Antenatal Care Flashcards
What are the aims of antenatal care?
- Detect and manage pre-existing maternal disorders
- Prevent or detect and manage maternal complications of pregnancy
- Prevent or detect and manage fetal complications of pregnancy
- Plan pregnancy care to ensure maximum safety
- Provide education and advice regarding lifestyle and minor conditions of pregnancy
List the aspects of preconceptual care and counselling
- Previous pregnancies
- Traumatic
- Discuss implications of another pregnancy - Health check - better if before conception
- Rubella status - checked so can be immunised before pregnancy if needed
- Optimise health in chronic disease (e.g. DM)
- Medication - optimised for pregnancy
- Folic acid - 0.4mg/day
What is the purpose of the booking visit?
To screen for possible complications that may arise in pregnancy, labour and the puerperium
What considerations are there in relation to age?
- Increased risk of obstetric and medical complications if <17 or >35
- Chromosomal trisomies increased with maternal age
How is the pregnancy dated?
- US used to date all pregnancies except IVF
- Can use Nagles rule to get EDD
What considerations are there in relation to past obstetric history?
- Obstetric disorders have a significant recurrence rate
What considerations are there in relation to past gynaecological history?
- Previous gynae surgery may influence delivery recommendations are increase pre-term labour risk
What is important in the past medical history?
- HTN
- DM
- Autoimmune disease
- Haemoglobinopathy
- Thromboembolic disease
- Cardiac or renal disease
- Past mental illness (increased suicide risk)
What considerations are there in relation to medications?
- Contraindicated drugs should be changed
What considerations are there in relation to family history?
- GDM risk increased if first degree relative diabetic
- HTN, thromboembolic and autoimmune disease, pre-eclampsia = all familial
What considerations are there in relation to personal/social history?
- Domestic violence
List the appropriate examination steps done on the booking visit
- General health and nutritional status
- BMI - >30 = increased complications
- Baseline BP - pre-existing HTN is a risk factor for pre-eclampsia
- Abdominal exam - this is limited before 3rd trimester
List the booking investigations
- Ultrasound scan
- Booking bloods
- Urine microscopy and culture
- Urinalysis
- Other tests depending on risk factors
List the routine booking bloods and explain why they are done
- FBC - pre-existing anaemia
- Blood group and antibody screen - to see if possibility of intrauterine isoimmunisation
- Syphilis - routine due to implications for the fetus
- Rubella immunity - if not immune vaccination offered postnatally
- HIV - counselling offered if positive
- Hep B - counselling offered if positive
List the other tests that can be done during antenatal care and give indications for them
- Oral glucose tolerance test - at risk women but done later in pregnancy
- Haemoglobinelectrophoresis - done in at risk women for sickle cell and thalassaemia
- Screening for infections implicated in preterm labour (not routine)
- Urine microscopy and culture - for asymptomatic bacteriuria
- Urinalysis - glucose, protein, nitrites
What advice should be given to pregnant women about medications?
- Avoid meds as far as possible in first trimester
- Regular meds ideally adjusted preconceptually
- Folic acid supplementation - continue until at least 12wks
- Vitamin D supplementation - 10mcg/day
- Aspirin - 75mg/day for increased risk of pre-eclampsia
- Immunisation - seasonal influenza and pertussis
What advice should be given to pregnant women about lifestyle?
- Diet - balanced; 2500 calories
- Avoid alcohol completely
- Smoking - advise quitting and offer NRT
- Coitus - only CI in placenta praevia or ruptured membranes
- Drink only pasteurised milk, avoid soft and blue cheeses, paté or partially cooked ready meals - to prevent Listeriosis
- Exercise advised
- Wear seatbelt in car
- Sleep in left lateral position from 28wks
What should pregnant women do to prepare for birth?
Antenatal classes
List the conditions checked for in early pregnancy risk assessment and the interventions used if present
- VTE - give LMWH
- Pre-eclampsia - Aspirin 75mg
- HTN - monitoring
- Chromosomal abnormalities - non-invasive prenatal diagnosis or invasive testing (not in Ireland)
- Fetal growth restriction - serial US of fetal growth
- GDM - OGTT
Describe the anomaly scan
- Done at 20wks
- Detects structural fetal anomalies
What other ultrasound screening tests can be done later in pregnancy?
- Cervical length measurement - risk assessment of pre-term delivery in low risk women
- Uterine artery resistance - screens for IUGR and pre-eclampsia
Describe the conduct of an antenatal visit
- History briefly reviewed
- Ask about physical and mental state
- BP and urine dipstick
- Abdomen examined - presentation variable and unimportant to 36wks
- Listen to fetal heart
- Reassessment of pregnancy risk
List the minor conditions of pregnancy
- Itching
- Pelvic girdle pain
- Abdominal pain
- Heartburn
- Backache
- Constipation
- Ankle oedema
- Leg cramps
- Carpal tunnel syndrome
- Vaginitis due to candidiasis
- Tiredness
Discuss itching in pregnancy
- Common
- Check for jaundice, LFTs and bile acids assessed
