Antenatal care in uncomplicated pregnancies

Question 1

What information should be given to pregnant women at booking appointment? (13)

Answer 1

1. Folic acid - 400 micrograms or 5 milligrams for women ar higher risk of NT defects or obese. To be taken when planning, up to 12 weeks 2. Food hygiene 3. Smoking, alcohol, drug cessation 4. Info on screening tests (Hbpathies sickle and thalassaemia, anomalies, Down’s) 5. How baby develops 6. vitamin D 10 micrograms and risks to darker skinned women 7. exercise and diet 8. place of birth 9. pregnancy care pathway 10. breastfeeding 11. antenatal classes 12. mental health 13. advice on working and benefits

Question 2

How many antenatal appointments for uncomplicated pregnancy in 1. a nulliparous woman 2. parous woman

Answer 2

1. 10 2. 7

Question 3

When is the dating scan done? What else other than gestational age does it detect?

Answer 3

• Between 10+0 and 13+6 weeks - multiple pregnancies

Question 4

What measurement should be used to determine gestational age? Any exception?

Answer 4

Crown Rump Length If CRL >84mm, gestational age should be estimated using HC

Question 5

What occupations put women at higher risk of complications?

Answer 5

Nursery teacher w/o chicken pox exposure HCP and infectious diseases Vets toxoplasmosis Chefs/butchers salmonella

Question 6

What foods to avoid to avoid listeriosis? (4)

What foods to avoid to avoid salmonella? (2)

Answer 6

Listeria: Unpasteurised milk, soft/blue cheese, pate, uncooked meals

Salmonella: uncooked eggs, uncooked meat esp poultry

Question 7

What is the advice on alcohol in pregnancy?

Answer 7

Avoid completely in first 3 months due to risk of miscarriage

Do not drink more than 1 to 2 units, once or twice a week (small glass of wine twice a week)

Binge drinking is harmful

Question 8

Advice on car travel?

Answer 8

Wear seatbelt under or above the bump, not over it

Question 9

Advice on N and V in pregnancy?

Answer 9

• most cases will resolve 16-20 weeks
• not associated with poor pregnancy outcome

non-pharm tx: ginger, wrist acupressure

pharm tx: antihistamines

Question 10

Other small problems of pregnancy and tx?

Answer 10

Heartburn - diet modification and antacids

Constipation - diet modification like bran

Haemorrhoids - diet modification

Varicose veins - stockings help with Sx

Question 11

Advice on discharge?

Answer 11

An increase in discharge is normal, but if assoc with itch, soreness or smell then Ix should be considered

Candidiasis in pregnancy can be treated by topical imidazole

Question 12

What is normal Hb in pregnancy at booking and at 28 weeks?

Answer 12

booking: 11 g/dl

28 weeks: 10.5 g/dl

Question 13

Who should routine anti-D prophylaxis be offered to?

Answer 13

All non-sensitised rhesus D-negative women

Question 14

On booking and 28 weeks, if a woman has atypical red cell alloantibodies (regardless of rhesus D status) what should happen?

Answer 14

Referred to specialist centre

Question 15

How can sickle cell disease be screened for?

Answer 15

Family Origin Questionnaire

Lab (high preformance liquid chromatography) ie electrophoresis

Question 16

Anomlay scan can identify anomalise and allow (4)

Answer 16

Termination choice

parents to prepare

managed birth in specialist centre

IU therapy

Question 17

Down’s screening details?

Answer 17

Combined test at 11 to 13+6

• Nuchal translucency, bHCG, PAPP-A

Triple or quadruple test at 15 to 20 weeks

new: fetal DNA fragments in mothers plasma from 10 weeks (98% sensitive)

Question 18

Invasive diagnostic tests for Down’s?

Answer 18

Amniocentesis (>15 weeks, needle through abdo wall into fluid, then PCR or culture)

Chorionic villlous sampling (11-13+6, fetal placenta, transabdominally or less commonly transcervically)

Question 19

Booking appt infections to test for?

Answer 19

MSU

Hep B

HIV

Rubella susceptibility screening

Syphilis

Question 20

What conditions are screened for?

Answer 20

GDM

Preeclampsia each visit (BP and urine), RFs at booking

Question 21

Sx of preeclampsia told to women?

Answer 21

severe headache

blurry flashing vision

pain below ribs

vomiting

sudden swelling of face hands feet

Question 22

At anomlay scan, what low-lying placentas should be offered another TA scan and when?

Answer 22

Only when placenta lies over internal os (as most other low-lying palcentas resolve)

Question 23

When to start measuring and recording Symphysis-fundal height?

Answer 23

each appt from 24 weeks

Question 24

When should fetal presentation be assessed?

Answer 24

36 weeks or later

Question 25

Uncomplicated singleton breech presentation at 36 weeks, offered what?

Answer 25

external cephalic version.

C/Is: uterine scar, fetal compromise, women in labour, ROM, PV bleed, medical conditions