Antenatal Care: Objectives, Theories and Practice - Dr. M Cheng

Question 1

Objectives of antenatal care

Answer 1

‘Healthy mother and healthy baby’
- Prevention of abnormalities (prescribe folic acid to prevent neural tube defect)
- Early detection of abnormalities (screening for early detection of foetal or vaginal abnormalities [Downs screening at 5 months, OGTT]
- Education [what to expect during labour, pain relief methods]

Question 2

What problems do we screen for in antenatal care (maternal & foetal)?

Answer 2

Maternal:
- General health including anaemia (thalassemia, screen father as well to see if baby is at risk of major thalassaemia)
- Common infections (rubella, HIV)
- Common pregnancy complications: GDM, HT

Fetal:
- Incorrect gestational age
- Multiple pregnancy
- Congenital abnormalities (TOP, there is legal limit)
- Abnormal growth (IUGR or excessive growth)
- Abnormal lie and presentation (transverse lie, oblique lie // not cephalic presentation, need to discuss mode of delivery)

Question 3

Screening in antenatal care:
- History
- P/E
- Ix
- Screening program for specific abnormalities

Answer 3

History:
- Past health
- Past obstetric Hx
- Age
- FHx of abnormal babies/pregnancies
- Habits (smoking, drinking, drug use)
- Menstrual Hx (estimated date of confinement)
- Sx during pregnancy (vomiting, may require antiemetics to take normal diet)

P/E:
- Weight
- Height (BMI)
- General (thyroid, heart, chest, breast)
- BP
- Urinalysis (sugar & albumin)
- Size of uterus (AGA)

Ix:
- Hb
- MCV
- HBsAg
- Rubella
- Rh
- VDRL
- HIV
- U/S

Screening program for specific abnormalities:
- Foetal Down syndrome
- Thalassaemia

Question 4

Systems for antenatal care

Answer 4

• Exclusive hospital (specialist) care [high-risk pregnancies]
• Primary health care based with referral to specialist only when indicated
• Shared care (between hospital and primary health care)
  — Outreach (usually by trained but not medically qualified persons)

Primary care can be by GPs or midwives

Question 5

Overview of antenatal care in Tsan Yuk Hospital

Answer 5

Question 6

What Ix are preformed during antenatal care in Tsan Yuk Hospital?

Answer 6

• Ultrasound: routine at booking (dating, viability, number), and at 18-20 weeks for foetal abnormalities) and when indicated
• Down syndrome screening (age, ultrasound fetal nuchal translucency measurement, biochemical screening)
• Thalassaemia screening (MCV)
• Gestational diabetes screening (risk factor and universal OGTT at 30 weeks) [screen earlier if mother has advanced maternal age, previous gestational DM, obesity, multiple pregnancy]
• Cervical smear (opportunistic screening)