Antenatal care

Question 1

Most common symptom of pregnancy?

Answer 1

Period cessation

Question 2

Common symptoms of pregnancy

Answer 2

N&V: common in 1st trimester

Increased micturition frequency: increased oressure on bladder & increased plasma volume > increased urine production

Fatigue: tends to go by week 12

Breast tenderness: early pregnancy

Foetal movements: week 20 in nullipara, week 18 if para

Pica

Question 3

What is Chadwick’s sign in pregnancy?

Answer 3

Cervix and vagina have blue tinge during pregnancy due to blood congestion

Question 4

What secretes hCG?

Answer 4

Trophoblastic tissues

Question 5

Outline rise in hCG during pregnancy

Answer 5

Rises exponentially from day 8 after ovulation

Peaks at 8–12 weeks

Can be measured in blood or urine

Question 6

How is a pregnancy dated?

Answer 6

Estimated date of delivery is based on the first day of the last menstrual period

By using Naegele’s rule:

Take of first day of LMP e.g. 19th September

Add 7 days e.g. 26th September

Minus 3 calendar months e.g. 26th June

Add 1 year = 26th June 2021

Question 7

Why is dating a pregnancy using the date of the last menstrual period not very accurate?

Answer 7

Women are often uncertain of last menstrual period dates, ovulation doesn’t always occur on day 14 and length of proliferative phase varies

40% of women deliver within five days of the estimated date of delivery and 60% deliver within 10 days

Question 8

How is an IVF pregnancy dated?

Answer 8

Begin counting from the day of embryo transfer

Question 9

When does the dating ultrasound scan occur?

Answer 9

8–13 weeks

Question 10

What is the most accurate way of assessing the date of the pregnancy?

Answer 10

Dating ultrasound scan which happens between 8 and 13 weeks

< 8 weeks: unreliable

>13 weeks: other factors affect fetal growth

Question 11

How is gestation calculated during the dating scan?

Answer 11

Crown – rump length is measured

Question 12

Which measurements can be made using ultrasound if there is a suspicion that a fetus may be small or large for gestational age?

Answer 12

Biparietal diameter and head circumference

Abdominal circumference: single most important measurement in assessing foetal size and growth

Femur length

Question 13

What might cause a uterus to measure small for dates?

Answer 13

Wrong dates, oligohydramnios, IUGR, presenting part of fetus deep in pelvis, abnormal lie

Question 14

What might cause a uterus to measure large for dates?

Answer 14

Wrong dates, macrosomia, polyhydramnios, multiple pregnancy, presence of fibroids

Question 15

How many antenatal appointments do women have?

Answer 15

7 if parous

10 if nulliparous

*Providing pregnancy is uncomplicated

Question 16

Outline schedule for antenatal visits

Answer 16

25, 31 and 40 weeks = nulliparous only

1. Booking visit by 10 weeks

2. 16 weeks

3. 18-20 weeks anomaly scan

4. 25 weeks (nulliparous only)

5. 28 weeks

6. 31 weeks (nulliparous only)

7. 34 weeks

8. 36 weeks

9. 38 weeks

10. 40 weeks (nulliparous only)

Question 17

What happens at the booking visit?

Answer 17

Should take place by 10 weeks

Hx: Obs hx, PMHx, family hx etc

Bloods: blod group, Rh status, infections, screen for rubella, HIV, hep B, Hb (anaemia)

Urine: proteinuria, bacteriuria

BMI

USS: gestational age (crown - rump), Down’s screening

* Dating scan doesn’t always occur during the booking visit, women may be invited for dating scan a few weeks after the booking visit

Question 18

What happens at the 16 week appointment?

Answer 18

Discuss screening results, if haemoglobin is less than 11 or 110 This is investigated and discussion regarding iron tablets occurs, 18–20 week anomaly scan is arranged

Question 19

What happens at the 18–20 week appointment?

Answer 19

Anomaly scan, discussion regarding fetal movements and what to do if fetal movements are reduced

Question 20

What happens at the 25 week appointment?

Answer 20

Blood pressure is taken and urine dip for protein urea

Symphysis fundal height is measured

*Nulliparous women only*

Question 21

What happens at the 28 week appointment?

Answer 21

Haemoglobin is checked to look for anaemia, screen for atypical red-cell alloantibodies, anti-D prophylaxis for Rh^- women, blood pressure, urine dip

Symphysis fundal height

Question 22

What happens at the 31 week appointment?

Answer 22

Protein urea, blood pressure and symphysis fundal height

*Nulliparous only*

Question 23

What happens at the 34 week appointment?

Answer 23

Second dose of anti-D, blood pressure, proteinurea, symphysis fundal height

Question 24

What happens at the 36 week appointment?

Answer 24

Discuss breastfeeding, newborn care, vitamin K injection after birth

Check baby’s position

Blood pressure, protein urea, symphysis fundal height

Question 25

What happens at the 38 week appointment?

Answer 25

Blood pressure, protein urea, symphysis fundal height

Question 26

What happens at the 48 week appointment?

Answer 26

Blood pressure, proteinuria, symphysis fundal height

Advice regarding prolonged pregnancy

Question 27

When is anti-D given during pregnancy?

Answer 27

Given to Rh^- women only

28 and 34 weeks

*No need to give if both parents are Rh^-*

Question 28

When is SFH usually measured from?

Answer 28

25 weeks, then measured at every subsequent appointment along with proteinurea and blood pressure

Question 29

Discuss routine antenatal bloods

Answer 29

FBC: looks for anaemia, lower limit in pregnancy is 10.5 which is lower than in non-pregnant women

Blood-group and antibodies

Rubella screen: 2% of nulliparous women are not immune to rubella and they are recommended to have a vaccination postpartum

Syphilis screen: Low incidence in the UK but screening is cost-effective and early treatment can prevent congenital syphilis

Hep B screen: In the urinates 90% of babies exposed to hepatitis B become chronic carriers therefore it is important to screen and treat

HIV screen: Risk of transmission is lowered through the use of anti–retrovirals, C-section and avoidance of breastfeeding

Question 30

Women tests positive for HbSAg - how is this managed?

Answer 30

Baby is given HBIG (hep B immunoglobulin) And vaccination immediately after birth, each injection is given on either thigh

GP will then give three further doses of the hepatitis B vaccine to the child during the 1st, 2nd and 12th month of life

Question 31

Woman is chronically infected with hepatitis B - how was this managed?

Answer 31

Indicated if the mother has HBcAb or anti-HBc

Baby will be given vaccination but they are not given Ig

Vaccination 1: within 24 hours of birth

Vaccination 2: at one month old – given by GP

Vaccination 3: at two months old – given by GP

Vaccination 4: at 12 months old – given by GP

Vaccination 5: with their other pre-school vaccinations (at three-and-a-half years old) – given by GP

Question 32

When is an HIV test done during the antenatl period?

Answer 32

Booking visit

Question 33

How is vertical HIV transmission avoided?

Answer 33

C-section

Use of anti-retrovirals

Avoidance of breast feeding

Question 34

Is sickle cell disease screened for in all women?

Answer 34

No - varies relative to local population

Question 35

Consequences of congenital syphilis

Answer 35

Rash, saddle nose, FTT, abnormal teeth, skin scarring

Tested for via blood test and treated with antibiotics to reduce vertical transmission

Question 36

What is given to strep B positive women during labour?

Answer 36

Benzylpenicillin