Antenatal care of uncomplicated pregnancy

Question 1

By what GA should a booking appointment take place ?

Answer 1

By 10 Weeks

Question 2

How many routine antenatal appointments for
- nulliparous?
-multiparous?

Answer 2

Nulli - 10
Multi - 7

Question 3

What do you do at the booking appointment ?

Answer 3

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

Question 4

Should the woman’s partner be involved ?

Answer 4

as per her wishes

Question 5

Risk of maternal mortality compared with white women
For black ?
For mixed ethnicity ?
For Asian ?

Answer 5

4 times in black
3 times higher in mixed
2 times higher in asia

Question 6

Risk of stillbirth compared with white babies
For black ?
For Asian ?

Answer 6

More than twice
50% higher

Question 7

Risk of maternal mortality in most deprived areas compared with least deprived ?

Answer 7

> 2.5 times

Question 8

Risk of stillbirth in most deprived areas compared with least deprived ?

Answer 8

Twice - 2 times

Question 9

At which GA are the scan appointments?

Answer 9

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

Question 10

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 ?

Answer 10

Refer to NHS Stop Smoking Services

If currently smoking or stopped within the past 2 weeks

Question 11

Which blood investigations are repeated at the 28 wk appointment?

Answer 11

CBC
BG
Antibodies

Question 12

Apart from the booking appointment, when is risk reassessed for
VTE
Pre eclampsia
IUGR

Answer 12

VTE - after any significant health event or hospital admission
Pre eclampsia and IUGR - 2nd trimester - 16 wk appointment

Question 13

What GA do you perform an OGTT ?

Answer 13

24-28
28 weeks with BP 150/90

Question 14

after OGTT, How urgent do you refer to secondary care ?

Answer 14

Within 24 hrs

If >=160/110 - same day

Question 15

What GA onwards do you ask for fetal movements ?

Answer 15

24 wks

Question 16

What GA do you examine for possible breech presentation?

Answer 16

36 w

Question 17

How do you treat pelvic girdle pain ?

Answer 17

Physiotherapy
Non rigid lumbopelvic belt
Done with the Antenatal Care guideline

Question 18

When to stat conceiving after course of Tamoxifen

Answer 18

3 months

because of tertogenicity, it taked from 2 to 3 months to wash out.

Question 19

what u/s measure we use to date pregnancy

Answer 19

Crown rump lenght

Question 20

which measurement we use to date pregnancy in case of CRL > 88mm

Answer 20

Head circumference

Question 21

With regard to the routine anomaly scan in pregnancy, what threshold of nuchal-fold measurement should trigger a referral to a fetal medicine specialist?

Answer 21

> 6 mm

Question 22

In an uncomplicated pregnancy, how often should auscultation of the fetal heart be performed by the midwifery team?

Answer 22

only when requesteed by the mother

Question 23

women after 42 weeks who decline IOL

Answer 23

close monitoring:
- CTG twice weekly
- AFV assessment

Question 24

in Non stress test, beat to beat variability indicates ?

Answer 24

intact fetal brain stem and heart

Question 25

FHR baseline

Answer 25

110-160

Question 26

in NST, Early deceleration indicates

Answer 26

Vagally mediated, caused by head compression usually at cervical dilation of 4–7 cm.

Question 27

in NST, variable deceleration indicates

Answer 27

cord compression

Question 28

in NST, late deceleration indicates

Answer 28

hypoxemia

Question 29

Reactive NST is

Answer 29

two or more accelerations over 20 min.

Question 30

How long it take NST and what to do if baby is non reactive

Answer 30

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.

Question 31

When can a baby’s heartbeat be detected with Doppler?

Answer 31

8–12 weeks of gestation

Question 32

fetal heart start beating at

Answer 32

22-24 d