Antenatal Care

Question 1

When is the booking appointment and what does it involve?

Answer 1

8-12 weeks (Preferable <10 weeks)

General information (10mcg vit. D, 400mcg folic acid)
BP, urine dip, BMI

Bloods/Urine:

• FBC, Blood group, Rhesus status, Haemoglobinopathies
• Hepatitis B, Syphilis, Rubella
• HIV Test
• Urine culture for asymptomatic bateriuria (MSU)

Question 2

When is the dating scan and what does it involve?

Answer 2

11 - 13+6 weeks

Assessment of date of pregnancy based on Crown-Rump length (Head circumference is used from 14+ weeks)

Checking for gross abnormalities
Checking for multiple pregnancies
Checking nuchal translucency for Down’s/Patau

Screening for down’s using: Nuchal translucency, HCG and PAPP-A (Greater NT, High HCG, Low PAPP-A indicates risk of Down’s)

Question 3

What is the Down’s quadruple screening?

Answer 3

Blood test carried out between 14-20 weeks, looking at levels of:

HCG
Unconjugated oestriol
Alpha fetoprotein
Inhibin

Question 4

When is the anomaly scan? What does it assess?

Answer 4

18-22 weeks

Assesses foetal anatomy
Conditions it checks for includes:
 - Congenital anomalies
 - Spina bifida
 - Diaphragmatic hernia
 - Renal agenesis

Question 5

What is conducted during the blood test after 28 weeks gestation?

Answer 5

• First dose of anti-D prophylaxis to rhesus negative women
• FBC
• Blood group again for confirmation
• Antibody screen
• Blood glucose
• If blood glucose is raised, an Oral Glucose Tolerance Test is performed (This also may be conducted if they have a PMHx of diabetes at 16-18 weeks)
  
  • If more than 7.8 mmol/l, then do fasted glucose
  • If fasted glucose test is more than 5.6 mmol/l, they have gestational diabetes

Question 6

What is the antenatal management for rhesus negative pregnant women?

Answer 6

Prophylactic anti-D immunoglobulins, first give at 28 weeks, second given at 34 weeks

Question 7

What is tested during routine urine tests?

Answer 7

An MSU is always sent during booking appointment

Urine screened for:
Protein - Pre-eclampsia or renal disease
Glucose - Gestational diabetes/Pre-existing diabetes
Nitrites - UTI, requires immediate MSU for asymptomatic bateriuria

Question 8

What are the risks & management of asymptomatic bacteriuria?

Answer 8

Risk of:
Preterm birth
Pyelonephritis during pregnancy

Management:
Immediate antibiotic prescription (nitrofurantoin, amoxicillin or cefalexin)

Question 9

How is growth tracked during pregnancy?

Answer 9

10-14 weeks = Crown-Rump Length
14-20 weeks = Head circumference
20+ weeks = Symphysis-Fundal height

Question 10

What should be offered to women with a high risk of Down syndrome according to initial screening tests?

Answer 10

CVS (10-14 weeks)

Amniocentesis (15+ weeks)

Question 11

What is increased nuchal translucency a sign of?

Answer 11

Down’s syndrome
Patau syndrome
Abdominal wall defect
Congenital heart defect

Question 12

What is hyperechogenic bowel a sign of?

Answer 12

Cystic fibrosis
Down’s syndrome
Cytomegalovirus