Antenatal care of uncomplicated pregnancy Flashcards
By what GA should a booking appointment take place ?
By 10 Weeks
How many routine antenatal appointments for
- nulliparous?
-multiparous?
Nulli - 10
Multi - 7
What do you do at the booking appointment ?
Detailed history
Assess risk for pre-eclampsia, IUGR, GDM, VTE, FGM
If face to face appointment - BMI,BP & urine dipstick
Blood investigation - CBC, BG, Rh
Offer screening for
Infections - HIV, HbsAg, VDRL
Sickle Cell and Thalassemia
Fetal anomaly
Should the woman’s partner be involved ?
as per her wishes
Risk of maternal mortality compared with white women
For black ?
For mixed ethnicity ?
For Asian ?
4 times in black
3 times higher in mixed
2 times higher in asia
Risk of stillbirth compared with white babies
For black ?
For Asian ?
More than twice
50% higher
Risk of maternal mortality in most deprived areas compared with least deprived ?
> 2.5 times
Risk of stillbirth in most deprived areas compared with least deprived ?
Twice - 2 times
At which GA are the scan appointments?
11.2 - 14.1 wks
For GA and to detect multiple pregnancy
If opted for, screen for T21,13,18
18 - 20.6 wks
Anomaly scan
Placental localization
My partner and I - both of us used to smoke but we have stopped smoking a week back when we found out we were pregnant.
What do you do for this woman ?
Refer to NHS Stop Smoking Services
If currently smoking or stopped within the past 2 weeks
Which blood investigations are repeated at the 28 wk appointment?
CBC
BG
Antibodies
Apart from the booking appointment, when is risk reassessed for
VTE
Pre eclampsia
IUGR
VTE - after any significant health event or hospital admission
Pre eclampsia and IUGR - 2nd trimester - 16 wk appointment
What GA do you perform an OGTT ?
24-28
28 weeks with BP 150/90
after OGTT, How urgent do you refer to secondary care ?
Within 24 hrs
If >=160/110 - same day
What GA onwards do you ask for fetal movements ?
24 wks
What GA do you examine for possible breech presentation?
36 w
How do you treat pelvic girdle pain ?
Physiotherapy
Non rigid lumbopelvic belt
Done with the Antenatal Care guideline
When to stat conceiving after course of Tamoxifen
3 months
because of tertogenicity, it taked from 2 to 3 months to wash out.
what u/s measure we use to date pregnancy
Crown rump lenght
which measurement we use to date pregnancy in case of CRL > 88mm
Head circumference
With regard to the routine anomaly scan in pregnancy, what threshold of nuchal-fold measurement should trigger a referral to a fetal medicine specialist?
> 6 mm
In an uncomplicated pregnancy, how often should auscultation of the fetal heart be performed by the midwifery team?
only when requesteed by the mother
women after 42 weeks who decline IOL
close monitoring:
- CTG twice weekly
- AFV assessment
in Non stress test, beat to beat variability indicates ?
intact fetal brain stem and heart
FHR baseline
110-160
in NST, Early deceleration indicates
Vagally mediated, caused by head compression usually at cervical dilation of 4–7 cm.
in NST, variable deceleration indicates
cord compression
in NST, late deceleration indicates
hypoxemia
Reactive NST is
two or more accelerations over 20 min.
How long it take NST and what to do if baby is non reactive
An NST usually takes 20–40 min to complete.
If the NST is nonreactive, the baby may be asleep. If this is suspected, ask the patient to eat or drink to make the baby active if not reactive within 1–2 hours, then additional testing may need to be performed.
When can a baby’s heartbeat be detected with Doppler?
8–12 weeks of gestation
fetal heart start beating at
22-24 d
Isolated raise of inhibin A levels in 2nd trimester
indicates:
- Preterm labour
- low birth weight
- preeclampsia
- IUFD
