Antenatal Care

Question 1

describe the key components & rationale for pre-pregnancy counselling

Answer 1

1. SCREENING - hx, exam, ix; rubella, varicella & pap smear
2. MX - optimise pre-existing issues (epilepsy, HTN (ACE-i), clotting dx (Warfarin –> LMWH), DM)
   - if PulmHT or Renal failure (Cr >0.3) then advise surrogacy
3. GENERAL ADVICE - diet (iodine, Fe), supplements (folate - start 3 months prior conception, Fe, vitD), exercise, alcohol/smoking, conception/sex, BMI, vaccines (influenza, rubella - prior preg)

Question 2

describe the key components and rationale for the first antenatal visit

Answer 2

1. CONFIRM PREG
   - Hx, Exam (uterine enlargement, bluish tinge cervix), Ix (B-hCG, US)
2. GA
   - US: CRL (6-12wks), biparietal diameter (12-20wks)
   - Naegel’s rule
3. SCREEN
   - Hx, Exam
   - Ix: CFTS = Biochem T21 (PAPP-A & B-hCG), US
   - β-hCG to confirm pregnancy
   □ FBE for anaemia/infection
   □ Blood group and antibodies
   □ Serology (HBV, HCV, rubella, varicella, HIV, syphilis)
   □ Consider Vit D, iron, TSH
   - MSU for asymptomatic bacteruria
4. MX
   - Tx anaemia/deficiencies, asymptomatic bacteruria; ToP for pulm HT/renal failure, avoid radiology
5. ADVICE
   diet, vitamins, exercise, smoking, alco, sex, work, medications
6. BOOKING
   - norm risk or high risk (Hx PE, HTN, GDM, BMI, prev CS, age)
   - norm risk = shared care or midwifery teams (Cosmos)
   - high risk = obstetrician

Question 3

describe the key components and rationale for subsequent antenatal visits

Answer 3

<28wks = every 4wks
28-36wks = every 2 wks
36+ wks = every week

Hx: general wellbeing, pain, oedema, breast tenderness, varicose veins; foetal movements; any concerns?
Exam: BP, fundal height, lie & presentation, auscultate, urinalysis (proteinuria, asymptomatic bacteruria)
Ix: OGTT at 28 & 34wks + passive anti-D (Rh-) 28/34wks

High risk pt - screen for risks (e.g. GDM, PE)

Question 4

explain the principles behind planning the timing and mode of delivery

Answer 4

Timing - median spontaneous onset 40wks after LMP, or 38wks after fertilisation. If over 10days past due date, induction or CS

Mode - prefer VD, but cases where CS preferred (Hx shoulder dystocia, previous CS, previous uterine surg)