Antenatal care Flashcards
When is first clinic appointment
<10 weeks
What is done in the first clinic appointment
Folic acid supplement 400mcg
Advice on food hygiene (avoid uncooked meat and seafood, soft cheese and unpasteurised milk) and lifestyle (smoking, alcohol, recreational drugs)
Risk assessment
‘Birth plan’
Advice on pelvic floor exercises
Refer to antenatal classes and breastfeeding workshops
Tests offered at first clinic appointment
FBC - anaemia and platelets
Blood group (ABO, rhesus and autoantibodies)
Infection screen - syphilis, hep B/C, HIV
Urine dipstick
BP
BMI
Cervical smear
Electrophoresis for high risk - haemoglobinopathies
Arrange 12 week dating scan
Arrange Down syndrome screening - combined and quadruple
Arrange 20 week anomaly scan
What are the fetal anomaly scans and when are they done
Nuchal translucency scan at ~12 weeks
Detailed ultrasound at ~20 weeks
Next step if fetal anomaly scan or serum screening positive
Confirm diagnosis by amniocentesis (>16 weeks) or chorionic villus sampling (9-12 weeks)
What is the cutoff for further investigation after fetal anomaly scan positive
If chance is higher than 1/150 of anomaly
What prompts screening for gestational diabetes
BMI above 30
Previous gestational diabetes
Previous macrosomic baby
FH diabetes (first degree relative)
Risk factors for pre-eclampsia
40+ Nulliparous >10 years since last pregnancy FH or previous history BMI >30 IVF Preexisting hypertension or renal disease Multiple pregnancy
Criteria for increased surveillance for hypertension in pregnancy
Diastolic BP 110 or greater
OR
140/90 or greater on 2 occasions over 4 hours apart
Criteria for treatment for hypertension in pregnancy
Systolic BP >160 on 2 consecutive occasions >4 hours apart
What checks are done in every antenatal clinic
BP Unite dipstick Symphysis fundal height (from week 24) Fetal presentation (from week 36) Ask about fetal movements - mothers perception is adequate, don't need a formal count
When is anti-D prophylaxis given
28
34
And within 72 hours of any sensitising event e.g APH, abdo trauma, CVS/amniocentesis, labour
When should induction of labour be offered
After week 41
When should external cephalic version be offered
If breech presentation after 36 weeks
Risks of pregnancy in high BMI
VTE
Gestational diabetes
Preeclampsia
Inaccurate fundal symphysis measurements therefore need serial growth scans
1st trimester Down syndrome screening and what are the positive results
NT scan - nuchal fold >3mm thickness
Blood test - high beta HCG, low PAPP-A
2nd trimester Down syndrome screening
US
Blood test before 20 weeks - beta HCG, inhibin, oestriol, alpha fetoprotein
Risk of miscarriage in amniocentesis or CVS
0.5-1%
Management of type 1 diabetes in pregnancy
Preconception counselling
Monitor blood glucose and HbA1c closely
Check renal function (irreversibly declines in pregnancy) and retinopathy
Management of asthma in pregnancy
Continue inhalers - all safe
If poorly controlled, risk of IUGR
If have high risk of preeclampsia, weigh up risk of using NSAIDs with asthma exacerbation
Naegele EDD calculation
+1 year
-3 months
+7 days
Results of quadruple testing suggestive of trisomy 21
Low alpha fetoprotein
Low oestriol
High inhibin
High beta HCG
Results of quadruple testing suggestive of trisomy 18
All low
Results of quadruple testing suggestive of NTD
Very high alpha fetoprotein
Everything else normal range
Describe CVS
Ideally performed at 9-12 weeks gestation
Ultrasound guided sampling of placental tissue for DNA and cytogenetic analysis
Transcervical or transabdominal
Risks of CVS
1% miscarriage
Contamination with maternal cells leading to false negative
Risk of limb defects higher if performed <9 weeks gestation
Infection
Describe amniocentesis
Ideally done at 16-18 weeks gestation
Ultrasounds guided sample of amniotic fluid for karyotyping
Transabdominal
Risks of amniocentesis
0.25% miscarriage. Much higher if <15 weeks gestation
Infection
Indications for further fetal anomaly screening
Maternal age >35 Previous child with chromosomal abnormality or NTD FH of chromosomal abnormality Abnormal screening scans or blood tests Teratogen exposure Maternal antiepileptic medication
Calculation for gestational age using CRL
CRL(mm) + 6.5 = gestational age (weeks)
When is screening for gestational diabetes done
24-28 weeks if no risk factors
16-18 weeks if high risk
Diagnosis of gestational diabetes
After 20 weeks:
2hr post OGTT glucose levels of >7.8mmol/l
Or
Fasting glucose >5.6mmol/l
Didn’t exist preconception and resolves after delivery
Vaccinations recommendations for pregnant woman and what gestation are they given?
Pertussis and Influenza between weeks 20-32
Varicella zoster Ig following exposure if never been exposed before
No live vaccines
What test are done on amniotic fluid
Karyotyping
Viral serology
Advice given for mothers if feel reduced fetal movements
Have cold drink
Lie left lateral
Count movements for 2 hours
<10 movements immediately go to maternal assessment unit
Who gets high dose folic acid and what is the dose
5mg Anti epileptic drugs Previous baby with NTD BMI >30 SCD Diabetes Multiple pregnancy
