Antenatal care Flashcards
Most common symptom of pregnancy?
Period cessation
Common symptoms of pregnancy
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
What is Chadwick’s sign in pregnancy?
Cervix and vagina have blue tinge during pregnancy due to blood congestion
What secretes hCG?
Trophoblastic tissues
Outline rise in hCG during pregnancy
Rises exponentially from day 8 after ovulation
Peaks at 8–12 weeks
Can be measured in blood or urine
How is a pregnancy dated?
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
Why is dating a pregnancy using the date of the last menstrual period not very accurate?
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
How is an IVF pregnancy dated?
Begin counting from the day of embryo transfer
When does the dating ultrasound scan occur?
8–13 weeks
What is the most accurate way of assessing the date of the pregnancy?
Dating ultrasound scan which happens between 8 and 13 weeks
< 8 weeks: unreliable
>13 weeks: other factors affect fetal growth
How is gestation calculated during the dating scan?
Crown – rump length is measured
Which measurements can be made using ultrasound if there is a suspicion that a fetus may be small or large for gestational age?
Biparietal diameter and head circumference
Abdominal circumference: single most important measurement in assessing foetal size and growth
Femur length
What might cause a uterus to measure small for dates?
Wrong dates, oligohydramnios, IUGR, presenting part of fetus deep in pelvis, abnormal lie
What might cause a uterus to measure large for dates?
Wrong dates, macrosomia, polyhydramnios, multiple pregnancy, presence of fibroids
How many antenatal appointments do women have?
7 if parous
10 if nulliparous
*Providing pregnancy is uncomplicated
Outline schedule for antenatal visits
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)
What happens at the booking visit?
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
What happens at the 16 week appointment?
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
What happens at the 18–20 week appointment?
Anomaly scan, discussion regarding fetal movements and what to do if fetal movements are reduced
What happens at the 25 week appointment?
Blood pressure is taken and urine dip for protein urea
Symphysis fundal height is measured
*Nulliparous women only*
What happens at the 28 week appointment?
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
What happens at the 31 week appointment?
Protein urea, blood pressure and symphysis fundal height
*Nulliparous only*
What happens at the 34 week appointment?
Second dose of anti-D, blood pressure, proteinurea, symphysis fundal height
What happens at the 36 week appointment?
Discuss breastfeeding, newborn care, vitamin K injection after birth
Check baby’s position
Blood pressure, protein urea, symphysis fundal height
What happens at the 38 week appointment?
Blood pressure, protein urea, symphysis fundal height
What happens at the 48 week appointment?
Blood pressure, proteinuria, symphysis fundal height
Advice regarding prolonged pregnancy
When is anti-D given during pregnancy?
Given to Rh- women only
28 and 34 weeks
*No need to give if both parents are Rh-*
When is SFH usually measured from?
25 weeks, then measured at every subsequent appointment along with proteinurea and blood pressure
Discuss routine antenatal bloods
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
Women tests positive for HbSAg - how is this managed?
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
Woman is chronically infected with hepatitis B - how was this managed?
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
When is an HIV test done during the antenatl period?
Booking visit
How is vertical HIV transmission avoided?
C-section
Use of anti-retrovirals
Avoidance of breast feeding
Is sickle cell disease screened for in all women?
No - varies relative to local population
Consequences of congenital syphilis
Rash, saddle nose, FTT, abnormal teeth, skin scarring
Tested for via blood test and treated with antibiotics to reduce vertical transmission
What is given to strep B positive women during labour?
Benzylpenicillin
