Antenatal care Flashcards
How many antenatal visits should someone with an uncomplicated pregnancy have ?
- 10 antenatal visits in the first pregnancy if uncomplicated
- 7 antenatal visits in subsequent pregnancies if uncomplicated
Note: women do not need to be seen by a consultant if the pregnancy is uncomplicated
Following confirmation of pregnancy what does the first antenatal appointment consist of and when should it occur ?
The booking visit should occur between weeks 8-12 but ideally before week 10
- History - menstural, medical, obstetric, social, family
- Examination -BP, BMI, CVS, Abdomen
- During it offer general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
- Screening: urine dipstick (for asymptomatic bacteruria and proteinuria) and blood tests for checking blood group and rhesus D status and screening for haemoglobinopathies, anaemia, red-cell alloantibodies, hepatitis B virus, HIV and syphilis
After the initial booking visit and screening what is the next antenatal visit
Early date US scan - occurs between 10 - 13+6 weeks
- To determine gestational age and exclude multiple pregnancies, determine viability
Note this may be done with the booking visit
What is the next antenatal visit after the early date US scan ?
The downs syndrome combined screening test between weeks 11 - 13+6
- Combined test consists of: nuchal translucency measurement + serum B-HCG + pregnancy associated plasma protein A (PAPP - A)
NT thickness = Measure of skin thickness behind fetal neck using U/S
For what reasons would a women undergo the triple or quadruple downs syndrome screening tests and when ?
If women book later in pregnancy or when it is not possible to measure nuchal translucency, owing to fetal position or raised BMI
What is measured in the triple or quadruple downs syndrome screening tests ?
- *alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin
- **alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin-A
> 1 in 250 pregnancies will be deemed as high risk for downs syndrome, what further investigations can be done to definitely diagnose or rule out downs syndrome ?
Amniocentesis:
- –Usually performed after 15 weeks
- –Carries a miscarriage rate of 1%
Chorionic villus sampling:
- –Usually performed after 11.5-12 until 14 weeks
- –Carries a miscarriage rate of 2%
Note the choice is up to the parents which test they choose
What percentage of downs syndrome babies will not be detected by downs syndrome screening ?
10% ==> 1 in 10 chance even if low risk that baby will have downs syndrome
Following downs syndrome screening what is the next antenatal appointment ?
16 week appointmeant consisting of:
- Review, discuss and record the results of all screening tests undertaken
- Investigate a haemoglobin < 11 g/100 ml and consider iron supplementation if indicated
- Routine BP and urine dipstick
Following the 16 week appointment what is the next antenatal appointment ?
- 18 - 20+6 weeks appointment
- If the woman chooses, an ultrasound scan should be performed for the detection of structural anomalies.
Note: For a woman whose placenta is found to extend across the internal cervical os at this time, another scan at 32 weeks should be offered.
Following the 18 - 20+6 week structural abnormality scan what is the next antenatal appointment and who is this only offered for ?
Only for nulliparous women consisting of:
- Measure and plot symphysis‒fundal height
- Measure BP and test urine for proteinuria
What is the next appointment for ALL pregnant women after the 18 - 20+6 week appointment ?
The 28 week appointment consisting of:
- Routine - BP, urine dipstick, SFH
- Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
- First dose of anti-D prophylaxis to rhesus negative women
Followinf the 28 week appointment what is the next aneonatal appointment and who is this only for ?
Only for nulliparous women it is simply a routine check up:
- BP, urine dipstick, SFH
Following the 28 week appointment what is the next antenatal appointment for ALL women ?
34 week appointment consisting of:
- Routine care - BP, urine dipstick and SFH
- Second dose of anti-D prophylaxis to rhesus negative women
- review, discuss and record the results of screening tests undertaken at 28 weeks
- Information on labour and birth plan
Following the 34 week antenatal appointment what is the next appointment ?
36 week appointment consisting of:
- Routine care - BP, urine dipstick and SFH
- Check presentation - offer external cephalic version (ECV) if baby is in the breech presentation
- Provide info on breast feeding, vitamin K, ‘baby-blues
Following the 38 week antenatal appointment what is the next appointment and who is this only for ?
40 week appointment only for nulliparous women consisting of:
- Routine care - BP, urine dipstick and SFH
- Discussion about options for prolonged pregnancy
Following the 38 week appointment what is the next antenatal appointment for ALL women ?
41 week appointment consisting of:
- Routine care - BP, urine dipstick and SFH
- Discuss labour plans - membrane sweep and induction of labour should be offered
What conditions should all pregnant women be screened for ?
- Anaemia
- Bacteriuria
- Blood group, Rhesus status and anti-red cell antibodies
- Down’s syndrome
- Fetal anomalies
- Hepatitis B
- HIV
- Neural tube defects
- Risk factors for pre-eclampsia
- Rubella immunity
- Syphilis
What conditions may a pregnant women be screened for ?
- Placenta praevia
- Psychiatric illness
- Sickle cell disease
- Tay-Sachs disease
- Thalassaemia
What conditions should a pregnant women not be screened for ?
- Bacterial vaginosis
- Chlamydia
- Cytomegalovirus
- Fragile X
- Hepatitis C
- Group B Streptococcus
- Toxoplasmosis
What supplements are pregnant women recommended to take ?
- Folic acid 400mcg should be given from before conception until 12 weeks into pregnancy
- 10 micrograms of vitamin D per day
Are iron supplements routinley recommended in pregnancy ?
No
Taking supplements of what vitamin can be tetragenic during pregnancy ?
Vit A - intake above 700 micrograms might be tetragenic. Liver is high in vitamin A so consumption should be avoided.
What is the recommendations for alcohol intake in pregnant women ?
To take none
What are the risks of smoking during pregnancy
Low birth weight and preterm birth
What are the 2 main food acquired infection pregnant women are informed about and how do they avoid them?
- listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
- salmonella: avoid raw or partially cooked eggs and meat, especially poultry
what are the recommendations for air travel for pregnant women ?
- women > 37 weeks with singleton pregnancy and no additional risk factors should avoid air travel
- women with uncomplicated, multiple pregnancies should avoid travel by air once >32 weeks
What is air travel in pregnant women associated with a risk of and what is done to reduce this risk?
- Associated with an increased risk of VTE
- Compression stocking are used to reduce the risk
What are the recommendations for exercise during pregnancy ?
- Beginning or continuing moderate exercise is not associated with adverse outcomes
- Although certain activities should be avoided e.g. high-impact sports where there is a risk of abdominal trauma and scuba diving
What are the recommendations on sexual intercose during pregnancy ?
It is not known to be associated with adverse outcomes
How is the due date of a baby calculated ?
You simply add 9 months and 7 days onto when they last had there period
What happens to the risk of downs sydrome in a pregnancy with increasing maternal age ?
List 3 good questions to ask mothers when assessing their mental health during antenatal visits ?
- Do you have new feelings and thoughs which you have never had before, which make you disturbed or anxious ?
- Are you experiencing thoughts of suicide or harming yourself in violent ways ?
- Are you feeling competent as a mother as though you cant cope or feeling distant or estranged
SFH is measured at each antenatal appointment after 24 weeks onwards and each result is plotted on a growth chart, if a single SFH is plotted below the 10th centile or serial measurements demonstrate slow or static growth by crossing a centile then what should be done ?
U/S assessment of fetal size
In what women is measurement of SFH inaccurate and therefore what is done instead to monitor their babies growth after 24 weeks onwards ?
- In women it is inaccurate - BMI > 35, large fibroids, hydraminos
- Fetal size should be assessed on U/S.
