Antenatal Care Flashcards by Amy Spicer

In UK law when does pregnancy begin?

Implantation

6-12days post-fertilisation

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How can pregnancy be diagnosed?

Amenorrhoea
Breast tenderness/swelling
Sickness
USS
Positive pregnancy test

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What is a pregnancy test based upon?

hCG levels
Rise rapidly up to 10weeks
Urine positive at: 25IU/ml
Can be detected in serum & urine 4weeks after LMP

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What are the main landmarks before & after 12weeks?

BEFORE: Organ development, placenta assumes major role
AFTER: Growth & maturation

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When is the highest chance of miscarriage?

before 12weeks

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What happens at the initial booking visit?

Calculate EDD
Book first scan
Obstetric Hx, risk assessment
Obs: BP, BMI, urine (culture for asymptomatic bacteriuria)
Dietary advice: Folic acid, iron, VitD, avoid certain diaries
Lifestyle advice: smoking, OH-
Bloods: FBC, Blood Group, Haemoglobinopathies (Rhesus -ve), resus status, red cell alloantibodies, Hep B, Syphilis, Rubella, HIV
Consent for antenatal screening & Genetic disorders tests
Flu vaccine
Antenatal classes

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When is the booking visit?

Ideally before 10weeks

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What disorders are tested for in the antenatal screening tests?

Combined test: Edward’s, Patau’s, Down’s syndrome

- Quadruple test for Down’s at 15-20weeks (women who present late)

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How many antenatal appointments should be made for Multips & Primips?

P=10

M=7

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What infections are screened for in antenatal clinic?

HIV
Syphilis
Hep B
Rubella

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What are customised growth charts based on?

Age, ethnicity, parity, BMI, symphysis-fundal height (from 24weeks)

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What will be seen at each of the following stages on USS?
4-5weeks
5-6weeks
6weeks
6-7weeks
8weeks

4-5: Gestational sac 6mm
5-6: Yolk sac
6: Fetal pole 5mm
6-7: Fetal heart activity
8: Limb buds, fetal movement

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At what gestation will fetal movement occur?

Multips: 16weeks
Primips: 18weeks
Pattern to movement: 26weeks

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What does a 1st &2nd trimester USS show?

1st: Optimal for dating (measure crown-rump length)
2nd: Placental location, relationship to internal cervical os

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When is an anomaly scan done?

Screening test comes back with ‘high/increased probability’
18-22weeks
Checks for: Anencephaly, gastroschisis, heart defects, trisomy 13&18

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How does the combined screening test work?

Opt-in
11-14weeks
Measure crown-rump length
Nuchal translucency scan
Maternal blood test
Cut off 1 in 150
High probability= CVS or amnio

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What chemicals are measured in the combined screening test?

Nuchal translucency (measure size of nuchal pad at nape of the neck)
Beta-human chorionic gonadotrophin
Pregnancy associated plasma protein-A.

What is amniocentesis?

Sample of amniotic fluid by passing a needle through the abdomen into the amniotic sac
15weeks+
Gives info about karyotype of fetus

What are the risks of amniocentesis?

COMMON: Discomfort, failure to obtain sample, miscarriage (1%)
OCCASIONAL: fluid leakage
RARE: Fetal & bowel injury, failure of cell culture, chorioamnionitis

What is chorionic villus sampling?

Sample of placental tissue obtained transabdominal/transcervial
11-14weeks
LA often used

What are the risks of CVS?

COMMON: Discomfort, failure to obtain sample, miscarriage (2%)
OCCASIONAL: Same as amnio
RARE: Same as amnio

What does increased nuchal translucency reflect?

Fetal heart failure

Strongly associated with chromosomal abnormality

What happens if the mother is diagnosed with Hep B or Syphilis in pregnancy?

Hep B: Newborn on vaccination programme (5doses)

Syphilis: Receive full Tx 4weeks prior to delivery, newborn undergo IV therapy

What is the management of a rhesus negative mother?

