Antenatal Care And Screening

Question 1

What physiological changes are associated with normal pregnancy in the mother?

Answer 1

• Morning sickness (increase in HCG)
• increase in cardiac output by 30-50%
• drop in BP in 2nd tm, normal in 3rd
• increase urine output
• UTI due to urinary stasis
• anaemia due to increase in plasma volume so dilutions occur and iron requirements increase
• shortness of breath
• hyperaemia of mucous membranes so nosebleeds, runny nose
• heartburn
• GORD
• constipation due to reduced GI motility

Question 2

What is pre pregnancy counselling?

Answer 2

Counselling pre pregnancy regarding: general health measures eg improve diet, optimise BMI, reduce alcohol consumption, smoking cessation and folic acid

If have medical problems: optimise maternal health, psychiatric health, drug assessment, advise regarding complications, occasionally against pregnancy

Previous pregnancy: counsel regarding risk of recurrence, and actions to reduce problems both maternally and foetally eg DVT, pre eclampsia, foetal abnormalities

Question 3

What is the procedure and implications of the antenatal examination?

Answer 3

• routine enquiry
• blood pressure
• urinanalysis
• abdominal palpation (SFH, size, liquor volume)
• determine foetal presentation
• listen to foetal heart

High quality antenatal care reduces foetal and maternal, mortality and aims to identify problems with mother, foetus and socially

Question 4

What is the basis for screening for foetal abnormality?

Answer 4

Allows conditions to be detected early in a symptomless population & treated

Infection: hep B, syphilis, HIV, UTI &
Iron deficency anaemia, rhesus, antiC, antiKell

Question 5

What screening tests are offered to women and what are their limitations?

Answer 5

First visit scan (10-14wk) - USS: ensures viability, multiple pregnancy, any abnormalities incompatible with life, Down syndrome screen (involves nuchal translucency - increases with gestational age and incidence of chromosomal and other abnormalities)

Detailed anomaly scan (2nd trimester 20wk) - USS: structural review, cannot identify all problems, can identify those which need intrauterine or postnatal treatment

Can also look at maternal serum biochemistry: alpha fetoprotein for neural tube defects

Question 6

What ethical dilemmas are associated with detection of foetal abnormalities?

Answer 6

Can detect chromosomal abnormalities or structural defects which will give mother option to terminate pregnancy and so ending a life, technically