Antenatal care - timeline, lifestyle, meds

Question 1

what do the following terms mean:

LMP
GA
EDD
gravida
primigravida
para
nulliparous
primiparous
multiparous

Answer 1

LMP: last menstrual period (The FIRST day of your most recent menstrual period)

GA: duration of pregnancy starting from LMP

EDD: (40 weeks gestation)

Gravida: total amount of pregnancies a woman has had (including abortions, stillbirths)

Primigravida: first pregnancy

Multigravida: pregnant for at least second time

Para: the number of times a woman has given birth after 24 weeks gestation regardless of it fetes was alive or stillborn (e.g G2 P1)

Nulliparous: never given birth after 24 weeks

Primiparous: given birth after 24 weeks once before

Multiparous: patient has given birth after 24 weeks two or more times

age: 5+0 e.g. five weeks
13+6 (13 weeks and 6 days

Question 2

Gravidity and parity

Answer 2

pregnant lady with three deliveries at term
G4 P3

a non pregnant woman with previous birth of healthy twins
G1, P1

non-pregnant woman with previous miscarriage
G1 P0+1

non pregnant woman wit previous stillbirth
G1 P1

Question 3

trimesters
1st
2nd
3rd

Answer 3

1st trimester: start of pregnancy to 12 weeks

2nd trimester: 13 weeks to 26 weeks
*fetal movements around 20 weeks

3rd trimester: 27 weeks to birth

Question 4

key milestones / dates and purpose

Answer 4

<10 weeks: booking clinic offer a baseline assessment

10-13+6: dating scan (crown rump length) and any multiple pregnancies

16 weeks: antenatal appointments, plan future appointments, discuss results

18-20+6 anomaly scan (heart conditions)

25-42 weeks monitor pregnancy

Question 5

additional appointments

Answer 5

• additional if higher risk
• OGTT if gestational diabetes risk (24-28 weeks)
• anti D injections in rhesus negative women (28-34 weeks)
• USS at 32 weeks with placenta praevia
• serial growth scans if risk of fetal growth resection

Question 6

what examinations are done in routine antenatal appointments?

Answer 6

Discuss plans for the remainder of the pregnancy and delivery

Symphysis–fundal height measurement from 24 weeks onwards

Fetal presentation assessment from 36 weeks onwards

Urine dipstick for protein for pre-eclampsia

Blood pressure for pre-eclampsia

Urine for microscopy and culture for asymptomatic bacteriuria

Question 7

vaccines offered to all pregnant women

Answer 7

Whooping cough (pertussis) from 16 weeks gestation

Influenza (flu) when available in autumn or winter

*avoid all live vaccines (MMR)

Question 8

lifestyle advice

Answer 8

1. folic acid 400mcg before pregnancy to 12 weeks (reduce neural tube defect)
2. vitamin d (10mcg or 400 IU daily)
3. avoid vitamin A (teratogenic in high doses)
4. don’t drink alcohol, don’t smoke
5. avoid unpasteurised dairy/blue cheese (listeriosis) and undercooked or raw poultry (salmonella)
6. continue moderate sport, sex is safe
7. place seatbelt above/below bump not across.
8. *VTE flying
   37 weeks in a single pregnancy
   32 weeks in a twin pregnancy
   (after 28 weeks most airlines need a note from midwife/GP to state the pregnancy is going well and there are no additional risks)

Question 9

fetal alcohol syndrome

Answer 9

Microcephaly (small head)

Thin upper lip

Smooth flat philtrum (the groove between the nose and upper lip)

Short palpebral fissure (short horizontal distance from one side of the eye to the other)

Learning disability

Behavioural difficulties

Hearing and vision problems

Cerebral palsy

Question 10

smoking in pregnancy

Answer 10

Fetal growth restriction (FGR)
Miscarriage
Stillbirth
Preterm labour and delivery
Placental abruption
Pre-eclampsia
Cleft lip or palate
Sudden infant death syndrome (SIDS)

Question 11

booking clinic bloods

Answer 11

• Blood group, antibodies and rhesus D status
• Full blood count for anaemia
• Screening for thalassaemia (all women) and sickle cell disease (women at higher risk)
• HIV
• Hepatitis B
• Syphilis

bloods for ‘combined test’ (Down’s syndrome) for 11 weeks onwards

Question 12

measurements in booking clinic

Answer 12

What to expect at different stages of pregnancy
Lifestyle advice in pregnancy (e.g. not smoking)
Supplements (e.g. folic acid and vitamin D)
Plans for birth
Screening tests (e.g. Downs screening)
Antenatal classes
Breastfeeding classes
Discuss mental health

Weight, height and BMI
Urine for protein and bacteria
Blood pressure
Discuss female genital mutilation
Discuss domestic violence

Question 13

risk assessment (e.g rhesus, diabetes)

Answer 13

Rhesus negative (book anti-D prophylaxis)

Gestational diabetes (book oral glucose tolerance test)

Fetal growth restriction (book additional growth scans)

Venous thromboembolism (provide prophylactic LMWH if high risk)

Pre-eclampsia (provide aspirin if high risk)