Antenatal care

Question 1

Booking visit Hx

Answer 1

Age: <17yrs and >35yrs are high risk
Hx of presenting pregnancy: early USS (usually 11-13+6 weeks) is used to date
Past obstetric hx: recurrence rates high for preterm
labour, small-for-gestational age, IUGR, stillbirth, antepartum and postpartum haemorrhage, congenital anomalies, Rhesus disease, pre-eclampsia and gestational diabetes
Past gynaecological hx: past gynaecological surgery
PMH: hypertension, diabetes, autoimmune disease, haemoglobinopathy, thromboembolic disease, cardiac or renal disease, psychiatric
DH: teratogenicity
FH: gestational diabetes, HTN, thromboembolic + autoimmune disease, pre-eclampsia

Question 2

Booking visit examinations & investigations

Answer 2

BMI
Baseline BP
Smear: if not had one in 3y
Fetal heart: from 12w
USS: 11-13+6w for dating and abnormalities using nuchal translucency measurement
Bloods: FBC, serum antibodies, GTT(BMI>30), syphilis, rubella immunity, HIV & HepB, haemoglobin electrophoresis 
Infection screening: chlamydia and BV
Urine MCS
Urinalysis: glucose, protein, nitrites

Question 3

Antenatal supplements

Answer 3

Folic acid: 0.4mg/day should continue until at least week 12, increased doses of 5mg/day in women with
BMI >30, sickle disease, malabsorption or if on anti-epileptics
Vitamin D: 10μg/day or 25μg/day in women with BMI >30, South Asian or Afro-Caribbean origin or with increased pre-eclampsia risk
Aspirin: 75mg recommended in women with increased pre-eclampsia risk
Immunisation: flu vaccine and >28weeks pertussis vaccine

Question 4

Minor conditions in pregnancy

Answer 4

Itching: common,sclerae are checked for jaundice, check LFTs and bile acids
Pelvic girdle pain: discomfort in pubic/sacroiliac joints, physio, corsets, analgesics
Abdominal pain: usually benign and unexplained
Heartburn: 70% of women
Backache: universal, may cause sciatica
Constipation:exacerbated by oral ion
Ankle oedema: worsens towards the end of pregnancy,
diuretics should not be given
Leg cramps: 30%
Carpal tunnel syndrome: fluid retention compressing the median nerve
Vaginitis: candidiasis –> imidazole vaginal perssaries (eg. Clotrimazole) for symptomatic infection