Antenatal Care

Question 1

At what gestation should the booking visit take place?

Which investigations are done at the booking visit?

Answer 1

8 - 12 weeks

Investigations:

• BMI
• Blood pressure
• Urine dip
• Bloods: FBC, blood group, rhesus status, haemoglobinopathies, HIV, hep B and syphilis

Question 2

At what gestation is the dating scan?

Answer 2

10 - 13+6 weeks

Question 3

At what gestation is Down’s syndrome screening available?

What is the name of this screening and what does it involve?

What results may suggest Down’s syndrome?

Answer 3

11 - 13+6 weeks

Combined test:

• PAPP-A (pregnancy associated plasma protein A)
• hCG (human chorionic gonadotrophin)
• Nuchal translucency

Results which may suggest Down’s syndrome:

• Low PAPP-A
• High hCG
• Nuchal thickening

Question 4

At what gestation is the anomaly scan?

Answer 4

18 - 20+6 weeks

Question 5

How many doses of anti-D are given to rhesus negative women?

When are these doses given?

Answer 5

2 doses:

• 1st dose at 28 weeks
• 2nd dose at 34 weeks

Question 6

At what gestation would you expect foetal movements to have started?

If there have been no foetal movements by this point, what should you do?

Answer 6

24 weeks

Refer to foetal medicine unit

Question 7

A very low PAPP-A may suggest…

Answer 7

PAPP-A is VERY low in trisomy 13 (Patau) and 18 (Edward’s), compared to trisomy 21 (Down’s)