: regular cycles/ 28days/ not IVF baby/ used contraception. Naegele’s rule:

Add one year, subtract 3 months, and add 7 days

Eg: 18th Jan 2008 = 26th Oct 2009

2) Based on first trimester dating scan. If regular cycle and u/s agrees to within 1 week of LMP dating - use LMP. If >1 week difference, use u/s dates.

Question 13

Which blood tests do you do routinely at 34-36 weeks gestation?

Answer 13

FBC

Syphilis screen in areas of high endemic rates (e.g. NQ)

Red cell antibody screen if Rh negative blood group

Question 14

What other screening/recommendations should you give a mother (who is newly pregnant) throughout her pregnancy?

Answer 14

• Tobacco /alcohol/drug cessation screening
• Genetic counselling/testing (as appropriate)
• Model of care confirmed
• Antenatal classes offered
• Breast feeding education
• Positioning and attachment of baby
• Early skin to skin contact
• Physical activity/exercise/rest discussed
• Healthy diet
• Home and safety/hazard identification
• Signs of early labour discussed
• Birth preferences
• Length of hospital stay
• Post natal community supports
• Post natal depression discussed
• Information about neonatal immunisations & vitamin K