Antenatal Care

Question 1

what are the aims of antenatal care

Answer 1

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

Question 2

at what week gestation does the booking visit take place and whats its purpose

Answer 2

10 weeks, to identify any risks of pregnancy and choose how the care will be led

Question 3

what are high risk ages for pregnancy

Answer 3

<17, >35

Question 4

what previous obstetric complications classify a patient as high risk for pregnancy

Answer 4

Preterm labour 
Small for age  
'growth restricted' foetus  
Still birth  
Antepartum/postpartum haemorrhage  
Congenital abnormalities  
Rhesus disease  
Pre-eclampsia  
Gestational diabetes

Question 5

what medical history components classify a patient as high risk for pregnancy

Answer 5

Diabetes

Hypertensioin

Autoimmune conditions

Cardiac disease

Renal disease

Thromboembolic disease

Haemoglobinopathy

Past mental illnessses

Question 6

what familial disease must be screened for at the 10 week booking visit

Answer 6

T1DM
HTN
Pre-eclampsia
thromboembolic disease
autoimmune diseases

Question 7

what investigations should be done at the 10 week booking visit

Answer 7

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

Question 8

what examinations are done at the 10 week booking visit

Answer 8

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

Question 9

what are the health promotion aspects used in antenatal care

Answer 9

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

Question 10

what is the criteria for the bigger (5mg) dose of folic acid in the antenatal period

Answer 10

Anti-epileptics

BMI >30

Malabsorption

Sickle cell disease

Question 11

what is the criteria for the bigger dose of vitamin D (25mcg)

Answer 11

BMI >30

South Asian/Afro-Caribbean

Low sunlight exposure

Question 12

what gestation is the pertussis vaccine offered

Answer 12

28 weeks

Question 13

What is tested for at the 20 week scan in antenatal care

Answer 13

structural foetal anomalies

cervical length (<24mm is 10th centile - risk for premature delivery)

Uterine artery scan - risk of IUGR/preclampsia

Question 14

how many antenatal visits are recommended by NICE

Answer 14

7 for uncomplicated women

10 for complicated pregnancies

Question 15

what is done at every antenatal visit

Answer 15

BP
Urine Dip
abdominal exam
foetal heartbeat

Question 16

when does the palpation of the abdomen become more important

Answer 16

36 weeks as you can only really assess presentation at this stage

Question 17

what is usually performed at the 16 week visit for antenatal care

Answer 17

Results of chromosomal abnormalities screen

Booking for blood tests

‘triple test’ is offered for women who missed the chromosomal analysis

Question 18

what is usually performed at the 25 week visit for antenatal care

Answer 18

Only for nulliparous women

Excludes pre-eclampsia

Glucose tolerance test (GTT) performed

Question 19

What is usually performed at the 28 week visit for antenatal care

Answer 19

Fundal height measures

FBC and antibody measure

Anti-D given to Rhesus –ve women with a Rhesus +ve baby

Question 20

What is usually performed at the 31 week visit for antenatal care

Answer 20

only for nulliparous women

fundal height

Question 21

What is usually performed at the 34 week visit for antenatal care

Answer 21

FBC

fundal height

Question 22

What is usually performed at the36,38,40 week visits for antenatal care

Answer 22

Fundal height measured

Foetal lie, presentation and engagement are checked

Breech = referral for external cephalic version

Question 23

What is usually performed at the 41 week visit for antenatal care

Answer 23

Fundal height checked

Foetal lie, presentation, engagement check

Membrane sweep is offered

Induction by 42 weeks also offered

Question 24

what are examples of minor conditions of pregnancy

Answer 24

Pruitis
pelvic girdle pain
abdominal pain
heartburn
backache
constipation 
ankle oedema 
leg cramps
carpel tunnel 
vaginits
tiredness

Question 25

how should you investigate pruitis in pregnancy

Answer 25

sclera, LFT, bile salts

Question 26

what is important to remember in the management of leg oedema in pregnancy

Answer 26

may be a sign of pre-eclampsia but its unreliable

DO NOT give diuretics - associated with preeclampsia and IUGR

Question 27

why is carpal tunnel syndrome associated in pregnancy

Answer 27

increased fluid retention causing compression