Antenatal care and dates Flashcards
what is gravidity
number of confirmed pregnancies a woman has had regardless of the outcome of the pregnancy
what is parity
the total number of pregnancies a woman has carried beyond 20 weeks (and delivered, live or stillborn)
total number of births after 20 weeks
when is the booking appointment
10 weeks gestation
What screening should be offered at the booking appointment
provide information about baby development, nutrition, pelvic floor exercises
offer antenatal screening eg BBV, STIs, asymptomatic bacteriuria, Down’s, structural anomalies, gestational age, GDM, PET, mental health conditions
What assessments should be done at the booking appointment
height, weight, BMI
blood group
RhD status
anaemia, haemoglobinopathies, HBV, HIV, syphilis
urinalysis
USS to determine gestational age using CRL
what is CRL
crown rump length - from top to toe of foetus
when can CRL be measured
between 10-13+6 weeks
When can you do a Down’s screening test
which is more accurate
1st and 2nd trimesters
1st trimester is more accurate
what is done in a 1st trimester Down’s screening test, and when
NT is measured
PAPP-A levels
HCG levels
11-13+6 weeks
what is NT in Down’s screening
Nuchal thickness = measure of skin thickness behind foetal neck
PAPP-A levels are high/low in Down’s screening
low
HCG levels are high/low in Down’s screening
high
what is done at 2nd trimester Down’s screening
blood test 15-20 weeks
HCG levels
AFP levels
AFP levels are high/low in Down’s screening
low
what happens if there is a high risk of Down’s with the screening tests
you do a definitive test such as amniocentesis or chorionic villi sampling
What should the USS assess on booking visits
viability of pregnancy single vs multiple pregnancy gestational age estimate structural anomalies offer Down's screening
when is the next appointment after the 10 week booking appointment
16 weeks
what is done at the 16 week appointment
discuss results of screening tests
BP and check for proteinuria
when is the anomaly scan
18-20 weeks
if placenta previa is found at the anomaly scan, how should she be followed up
offer another USS at 32 weeks
for nulliparous women, when is the next appointment after the anomaly scan
25 weeks
What is done at the 28 weeks appointment
screening for anaemia
anti-D prophylaxis to Rh- women
BP and urinalysis
when is a second dose of anti-D administered
34 weeks
when can external cephalic version be offered
36 weeks
Increased NT is specific to Down’s syndrome, true or false
false
can be associated with a range of conditions
list biomarkers for aneuploidy screening
AFP
HCG
UE3
inhibin A
what is non-invasive prenatal testing NIPT
detects cell free foetal DNA cffDNA
when can amniocentesis be carried out
> 15 weeks
when can chorionic villus sampling be carried out
> 12 weeks
how are sickle cell anaemia and thalassemias inherited
autosomal recessive
who manages women in the green pathway
midwives
who manages women in the red pathway
obstetricians + midwifery support
why is it important to give anti-D to Rh- women
to prevent formation of antibodies against Rh which can attack baby in future pregnancy
what is looked for in urinalysis in pre-eclampsia
proteinuria ++
what are RF for GDM
BMI>30 previous macrosomic baby previous GDM FH ethnic minority
what should women take if they are at high risk of PET
75mg aspirin from 12 wk until delivery
what are RF for PET
HTN during previous pregnancy CKD autoimmune disease T1/2DM chronic HTN BMI>35 multiple pregnancy
why should women take folic acid in early pregnancy and at which doses
to prevent NTD e.g. spina bifida and anencephaly
400ug normally
5mg if: obese, AED, DM, coeliac, FH/personal history of NTD
what should be offered by 41 weeks for women who have not yet given birth
membrane sweep
induction of labour
BP and urinalysis
symphyseal fundal height
how many USS scans does a normal pregnancy get
2
purpose of USS at booking
gestational age abnormalities e.g. gastrochisis multiple pregnancy viable foetus in utero
rank multiple pregnancy chorionicity from most dangerous to safest
monoamniotic
monochorionic diamniotic
dichorionic diamniotic
TTTS is more likely to occur in monochorionic/dichorionic
mono
which trisomies are screened for in the 1st trimester
Downs - 21
Edwards - 18
Pataus - 13
order of anomaly screening
- NT and maternal blood markers (hCG and PAPP-A)
- NIPT or go straight to
- diagnostic amniocentesis / CVS
teratogenic drugs
ACEI warfarin Na valproate Lithium Methotrexate
are TCA and SSRIs safe in pregnancy generally?
yes
you must stop teratogenic drugs ASAP e.g. lithium
false, must refer to specialist ASAP instead
previous c-section increases the risk of
uterine rupture
any operation that has breached the uterine cavity can increase the risk of ..
uterine rupture
what are the booking bloods that are done in absolutely everyone who is pregnant
FBC - Hb (booking, 28 weeks) Blood group Rh status and red-cell antibodies haemoglobinopathies HIV, HBV, HCV, syphilis CMV only if in contact or symotomatic or foetal anomalies detected
what does maternal anaemia put a woman at increased risk of
maternal death by PPH
are congenital infections routinely screened for
not routinely screened: CMV toxoplasmosis rubella HSV HZV
are women screened for PID
no
unless symptomatic etc..
is D antigen the only one that can cause foetal anaemia
no, it is one of many
it is the only one that we can do anything about ie giving anti-D to Rh- mothers
USS can be used to identify foetal anaemia by looking at MCA, true or false
true
who is the primary responsibility for, mother or baby
mother
TVUSS is safe in pregnancy, true or false
true
what is cervical ‘incompetance’
the cervix just silently opens up meaning the baby can be lost
150mg aspirin taken at night instead of 75mg?
150mg is from new research and is found to be more effective
contraindications to aspirin
some asthmatics
PUD
vaccines available to pregnant women
flu
whooping cough
covid - for high risk women
at any gestation - maybe after 20 weeks
elective c-section indications
maternal choice
dont want to do c-section before 39 weeks
risk of ADHD and autism in child
IOL is safe at 39-42 weeks
it is always offered at 42 weeks
from increased risk of stillbirth
GBS prophylaxis
previous babies affected
if she is known to have it
yes - antibiotics
postnatal contraception
mirena coil…
if you fall pregnant within a year of c-section, risk of
accreta
rupture
where can a woman deliver
home
community
labour suite
any one at increased risk of PPH should be encourage to have active/physiological 3rd stage
active
does increase risk of N+V
reduces risk of PPH by 50%
anyone at risk of an emergency should have IV access, true or false
true
e.g. PET, epileptic, obese, twins
epidural labour for patients who are at high risk of needing an operation
yes
