Antenatal care Flashcards
Prepregnancy counselling
Hx
Ex
Ix: Rubella ab, Varicella ab, Pap smear
Perform any imaging before pregnancy
Optimise Rx for medical conditions e.g. DM (oral hypoglycemics to insulin), epilepsy (avoid valproate), anticoagulants (warfarin to low molecular weight heparin), HTN (ACE inhibitors to methyldopa or lebatalol), avoid methotrexate, continue asthma meds
Consider conditions with poor prognosis in pregnancy e.g. pulmonary HTN, renal failure with creatinine <0.3
Folate (0.5 mg for 3 months)
Avoid teratogens
Plan sexual intercourse at least every second day or daily leading up to ovulation
Avoid smoking/ alcohol
6 steps for first antenatal visit
- Confirm pregnancy
- Gestational age
- Screen for potential problems
- Mx of any problems
- General advice
- Booking
- Confirm pregnancy
Hx: missed period? urinary frequency? nausea? breast tenderness?
Exam: vaginal enlargement at 8 weeks’, uterine enlargement is abdominally palpable at 12 weeks’
Ix: serum bHCG
- Gestational age
U/S: measure crown rump length, accurate 6-12 weeks’, after 12 weeks’ measure biparietal diameter to get the age as the embryo begins to flex/extend (but not as accurate)
Menstrual dates: Naegele’s rule: EDD= 9 months + 1 week from 1st day of last normal menstrual period (adjust if cycle is shorter/longer than 28 days, not reliable if irregular cycle of if recently ceased the pill)
- Screen for potential problems
Hx
Exam: general inspection, height/weight/BMI, vitals, head and neck including thyroid, UL, chest, breast, abdomen, LL, neurological, gynaeological
Ix: FBE (anaemia, thalassemia), blood group and antibodies (Rh-ve), rubella ab (if not already performed) varicella immunity (if not certain), syphilis ab, hep B, hep C, HIV, MSU MCS, Pap smear (if due), Serum screen at 12 weeks’ (fetal aneuploidy), scan at 12 weeks’ (fetal aneuploidy, structural anomaly, multiple pregnancy), morphology scan at 19 weeks’ ( structural anomaly dx, placenta localisation)
- Mx of any problems
Optimise during pregnancy
- General advice
Diet and nutrition: avoid soft cheese/ soft serve ice cream, raw fish, cold meats, salad bars with mayo (Listeria), protein and complex carbs, iron (red meat)
Smoking/drugs/alcohol: avoid smoking and alcohol, >2/day can lead to fetal alcohol syndrome, cocaine is particularly bad
Exercise: light to moderate is fine, strenuous exercise leads to smaller babies
Work: most cease work by 34 weeks’ due to fatigue
Travel: long flights undesirable, avoid after 28 weeks’
Sexual intercourse: fine (unless placenta praevia)
Multivitamin: can take, no need to supplement Fe/Ca/D unless deficient
Medication: paracetamol (headache), metoclopramide (nausea), penicillin (UTI), common asthma and common laxatives are fine, anything else you should check
Vaccinations: flu and whooping cough
Infections: CMV and toxoplasmosis can be avoided by sensible handwashing e.g. after gardening, childcare
- Booking
Models of care: public hospital with midwife/ reg (normal risk), shared care with GP obstetrician, specialist obstetrician (high risk), MDT (complex), private obstetrician
What do subsequent visits involve?
Hx: well? FM? concerns/ questions?
Exam: general, maternal weight, BP, palpation - lie (longitudinal, transverse, oblique) position (cephalic, breech), fundal height, fetal HR
Ix: urine dipstick, FBE and OGTT at 28 weeks’, FBE and GBS swab at 36 weeks’
Anti D if Rh-ve at 28 and 34 weeks’
What are the objectives of subsequent visits?
Health promotion and preventative medicine
Management of any pregnancy Cx
Maternal support and preparation for birth
Frequency of visits
<28 wks’ = 4 weekly
28-36 wks’ = 2 weekly
≥36 wks’ = weekly
Common Sx that arise in pregnancy
Headaches Heartburn Lower abdominal discomfort or round ligament pain Constipation Haemorrhoids Varicose veins Carpal tunnel syndrome Oedema Muscle cramps Fainting or light-headedness General fatigue Itch
