Antenatal Care and screening in pregnancy

Question 1

what are the objectives of antenatal care? (5)

Answer 1

detect and manage pre-existing maternal disorders that may affect pregnancy outcomes
prevent/detect and manage maternal complications of pregnancy & foetal complications of pregnancy
detect congenital foetal problems if requested by parents
plan with the mother the circumstances of birth to ensure max safety
lifestyle advice

Question 2

Describe the typical pattern of antenatal care:

• wk 12
• wk 16
• wk 18
• wk 28
• wk 34
• when are follow up visits carried out? (3)

Answer 2

-booking visit (advice on diet and lifestyle + folic acid)
FBC, Antibodies, glucose, rubella, syphillis

• alpha FP or triple test
• USS
• Anti-D id Rh -ve
• FBC, antibodies, Anti-D if Rh-ve

-20-28 wks 4 weekly
28-36 wks fortnightly
36+ weekly

Question 3

name the hx (5) and examination (5) that should be done during a booking visit?
-investigations? (5)

Answer 3

Hx:
Menstrual (gestational age)
Medical (DM, Drug abuse)
Obstetric (post partum haemorrhage)
Family (congenital, genetic disease)
Social (alcohol/smoking/drugs)

examination:
HT, WT, BP, CVS, Abdomen

-Hb (anaemia)
ABO, Rhesus 
Syphilis, Rubella, HIV, Hep B&C
Urinalysis; MSSU C&S
US (confirm viability, No. of feotuses, confirm gestation)

Question 4

Follow up visits:

• Hx (2)
• examination(5)

Answer 4

-physical and mental health
foetal movement

-BP and urinalysis 
Symphysis- fundal height
Lie and presentation 
Engagement of presenting part 
Foetal heart auscultation

Question 5

Screening for foetal anomaly

• either specific or for “screening”
• what can US screening detect?

Answer 5

-cardiac defects

Gastroschisis

Question 6

How is a risk assessment for Down’s syndrome carrie out?

• first trimester
• second trimester
• what figure is considered high risk?
• specific diagnostic tests?
• what levels of AFP & HCG would indicate a higher risk?

Answer 6

-Nuchal thickness
(measured 11, 13, 6 weeks)
Combined with HCG and PAPPA

-blood sample at 15-20 wks & assay of HCG and AFP

+maternal age ad gestation to give personal risk

-1:250 high risk and requires

-amniocentesis
(US guided, after 15 wks, miscarriage risk of 1%)
Chorionic villus sampling
(after 12 weeks, miscarriage rate of 12%)

-AFP- low HCG- high