Antenatal Care Flashcards
When is morning sickness worse and what do we call the extreme form?
Worse when Human Chorionic Gonadotrophin is high e.g. in twins or molar pregnancies
Can progress to Hyperemesis Gravidarum
Why are pregnant women more at risk of UTIs and pyelonephritis [2]
What is the major danger of a UTI to a pregnant woman?
Urinary stasis increases - hydronephrosis is even physiological come 3rd trimester
Increased risk of preterm labour
Many maternal issues may recur in the next pregnancy, give 3 examples of these that are important in pre-pregnancy counselling?
Caesarean section
DVT
Pre-eclampsia
Pre-term delivery
IUGR
Fetal Abnormality - NTD
Whan can we do at pre-pregnancy counselling to reduce the risk of previous problems recurring? [4]
Thromboprophylaxis if h/o DVT - low dose aspirin
Treat any infections
High dose folic acid to reduce abnormalities 400mcg until 13w, 5mg if high risk
Whats involved in a routine antenatal exam? [6]
Abdominal palpation is an important part of an antenatal exam, what can it tell us? [4]
- Feeling well?
- Feeling fetal movements (>20wks)
- BP, BMI
- Urinalysis
- Abdominal palpation
- Listen to fetal heart
Abdominal palpation:
- Fetal presentation
- Sympheseal Fundal height (SFH), estimate baby size
- Fetal lie
- Estimate Liqour volume
What is looked for on an Antenatal screen at booking visit?
Lab tests [4]
Infection screening bloods [3]
- FBC, blood group
- Rhesus status
- Red cell alloantibodies
- Urine culture
Infection screening bloods:
- HIV
- Hep B
- Syphilis
How do we treat if a basic antenatal screen shows a Hep B, syphilis or HIV infection in the mother?
Hep B give passive and active immunisation to neonate at birth
Syphilis give penicillin esp before 16 GA has good outcomes
HIV give maternal treatment to prevent vertical transmission - reduce viral load
Who are considered higher risk of NTD [6]
Past NTD Anti-epileptics Obese, DM HIV on cotrimoxazole SCD, Thalassemia trait Coeliac disease
Dose of vitamin D in antenatal pregnancy
10mg vitamin D per day as per healthy start vitamins (especially if darker skin or limited sunlight exposure)
Pre-pregnancy counseling
o Diet: normal healthy balanced diet
o Smoking: discuss risks of LBW and preterm birth; stop smoking (NRT may be used but need to discuss risks and benefits)
o Alcohol: no alcohol
o Folic acid supplements
o Vitamin D
o Work: inform of rights and benefits
o Air travel: avoid after 37w if uncomplicated singleton and after 32w if uncomplicated multiple; wear stockings due to VTE risk
o Car travel: seatbelt above and below bump
o Antenatal classes
Gravidity
Parity
- Gravidity: total number of pregnancies the woman has had at any stage, incl. the current one
- Parity: pregnancies that resulted in delivery beyond 24w
Dating a pregnancy using Naegele’s rule
EDD = 1y and 7d after the LMP minus 3months
Number of midwife visits recommended by NICE for:
- Primigravidas
- Subsequent pregnancies
10 midwife visits in first pregnancy
7 visits in subsequent pregnancies if uncomplicated
Name in chronological order at what stage the ten midwife visits are scheduled for?
Indicate which ones are for primis only [3]
First trimester
- 8-12w
- 16w (Second trimester)
- 25w*
- 28w (Third trimester)
- 31w*
- 34w
- 36w
- 38w
- 40w*
- 41w
When are the second screen bloods done [1] and anti-D prophylaxis given? [2]
Second screen bloods: 28w - FBC - Atypical red cell alloantibodies Anti-D prophylaxis: 1. First dose 28w 2. Second dose 34w
