Antenatal Care

Question 1

After initial contact, how many antenatal care appointments are considered sufficient for low-risk pregnancies

Answer 1

10 visits - for primiparous woman

7 visits for a parous woman

Question 2

How do you calculate the estimated date of delivery (EDD)

Answer 2

1st Day of LMP + 9 months + 1 week

Question 3

For which infections do you offer screening at booking?

Answer 3

HIV, Hep B and syphilis
If result is +ve, must inform partner/partner tracing must occur
Asymptomatic bacteriuria

These require consent - are opt out tests

Chlamydia not screened for, but if in at risk age group advised to go to GUM clinic

Question 4

What blood tests are routinely offered at the booking visit?

Answer 4

Screen for haemoglobinopathies, anaemia, red-cell allo-antibodies (Rh status), sickle cell disease

Question 5

Which risk factors qualify you for screening for GDM?

Answer 5

BMI >30
Previous macrosomic baby (>4.5Kg)
Previous GDM
Family history of diabetes (1st degree relative)
Being of afro-Caribbean/south-Asian/middle eastern descent

Question 6

Between what dates must the Down’s scan take place

Answer 6

From 11+0 - 13+6 at the latest

Question 7

What maternal measurements must be taking at Booking

Answer 7

Height/Weight - BMI
Measure blood pressure
Dipstick urine for proteinuria / glucose

Ask about maternal mood and domestic violence

Question 8

When does the Dating Scan take place

Answer 8

10 - 13 weeks

Question 9

What takes place at 16 weeks?

Answer 9

discussion of results of Down’s screen.

Consider iron supplementation if bloods show anaemia (<11g/L)

Question 10

What is involved in the combined test (Down’s screen)

Answer 10

Screens for Trisomy’s 21, 18 and 13 - Down’s, Edwards and Patau

Tests - Nuchal translucency, beta-hCG, pregnancy associated plasma protein A (PAPPA)

Question 11

If women book late - i.e. >14 weeks, what fetal screening can be offered to them?

Answer 11

Quadruple test - just for Down’s - from 15 - 20 weeks

measures plasma beta-hCG, unconjugated estriol, alpha-fetoprotein and inhibin A

Question 12

How to interpret results of screening tests

Answer 12

results will be provided as a probability

The cut of for high probability after Downs screen - is 1 in 150 - higher probability

Question 13

What further testing is available if the result of screening is high probability

Answer 13

Chorionic Villus Sampling
Amniocentesis

Non-Invasive prenatal testing

Question 14

Differences between CVS and amniocentesis

Answer 14

CVS - <15 weeks, samples placenta, rapid, early diagnosis

Amniocentesis - 15-18 weeks, miscarriage risk slightly higher (0.5 - 1.0%)

Question 15

What scan takes place at 18 - 20+6 weeks

Answer 15

Anomaly scan - USS scan checklist - specific conditions to check for e.g NTD, gastroschisis

Question 16

When is Rhesus prophylaxis provided?

Answer 16

To Rh-ve women

First dose of Anti-D immunoglobulin at 28 weeks
Second dose at 34 weeks

Question 17

Which foods must be avoided during pregnancy?

Answer 17

Mouldy cheese - blue cheese - risk of listeria
Undercooked meals - salmonella
Liver/liver products - too much vitamin A

Limit consumption of Tuna
And Caffeine - 200mg/day - 2 mugs instant coffee

Question 18

What is the antenatal care schedule in the last 4 weeks of pregnancy

Answer 18

36 weeks - Routine scan + check presentation + advice on breastfeeding, vitamin K and baby blues
38 weeks - routine scan
40 weeks - routine scan + labour plan

(41 weeks - discuss induction)

Question 19

Which conditions require higher amount of folic acid?

Answer 19

Folic acid 5mg - available only on prescription

Previous history of NTDs
Coeliac
GDM
Sickle cell anaemia
Taking epilepsy medication