Antenatal Care Flashcards
what are the aims of antenatal care
Screen and protect for complications related to:
Pre-existing maternal conditions that complicate pregnancy
Plan the pregnancy and birth order to provide maximum safety of both mother and child, as well as the happiness of the parent
Provide advice and guidance on the lifestyle and physiological changes that occur in pregnancy
at what week gestation does the booking visit take place and whats its purpose
10 weeks, to identify any risks of pregnancy and choose how the care will be led
what are high risk ages for pregnancy
<17, >35
what previous obstetric complications classify a patient as high risk for pregnancy
Preterm labour Small for age 'growth restricted' foetus Still birth Antepartum/postpartum haemorrhage Congenital abnormalities Rhesus disease Pre-eclampsia Gestational diabetes
what medical history components classify a patient as high risk for pregnancy
Diabetes
Hypertensioin
Autoimmune conditions
Cardiac disease
Renal disease
Thromboembolic disease
Haemoglobinopathy
Past mental illnessses
what familial disease must be screened for at the 10 week booking visit
T1DM HTN Pre-eclampsia thromboembolic disease autoimmune diseases
what investigations should be done at the 10 week booking visit
Bloods :
FBC (anaemia)
Serum-antibodies (anti-D)
Glucose tolerance test in at risk women (>30 BMI)
Syphilis test (has serious foetal implications
Rubella immunity
HIV
Hep B
Haemoglobin electrophoresis (Detect any thalassaemias/sickle cell )
Infection screen – some can cause premature labour
Chlamydia
Bacterial vaginosis
Urine MCS - Asymptomatic bacteriuria leads to pyelonephritis in roughly 20% of women
Urine dip (Protein, blood and glucose) Tests for any renal disease/diabetes/infection
what examinations are done at the 10 week booking visit
BMI - >30 = higher chance of complications
Baseline BP For comparison later on in pregnancy
Abdominal palpation and foetal heartbeat
Palpation is hard before the 3rd trimester
Auscultation cannot be done before the 12th week
Smear if not done for 3 years
what are the health promotion aspects used in antenatal care
folic acid 0.4mg/day for at least 12 weeks to prevent neural tube defects
Vit D - 10mcg/day
aspirin - 75mg/day - especially if at risk for preeclampsia
immunisation - flu + pertussis
diet - 2500 calories, no smoking/alcohol/reduced caffeine, no unpasteurised food
exercise
sleeping in left lateral position from 28 weeks
antenatal classes
what is the criteria for the bigger (5mg) dose of folic acid in the antenatal period
Anti-epileptics
BMI >30
Malabsorption
Sickle cell disease
what is the criteria for the bigger dose of vitamin D (25mcg)
BMI >30
South Asian/Afro-Caribbean
Low sunlight exposure
what gestation is the pertussis vaccine offered
28 weeks
What is tested for at the 20 week scan in antenatal care
structural foetal anomalies
cervical length (<24mm is 10th centile - risk for premature delivery)
Uterine artery scan - risk of IUGR/preclampsia
how many antenatal visits are recommended by NICE
7 for uncomplicated women
10 for complicated pregnancies
what is done at every antenatal visit
BP
Urine Dip
abdominal exam
foetal heartbeat
when does the palpation of the abdomen become more important
36 weeks as you can only really assess presentation at this stage
what is usually performed at the 16 week visit for antenatal care
Results of chromosomal abnormalities screen
Booking for blood tests
‘triple test’ is offered for women who missed the chromosomal analysis
what is usually performed at the 25 week visit for antenatal care
Only for nulliparous women
Excludes pre-eclampsia
Glucose tolerance test (GTT) performed
What is usually performed at the 28 week visit for antenatal care
Fundal height measures
FBC and antibody measure
Anti-D given to Rhesus –ve women with a Rhesus +ve baby
What is usually performed at the 31 week visit for antenatal care
only for nulliparous women
fundal height
What is usually performed at the 34 week visit for antenatal care
FBC
fundal height
What is usually performed at the36,38,40 week visits for antenatal care
Fundal height measured
Foetal lie, presentation and engagement are checked
Breech = referral for external cephalic version
What is usually performed at the 41 week visit for antenatal care
Fundal height checked
Foetal lie, presentation, engagement check
Membrane sweep is offered
Induction by 42 weeks also offered
what are examples of minor conditions of pregnancy
Pruitis pelvic girdle pain abdominal pain heartburn backache constipation ankle oedema leg cramps carpel tunnel vaginits tiredness
how should you investigate pruitis in pregnancy
sclera, LFT, bile salts
what is important to remember in the management of leg oedema in pregnancy
may be a sign of pre-eclampsia but its unreliable
DO NOT give diuretics - associated with preeclampsia and IUGR
why is carpal tunnel syndrome associated in pregnancy
increased fluid retention causing compression
