Antenatal Care

Question 1

Pattern of care

Answer 1

• 10 appointments in first pregnancy
• 7 appointments in subsequent pregnancies
• Women with no risk factors managed by midwives in community and those with risk factors by MDT

Question 2

Aim of first appointment

Answer 2

• Identify risks (including domestic abuse)
• Screen for abnormalities or illness
• Develop rapport and encourage future attendance
• Health promotion (smoking cessation, dietician, dental care, folic acid, alcohol, food hygiene)
• Social work involvement if required

Question 3

First trimester (0-11 weeks)

Answer 3

• Gain initial observations of mother to enable care planning and identify deterioration later

Question 4

Risk factors

Answer 4

• Age >40 or <18
• Para 6+ or para 0
• Extremes of BMI
• Low socioeconomic status
• Drug and alcohol misuse
• Previous obstetric problems
• Vulnerable groups (i.e. refugees)
• Pre-existing medical problems
• Fertility treatment
• Previous miscarriage/stillbirth/neonatal death

Question 5

Screening

Answer 5

• FBC (anaemia, thrombocytopenia)
• Blood group (ABO/Rhesus)
• Sickle cell and thalassaemia
• Rubella/Hep B/Syphilis/HIV

Question 6

Fetal screening

Answer 6

• Down syndrome (Nuchal translucency 11-14 weeks - risk not diagnosis)
• Fetal anomaly scan 18-22 weeks
• CVS from 11 weeks or amniocentesis from 15 weeks
• NIPT - cell free fetal DNA for T21, T18, T13, C and Y

Question 7

Second trimester (12-20 weeks)

Answer 7

• Fetal anomaly scan (18-22 weeks)
• AN appointments
• Ask about common problems

Question 8

Third trimester (20 weeks to term)

Answer 8

• AN appointments (pain/vaginal loss, common problems, fetal movements, abdominal examination, fetal growth evaluation, observations)

Question 9

Antenatal complications

Answer 9

• Polyhydramnios
  
  • Refer for USS is suspected, large for dates, tense abdomen, unable to feel fetal parts
  • Single deepest vertical pool (DVP) >8cm/amniotic fluid index (AFI) >90th centile for gestation
• Oligohydramnios
  
  • Refer for USS
  • AFI <5cm or single DVP <2cm
• HTN and pre-eclampsia
• Anaemia
  
  • Test FBC, folate, B12 and ferritin
  • Oral iron to treat
• Impaired glucose tolerance
  
  • Urinalysis
  • GTT if glycosuria or risk factors
• Mental health problems
  
  • Pre-conception counselling
  • Risk of postnatal depression