Antenatal Care

Question 1

What are the aims of antenatal care?

Answer 1

Detect any disease in the mother
Monitor and promote fetal wellbeing
Prepare mothers for birth and make care plan
Monitor trends to detect any early complications of pregnancy - BP most important variable
Is thromboprophylaxis or aspirin needed?

Question 2

Who gives antenatal care?

Answer 2

Midwives manage care

Obstetricians if risks or specific needs identified

Question 3

What is the first antenatal visit called?

Answer 3

The booking visit

Question 4

When should the booking visit be done?

Answer 4

8 to 12 weeks

Ideally before 10 weeks as some tests should be done before 10w e.g sickle cell and thalassaemia screening

Question 5

What happens at the booking visit?

Answer 5

Full obstetric history 
Concurrent conditions 
FH of inherited conditions 
Risk assessment for VTE 
Risk assessment for gestational diabetes 
Past mental illness 

Give information about:
Folic acid supplements
Nutrition, diet, food hygiene, vitamins 
Exercise and pelvic floor exercises 
Smoking, alcohol, recreational drug use 

Discuss screening tests
Offer scans at 8-14 weeks then 18-20w

Examination
Investigations

Question 6

What examinations are done at booking visit?

Answer 6

BMI
Check heart, lungs, abdomen 
Is smear needed?
Varicose veins 
Ask about FGM 
Look for signs of domestic violence (it increases during pregnancy)

Question 7

What dose of folic acid should be taken daily?

Answer 7

400mcg

Question 8

What food acquired infection is there an increased risk of during pregnancy?

Answer 8

Listeriosis

Question 9

What advise should be given to avoid food acquired infection (listeriosis)?

Answer 9

Drink only pasteurised or UHT milk
Avoid soft ripened cheeses e.g Brie, Camembert, blue veined
Avoid pate
No uncooked/undercooked ready prep meals

Question 10

What advise should be given to avoid salmonella?

Answer 10

Avid raw eggs and food that may contain them e.g Mayo

Avoid raw meat especially poultry

Question 11

What risks are there with drinking alcohol during pregnancy?

Answer 11

Risk of LBW
Preterm birth
Miscarriage

Fetal alcohol syndrome - facial abnormalities, heart defects, growth problems, developmental and mental delays

Question 12

What tests are done/offered at the booking visit?

Answer 12

BP and urine for protein
Screening for HIV, hep B and syphilis
Blood group and rhesus status
FBC - screening for anaemia (done at booking and at 28 weeks)
Screening for gestational diabetes - if at risk: OGTT
Test for sickle cell anaemia and thalassaemia (before 10 weeks)

Question 13

What vitamin are women recommended to take through pregnancy?

Answer 13

Vitamin D

Question 14

What should be checked at each antenatal visit?

Answer 14

BP and urinalysis

Question 15

How many scan are offered for low risk pregnancy and what are they?

Answer 15

2

The dating scan between 8-14 weeks
Anomaly scan between 18-21 weeks

Question 16

What happens at the dating scan?

Answer 16

To date the pregnancy - crown rump length between 6-12w is most accurate
Estimated date of delivery calculated
Includes a nuchal translucency scan (part of the combined screening to test for Down, Patau and Edward’s syndromes)

Question 17

What is the combined test?

Answer 17

Nuchal translucency and blood test - for Down, Patau and Edward’s syndromes
Carried out at same time as dating scan

Mother’s age and results of 2 tests used to calculate chances of having a baby with a trisomy

Question 18

If a combined test is not possible, what is offered?

Answer 18

Quadruple test
Only screens for Down’s syndrome
Not as accurate as combined

(Can be offered a mid pregnancy scan for Patau and Edwards)

Question 19

What result would indicate high risk of a trisomy?

Answer 19

Higher than 1 in 150

Will be offered a diagnostic test: CVS or amniocentesis

Question 20

After 14 w what is the accurate way to date a pregnancy?

Answer 20

Biparietal diameter (up to 20w) 
After 34w BPD is unreliable

Question 21

In the combined test, what 2 factors are measured as part of the blood test?

Answer 21

Beta hCG

PAPP-A - produced by placenta, low levels reflect poor early placentation

Question 22

What conditions does the anomaly scan look for?

Answer 22

Anencephaly
Open spina bifida
Cleft lip
Diaphragmatic hernia
Gastroschisis
Exophthalmos
Serious cardiac abnormalities
Bilateral renal agenesis 
Lethal skeletal dysplasia
T18
T13

Question 23

How many antenatal appointments are done for uncomplicated nulliparous and parous women?

Answer 23

Uncomplicated nulliparous: 10

Uncomplicated parous: 7

Question 24

When should fetal presentation be checked?

Answer 24

36 weeks

Question 25

Is formal fetal movement counting required?

Answer 25

No

Question 26

If a low lying placenta is found at 20 weeks, what should be done?

Answer 26

Rescan at 32 weeks

Question 27

After 41 weeks, what should be done?

Answer 27

Membrane sweep

Offer induction - if she declines > 42 weeks increase surveillance with CTG and USS