Antenatal Care - Normal Pregnancy Flashcards
Which vitamin supplementations are recommended for pregnancy women?
Folic acid 400mg - before conception, until 12 weeks gestation
Vitamin D - during pregnancy and continued when breastfeeding
Which groups of women should carry on taking folic acid after 12 weeks? How much should they take?
Diabetes Anti-epileptic medications BMI > 30 Previous neural tube defect in pregnancy --> take 5mg daily from 12 weeks
What are the risks of smoking in pregnancy?
Increased risk of:
- miscarriage
- pre term labour
- IUGR
- still birth
- SIDS (sudden infant death syndrome)
What are the risks of drinking alcohol during pregnancy?
Foetal alcohol syndrome (FAS) IUGR + postnatal restricted growth Learning difficulties Risk of miscarriage Withdrawal Wernicke's encephalopathy + Korsakoff's syndrome Microcephaly
What are the features of FAS?
Learning + behavioural problems Poor growth Facial abnormalities: - smooth philtrum - thin vermillion - small palpebral fissures
When is the booking visit and who is it with?
At 10-12 weeks gestation (ideally - can be done up to 14 weeks)
With community midwife
(referred to obstetrician if any risk factors identified)
What is done at the booking visit?
Detailed history - medical - drug - social - family - ethnicity (haemoglobinopathies) - LMP Obstetric history Measure BP Blood tests: - blood group (Rh status) - Hb levels - haemoglobinopathies - infections: HIV/AIDs, syphilis, hep B + C - immunity against chicken pox, rubella etc Dating scan
What is the normal schedule for antenatal care in Scotland?
10 - 13+6 weeks (booking) 16 weeks 18-20 weeks 24 weeks 28 weeks 31-32 weeks (primiparous women) 34-36 weeks 38 weeks 40 weeks 41 weeks 42 weeks
What happens at the 16 weeks appointment?
Discuss results from screening tests
BP + urine to check for protein
Information about anomaly scan
What happens are the 18-20 weeks appointment?
Anomaly scan
offered to all - can decline
What happens at the 24 weeks appointment?
Advice on antenatal classes Discuss foetal movements BP + urine check Check symphyseal fundal height (SFH) Foetal heart auscultation
What happens at the 28 weeks appointment?
Discuss whooping cough vaccine (offered between 28-32 weeks)
Random glucose - gestational DM
Anti-D if rhesus negative
What happens at the 34-36 weeks appointment?
Discuss labour + birth plan
BP, urine, SFH, foetal heart
Position + lie of baby
What happens at the 40 weeks appointment?
Information on what will happen if pregnancy lasts more than 41 weeks –> induction
How many antenatal appointments will uncomplicated nulliparous + multiparous women have?
Nulliparous –> 10
Multiparous –> 7
(with midwife)
What additional monitoring is given to women with pre-existing or gestational DM?
Additional scans at money intervals between 28 + 36 weeks gestation
- monitor foetal growth + amniotic fluid volume as increased risk of stillbirth, congenital malformation + polyhydramnios
Which conditions are screened for during the anomaly scan at 18-20 weeks?
Anencephaly Open spina bifida Cleft lip Diaphragmatic hernia Gastroschisis Exomphalos Cardiac anomalies e.g. TGA, ASD, VSD, TOP, HLHS Bilateral renal agenesis Lethal skeletal dysplasia Edward's (trisomy 18) Patau's (trisomy 13)
How is Down syndrome screened for?
Combined test –> blood test + USS
Done at 11+0 and 13+6 weeks gestation
What is the USS looking for in Down’s screening?
Nuchal thickness
What is the blood test looking for in Down’s screening?
Triple test:
- PAPP-A
- alpha fetoprotein (aFP)
- beta-hCG
If foetus has Down syndrome –> PAPP-A + aFP is low, beta-hCG + nuchal thickness increased
Why does exposure to rhesus antigen in an rhesus -ve mother cause problems for future pregnancies, rather than the current pregnancy?
When first exposed to rhesus antigen, mother forms IgM which is too big to cross the placenta
In future pregnancies, when exposure to same antigen on foetal RBCs, mother forms IgG (smaller and can cross placenta)
–> haemolytic disease of newborn
What can be done in cases of suspected rhesus isoimmunisation and how does it work?
Anti-D can be given to Rhesus negative mothers who have been exposed
- removes rhesus positive RBCs from mother’s circulation before antibodies are formed
When does anti-D have to given for maximal effect?
Within 72 hours of sensitising event or after birth
Which situations would require anti-D?
Placental abruption Abdominal trauma Amniocentesis or chorionic villus sampling External cephalic version Intra-uterine surgery/transfusion Foetal death Vaginal bleeding from 12 weeks Surgical management of miscarriage at < 12 weeks Evacuation of retained products Termination of pregnancy Ectopic pregnancy Delivery (if baby is rhesus positive)
How is the anti-D dose calculated?
Kleinbauer test –> quantifies foetal RBCs in mother’s blood
When is prophylactic anti-D given even if there has been no sensitising event?
at 28 weeks gestation in rhesus negative mothers
