Antenatal Care Flashcards
What are the aims of antenatal care?
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?
Who gives antenatal care?
Midwives manage care
Obstetricians if risks or specific needs identified
What is the first antenatal visit called?
The booking visit
When should the booking visit be done?
8 to 12 weeks
Ideally before 10 weeks as some tests should be done before 10w e.g sickle cell and thalassaemia screening
What happens at the booking visit?
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
What examinations are done at booking visit?
BMI Check heart, lungs, abdomen Is smear needed? Varicose veins Ask about FGM Look for signs of domestic violence (it increases during pregnancy)
What dose of folic acid should be taken daily?
400mcg
What food acquired infection is there an increased risk of during pregnancy?
Listeriosis
What advise should be given to avoid food acquired infection (listeriosis)?
Drink only pasteurised or UHT milk
Avoid soft ripened cheeses e.g Brie, Camembert, blue veined
Avoid pate
No uncooked/undercooked ready prep meals
What advise should be given to avoid salmonella?
Avid raw eggs and food that may contain them e.g Mayo
Avoid raw meat especially poultry
What risks are there with drinking alcohol during pregnancy?
Risk of LBW
Preterm birth
Miscarriage
Fetal alcohol syndrome - facial abnormalities, heart defects, growth problems, developmental and mental delays
What tests are done/offered at the booking visit?
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)
What vitamin are women recommended to take through pregnancy?
Vitamin D
What should be checked at each antenatal visit?
BP and urinalysis
How many scan are offered for low risk pregnancy and what are they?
2
The dating scan between 8-14 weeks
Anomaly scan between 18-21 weeks
What happens at the dating scan?
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)
What is the combined test?
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
If a combined test is not possible, what is offered?
Quadruple test
Only screens for Down’s syndrome
Not as accurate as combined
(Can be offered a mid pregnancy scan for Patau and Edwards)
What result would indicate high risk of a trisomy?
Higher than 1 in 150
Will be offered a diagnostic test: CVS or amniocentesis
After 14 w what is the accurate way to date a pregnancy?
Biparietal diameter (up to 20w) After 34w BPD is unreliable
In the combined test, what 2 factors are measured as part of the blood test?
Beta hCG
PAPP-A - produced by placenta, low levels reflect poor early placentation
What conditions does the anomaly scan look for?
Anencephaly Open spina bifida Cleft lip Diaphragmatic hernia Gastroschisis Exophthalmos Serious cardiac abnormalities Bilateral renal agenesis Lethal skeletal dysplasia T18 T13
How many antenatal appointments are done for uncomplicated nulliparous and parous women?
Uncomplicated nulliparous: 10
Uncomplicated parous: 7
When should fetal presentation be checked?
36 weeks
Is formal fetal movement counting required?
No
If a low lying placenta is found at 20 weeks, what should be done?
Rescan at 32 weeks
After 41 weeks, what should be done?
Membrane sweep
Offer induction - if she declines > 42 weeks increase surveillance with CTG and USS
