antenatal care and screening Flashcards
what history is taken during the booking visit
menstrual hx PMH obstetric hx FHx SHx
what examination is done during the booking visit
height weight BP CVS abdo
what is naegele’s rule
predicts an estimated due date based on the onset of the women last menstrual period
(add nine months as 7 days)
what investigations are done during the booking visit
Hb ABO, rhesus syphilis, HIV, Hep B&C urinalysis USS
what does the USS look for during the booking visit
confirm viability singleton/multiple pregnancy estimate gestational age detect major structural anomalies that may be identified in early pregnancy offer DSS
what history is taken during follow up visits
physical and mental health
fetal movements
what examination is done at follow up visits
BP and urinalysis symphysis-fundal height lie and presentation engagement of presenting part fetal heart auscultation
what are the objectives for ultrasound screening for fetal anomaly
reduction in perinatal mortalities and morbidity
potential for in utero treatment
identification of conditions amenable to neonatal surgery
what is placenta praevia
the placenta is low lying in the womb and covers all or part of the entrance to the cervix
what should be done if an early USS (18 weeks to 20+6) shows that the placenta extends over the cervix
offer another scan at 32 weeks
if unclear offer a vaginal scan
down’s risk assessment during the first trimester
measure skin thickness behind the fetal neck using USS (nuchal thickness)
<3.5 mm is normal if CRL is between 45 and 84 mm
down’s risk assessment in the second trimester
blood sample at 15-20 weeks
assay of HCG and AFP
which biochemical markers are used to screen for aneuploidy
AFP
hCG
unconjugated oestradiol (UE3)
inhibin A
examples of specific diagnostic tests
amniocentesis
chorionic villus sampling
when can specific diagnostic tests be carried out
amniocentesis after 15 weeks
CRV after 12 weeks
risk of miscarriage with specific diagnostic tests
amnio = 1% CRV = 2%
when is maternal anaemia screened for
at booking and 28 weeks
how does rhesus disease develop
Rh -ve mother carries Rh +ve baby
Rh +ve blood cells from baby enter mother’s bloodstream
invading Rh +ve blood cells cause the production of Rh antibodies
Rh antibodies attack future baby’s +ve blood cells causing Rh disease
risk factors for gestational diabetes
BMI >30
previous maccrosomic baby weighing 4.5 kg or above
previous gestational diabetes
FHx of diabetes
minority ethnic family origin with a high prevalence of diabetes
why might symphysis fundal being be inaccurate
BMI >35
large fibroids
hydramnios
high risk factors for pre-eclampsia
HTN during previous pregnancy CKD autoimmune disease eg SLE or APS diabetes chronic HTN
what treatment can be given prophylactically if risk factors for pre-eclmapsia are present
75 mg aspirin for 12 weeks
one high risk factor
more than one moderate risk factor
moderate risk factors for pre-eclampsia
first pregnancy pregnancy interval of more than 10 years BMI >35 FHx of pre-eclampsia multiple pregnancy
why perform urinalysis at screening appointments
UTI
asymptomatic bacteriuria
PET diabetes
