Antenatal Care Flashcards
Describe the timeline of a low risk pregnancy appointments
Booking appointment - 8-12 weeks
Review 16 weeks
Anomaly Scan 20 weeks
Midwife review - 25,28,31,34,36 weeks
What is classed as ‘term’?
37-42 weeks
What is included in the booking appointment history?
Obstetric Medical Surgical Allergies Mental Health Family Social - domestic abuse and FGM
What examination is done at booking visit?
Height
Weight
BP
What blood tests are done at booking?
Hb
ABO - rhesus/antibody
Syphilis, HIV, HBV and HCV
Urinalysis
What will a booking ultrasound determine?
Confirms viability Most accurate time to determine chronicity Shared sac/placental site Estimated Delivery Date Major structural abnormalities Offer trisomy screening
How do you calculate the estimated due date?
Add 280 days to the woman’s last menstrual period using gestational calculator
What is done on examination at the review appointments?
BP Urinalysis Symphysis-fundal height Lie and presentation Engagement of presenting part Foetal heart auscultation
State the 11 diseases an anomaly scan screens for
Anencephaly Bilateral renal agenesis Cleft Lip Diaphragmatic Hernia Exomphalos Gastroschisis Spina Bifida Serious cardiac abnormality Lethal skeletal dysplasia Edward's syndrome Patau's Syndrome
When is the anomaly scan?
18-20 weeks
Describe the variations in placental site
Does not cover cervix - no further scans needed
Covers cervix - scan at 32 weeks to ensure it has moved
Transvaginal ultrasound may be required
What is placental praevia and how is it managed?
Placenta covers lower uterus and part of cervix
C-section at 37-38 weeks
Antepartum haemorrhage - immediate section
Name three types of trisomy
21 - Down’s
18 - Edward’s
13 - Patau’s
Describe trisomy 21
50% have a normal anomaly scan, cannot predict severity
Describe trisomy 18/13
Edwards - lethal if complete - stillbirth or neonatal death
Partial - significant disability can be identified on anomaly
What is the rate of recurrence of anomalies?
1%
How are trisomy screened for in the first trimester?
Nuchal Thickness
Blood tests - hCG and PAPP-A
Describe nuchal thickness
Fluid behind the foetal neck, measured at 11-13+6 weeks
<3.5 normal when CRL 45-84mm
What two substances are measured in the trisomy blood test?
HCG
PAPP-A
What does an increased NT indicate?
Chromosomal abnormality
Cardiovascular abnormality
Higher risk of foetal death
When and why is trisomy screened in the second trimester?
15-20+6 weeks
Women who book late or have unsuccessful first trimester screening
How is down’s screening carried out in the second trimester?
Includes maternal age and biochemical markers
Which biochemical markers are included in a second trimester test?
Alpha-fetoprotein
hCG
Unconjugated oestradiol
Inhibin A
Describe an NIPT test
Cell free foetal DNA - detects foetal DNA in blood sample from mother. Detectable from 10 weeks and continues to rise - screening tool
Name the two diagnostic tests for trisomy and when are they performed
Amniocentesis - after 15 weeks
Chorionic villus sampling - after 12 weeks
What are the two main haematological conditions screened for in pregnancy?
Sickle cell and thalassemia
Why does alpha fetoprotein increase in certain abnormalities?
Spina bifida
Gastroschisis
Twins
Internal organs are closer to the amniotic fluid causing increased circulating alpha fetoprotein
Name the four findings on urinalysis in pregnant women
- UTI
- Asymptomatic bacteriuria
- Proteinuria (pre-eclampsia)
- Glucose (diabetes)
Name three types of anaemia in pregnancy
Iron deficiency
Folate deficiency
B12 deficiency
When is anaemia screened for?
Screening at booking and 28 weeks
When is the blood group/antibodies determined?
Booking and 28 weeks
What is meant by rhesus negative?
You do not have the D antigen on blood cell surface
What happens if a rhesus negative mother is exposed to rhesus antigen?
Sensitising event - mother will produce antibodies and attack the baby’s blood cells
What can sensitising events lead to in terms of the baby?
Foetal anaemia, hydrops and intrauterine death
How is haemolytic disease of the newborn investigated?
Ultrasound - foetal middle cerebral artery
How is haemolytic disease of the newborn treated?
Deliver with blood transfusion
In-utero transfusion
What test can check for antibodies?
Coombs test
Where is anti-D immunisation given?
Deltoid - IM or SC
What doses of anti-D immunisation?
<20 weeks 250 units
>20 weeks 500 units
Prophylaxis 1500 units
What would be classed as a sensitising event?
TOP Abdominal trauma Invasive investigation Haemorrhage External cephalic version Miscarriage Ectopic pregnancy
How is a baby born with haemolytic disease of the newborn treated?
Phototherapy
Exchange transfusion
State the risks of gestational diabetes
BMI >30 Previous macrocosmic baby weight Previous gestational diabetes Family history of diabetes Ethnic minority All women who have gone through stillbirth should be tested
Describe the difference between high risk and low risk pre-eclampsia treatment
High Risk - 150mg aspirin daily 12-36weeks
Low Risk - 75mg aspirin daily 12 weeks - birth