Anti-D immune globulin 500IU at 28weeks

What is Rh incompatibility?

Destruction of fetal erythrocytes from transplacental passage of maternal IgG antibodies produced by the immune system. Anti-D antibodies produced to a Rh+ve foetus and can freely cross the placenta binding to and destroying RBCs. Rh-: RBC's do not carry inherited RhD antigen

What are the consequences of Rh incompatibility?

Sensitising event will cause maternal immune system to react to 'foreign' D antigens on RBCs & produce Abx No problem in current pregnancy Consequent pregnancies: Haemolytic disease of the newborn= Progressive fetal anaemia which may lead to hydrops fetalis and death

Which pregnant women should be given Rho D immune globulin?

Ectopic pregnancy Miscarriage/TOP Any invasive procedure (amnio, CVS) Possibility of fetal-maternal haemorrhage If they deliver a neonate who is Rh-positive

Which haemoglobinopathies should be tested for?

Thalassaemia (including carriers) | Sickle Cell

How can Sickle Cell be identified?

Newborn Blood Spot | 5days post-delivery

What is IUGR an indicator of?

Placental insufficiency

What does it mean if a baby is constitutionally small?

Small baby due to e.g small mother, placenta working sufficiently

What fetal growth measurements should be taken?

BPD: Biparietal diameter HC: Head circumference AC: Abdominal circumference FL: Femur length

How is EDD calculated?

LMP +7days +9months

Define gravidity & parity

G: Number of times a woman has been pregnant P: Number of times that a woman has given birth with a gestational age of 24weeks

How is parity calculated?

Parity = (A) + (B) A)Deliveries after 24weeks (live/stillborn) B)Losses before 24weeks (TOP/miscarriage)

How do the following change in pregnancy: - RR - HR - Hb Conc - Albumin - Renal blood flow

- RR: Stays the same - HR: Increases - Hb Conc: Decreases - Albumin: Decreases - Renal blood flow: Increases

What are the changes to the CV, Resp, GI system in pregnancy?

CV: Inc= Plasma vol, HR, SV, CO, Uterine & renal BF Same= MAP, CVP Dec= Systemic & pulm vasc resistance, mid-trimester BP Resp: Inc= Tidal vol, Insp capacity, O2 consumption Same= RR, Peak flow Dec= Total lung capacity, resid vol, exp & insp reserve, functional resid capacity GI: Inc= Weight, Gallstones, reflux, Nutritional requirements Same= Amylase Dec= GI motility, Stomach pH

What are the changes to the liver, haematology, renal & immune system in pregnancy?

Liver: Inc= Alkaline phosphatase Same= Bilirubin Dec= Albumin, Aspartate & Alanine transaminase Haem: Inc= MCV, RC mass, WCC, Total iron binding capacity Same= MCHb, Ferritin Dec= Hb Conc, Platelet count, haematocrit Immune: Inc= ESR Same= CRP Renal: Inc= Blood flow, Creatinine clearance Same= Daily voided vol, plasma Na+, K+, Cl- Dec= Plasma urea, creatinine

What test can be used to detect if a fetomaternal haemorrhage has occured?

Kleinbauer test at 20weeks Detects & quantifies level of haemorrhage Can alter amount of anti-D required

What occurs at each antenatal appointment?

8-12: Booking 10-13+6: Dating scan 11-13+6: Triple test 16: Info on blood/rhesus results, routine BP & urine 18-20+6: Anomaly scan 25: PRIMIP ONLY- BP, urine, symphysis-fundal height 28: BP, urine, SFH, 2nd screen for anaemia & red cell alloantibodies. Hb < 10.5 g/dl consider iron, 1st dose anti-D to rhesus -ve women 31: PRIMIP ONLY- same as 25week 34: Routine monitoring as above, 2nd dose anti-D, info on labour & birth plan 36: Routine monitoring, check presentation (offer ECV), info on BF, Vit K, baby-blues 38: Routine monitoring 40: PRIMIP ONLY-Routine monitoring 41: Routine monitoring, discuss IOL