Antenatal care Flashcards
What are the aims of antenatal care?
- Detect and manage pre-existing maternal disorders that may affect pregnancy outcome
- Prevent or detect and manage maternal complications of pregnancy
- Prevent or detect and manage foetal complications of pregnancy
- Detect congenital foetal problems, if requested by the parents
- Plan, with the mother, the circumstances of pregnancy care and delivery to ensure maximum safety for the mother and baby, and maximum maternal satisfaction
- Provide education and advice regarding lifestyle and ‘minor’ conditions of pregnancy
What’s involved in preconceptual care and counselling?
- Previous pregnancies: could have been traumatic and have implications on another pregnancy
- Health check: assess for cardiovascular health or cervical smear abnormalities
- Rubella status: so immunisation can occur prior to pregnancy
- Chronic condition check: glucose control optimised in diabetes or blood pressure control
- Medication: eg. anti-epileptics
- Folic acid supplements: reduce the chances of neural tube defects
What is the booking visit?
10 weeks gestation
screen for possible complications that may arise in pregnancy, labour and the puerperium
Gestation checked, appropriate prenatal screening is discussed and a general health check
What are the risk factors for complications during birth or pregnancy?
<17 and >35
Preterm labour, SGA, stillbirth, haemorrhage, rhesus disease, pre-eclampsia, gestational diabetes
Past gynaecological surgery
PMH: hypertension, diabetets, autoimmune disease, cardiac, renal, mental illness
Drugs
FH: gestational diabetes is more common if a 1st degree relative has diabetes: hypertension, thromboembolic and autoimmune disease and pre-eclampsia are also familial
Which examinations are performed at the booking visit?
- BMI is calculated: if >30 maternal and foetal complications are more common
- Baseline BP: enables comparison if hypertension occurs later in pregnancy
- From 12 weeks the foetal heart can be ausculated, but abdominal palpation is hard before 3rd trimester
- If a smear has not been performed for 3 years: it is usually done 3 months postnatally
Which investigations are performed at the booking visit?
• Ultrasound scan: 11-13 +6 weeks, foetus is ‘dated’ using crown-rump length, unless IVF pregnancy
detects multiple pregnancy and screening for chromosomal abnormalities with nuchal
translucency measurement, in conjunction with β-hCG and PAPPA as the ‘combined test’
Blood tests
Infection screening: chlamydia and BV cause preterm labour
• Urine MC&S: asymptomatic bacteriuria in pregnancy commonly leads to pyelonephritis (20%)
• Urinalysis for glucose, protein and nitrites, underlying diabetes, renal disease and infection
Which blood tests are perfumed at the booking visit?
o FBC: pre-existing anaemia
o Serum antibodies (anti-D): intrauterine isoimmunisation
o Glucose tolerance test: in at risk women (>30 BMI)
o Blood tests for syphilis: serious implications on foetus
o Rubella immunity: vaccination offered postnatally
o HIV & HepB: counselling and screening offered
o Haemoglobin electrophoresis, in at risk women, sickle cell anaemia & thalassaemias
What health promotion advice is given in antenatal care?
- Folic acid: 0.4mg/day should continue until at least week 12, increased doses of 5mg/day in women with BMI >30, sickle disease, malabsorption or if on anti-epileptics
- Vitamin D: recommended for all women (10µg/day) or 25µg/day in women with BMI >30, South Asian or Afro-Caribbean origin or with low sunlight exposure or with increased pre-eclampsia risk
- Aspirin: 75mg recommended in women with increased pre-eclampsia risk
- Immunisation: seasonal flu vaccine and >28weeks pertussis vaccine
- Exercise: advised, with swimming being good
- Sleeping: left lateral position from 28 weeks
- Antenatal classes: prepare and educate women and partners about pregnancy and labour
What diet advice is given in antenatal care?
o 2500 calories
o No alcohol or smoking
o Avoid Listeriosis by drinking only pasteurised or UHT milk, avoiding soft/blue cheese, pate and uncooked/partially cooked ready prepared food
What is the anomaly scan?
USS at around 20 weeks
enables detection of most structural foetal abnormalities
• USS cervical length measurement, around 20 weeks can be used for risk assessment of preterm delivery-
progesterone can be given to women who have a short cervix but are otherwise ‘low risk’
• USS measurement of uterine artery, can be used as screening for IUGR and pre-eclampsia
What is the routine later pregnancy test?
FBC and antibody assessment- performed at 28 weeks
FBC repeated later if treated for anaemia
• Non-invasive prenatal testing (NIPT)- used to determine if Rhesus –ve mother is carrying a Rhesus +ve baby, only those with a +ve baby are given anti-D
How many antenatal appointments do the NICE guidelines recommend?
10 appointments for uncomplicated pregnancies in a nulliparous women and 7 appointments for uncomplicated pregnancies in a multiparous women
more frequent visits are appropriate in ‘high-risk’ pregnancies
What occurs during the antenatal appointments at each week?
• 16 weeks: results of screening tests for chromosomal abnormalities and booking blood tests, ‘triple test’
is offered for women who missed chromosomal abnormality testing
• 18-21 weeks: anomaly scan is performed, further scan at 32 weeks if placenta is low
• 25 weeks: only recommended for nulliparous women, exclude onset of pre-eclampsia and GTT if required
• 28 weeks: fundal height is measured, FBC & antibodies checked, anti-D given to Rhesus –ve women
• 31 weeks: fundal height is measured in nulliparous women
• 34 weeks: fundal height is measured, FBC is rechecked if haemoglobin was low
• 36, 38 & 40 weeks: fundal height is measured and foetal lie & presentation are checked, referral for external cephalic version (ECV) is offered if in breech position
• 41 weeks: fundal height is measure and foetal lie & presentation check, membrane sweeping is offered, as is induction of labour by 42 weeks
What are the minor conditions in pregnancy?
Itching: check for jaundice and bile acids assessed
Pelvic girdle pain: pubic/sacroiliac joints- physio, corsets, analgesics and crutches may be used
Abdo pain
Heartburn: affects 70% of women
Backache: may cause sciatica
Constipation: exacerbated by oral iron
Ankle oedema: don’t give diuretics
Leg cramps: 30% of women
Carpal tunnel syndrome: due to fluid retention
Vaginitis: due to candidiasis- imidazole vaginal pessaries
Tiredness
Which congenital abnormalities are commonly found?
o Structural derformities: diaphragmatic hernia
o Chromosomal abnormalities: Down’s syndrome
o Inherited disease: cystic fibrosis
o Intrauterine infection: rubella
o Drug exposure: anti-epileptics
