Antenatal care Flashcards
What are the aims of antenatal care?
- Detect and manage pre-existing maternal disorders
- Detect and manage maternal complications
- Prevent or detect and manage foetal complications
- Detect foetal congenital problems, if requested by the parents
- Plan with the mother pregnancy care and delivery
- Provide education and advice regarding lifestyle and minor conditions during pregnancy.
When is the first booking visit and what is discussed?
Before 10 weeks.
Screen for possible complications that may arise during pregnancy, labour and puerperium. Risk is assessed using history, examination and investigations.
Gestation age is also checked.
When is the first ultrasound offered?
Between 11 and 13 weeks.
What is checked at the first ultrasound scan?
- Crown-rump length to see the gestation age if <14 weeks and not IVF.
- Chromosomal abnormalities using nuchal translucency measurement, in conjunction with blood levels of hCG and pregnancy-associated plasma protein A (PAPPA) as the “combined test”
What routine booking investigations are done?
FBC
Serum antibodies (e.g. anti-D)
Glucose tolerance test
Blood tests for syphilis
Rubella immunity is checked (vaccination offered postnatally if required)
HIV and hep B counselling and screening offered.
Haemoglobin electrophoresis in high risk women –> sickle cell and thalassaemias. If the woman is a carrier the partner should be tested to identify women who should be offered prenatal diagnosis.
Urine microscopy and culture
Urinalysis for glucose, protein and nitrites for underlying diabetes, renal disease and infection respectively.
What drugs and vaccinations are recommended in women?
Folic acid, vitamin D, aspirin in women at risk of pre-eclapsia, influenza vaccination and pertussis immunization after 28 weeks. .
What dose of folic acid should be given to different women and for how long?
Dose = 0.4mg/day.
An increased dose of 5mg/day is recommended in those who have a BMI > 30, diabetics, malabsorption, sickle-cell and those on anti-epileptics.
Should be continued to week 12.
What lifestyle advice is given?
2500 calories a day
Alcohol and smoking should be avoided
Dental check up advised
Infection with Listeriosis is avoided by drinking only pasteurised of UHT milk, avoiding soft and blue cheeses, pate and uncooked or partially cooked ready-prepared food.
Coitus is not contraindicated
Exercise is advised - swimming is good, contact sports are avoided.
How should a woman sleep from 28 weeks?
Left lateral position.
What are the consequential actions if a pregnant woman is found to be at high risk of:
- Venous thromboembolism
- Pre-eclampsia
- Chromosomal abnormalities
- Foetal growth restriction
- Gestational diabetes?
- Low molecular weight heparin
- Aspirin 75mg a day and increased BP monitoring
- Non-invasive prenatal diagnosis or invasive testing
- Serial US of foetal growth
- Glucose tolerance testing
When is the late ultrasound examination?
20 weeks
What is measured in US which correlates to preterm delivery and what can be given to these women to reduce the risk?
US cervical length assessment.
Progesterone administration to those women who have a short cervix but are otherwise ‘low risk’ of preterm labour probably halves their risk.
What does US measurement of the uterine artery resistance screen for?
Pre-eclampsia and IUGR.
Why are FBC taken in early and late pregnancy?
To check for and treat anaemia.
What is the non-invasive prenatal testing checking for at 28 weeks?
Rhesus negative mothers with Rhesus positive babies to know to give the mother anti-D.
