Antenatal care timetable

Question 1

How many antenatal visits for the first pregnancy vs later pregnancies (if uncomplicated)?

Answer 1

• 10 antenatal visits in the first pregnancy if uncomplicated
• 7 antenatal visits in subsequent pregnancies if uncomplicated

Question 2

When does the booking visit ideally occur?

Answer 2

8 - 12 weeks (ideally < 10 weeks)

Question 3

What is done during the booking visit?

Answer 3

1. General information gathered e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
2. BP, urine dipstick, check BMI
3. Booking bloods/urine:
   
   • FBC, blood group, Rh status + red cell alloantibodies, haemoglobinopathies
   • HBV, syphilis
   • HIV test is offered to all women
   • urine culture for asymptomatic bacteriuria

Question 4

When does the dating scan occur? What else does it look for?

Answer 4

Early scan to confirm dates + exclude multiple pregnancy happens at:

10 - 13+6 weeks

Question 5

When does trisomy 21 screening and nuchal scanning occur?

Answer 5

11 - 13+6 weeks

Question 6

When do anomaly and blood results usually come back? What is also done at this stage?

Answer 6

Information on the anomaly and the blood results at 16 weeks

1. If Hb <11 g/dl consider iron
2. Routine care: BP and urine dipstick

Question 7

When is the anomaly scan done?

Answer 7

18 - 20+6 weeks

Question 8

When is the symphysis-fundal height (SFH) first measured?

Answer 8

On the antenetal care timetable it is measured at 25 weeks

…alongside routine BP and urine dipstick

Question 9

Visits at which weeks are only done if primipara?

Answer 9

• 25 weeks
• 31 weeks
• 40 weeks *(incl discussion about options for prolonged pregnancy)

Routine care at all above which includes: BP, urine dipstick, symphysis-fundal height (SFH)

Question 10

When is the first dose of anti-D prophylaxis given to Rh-ve women?

Answer 10

28 weeks:

• Routine care: BP, urine dipstick, SFH
• Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
• First dose of anti-D prophylaxis to rhesus negative women

Question 11

When should you consider giving iron to a pregnant patient? When is Hb measured antenatally?

Answer 11

1. Measured first at 10-12 weeks but results at 16 weeks - if Hb is <11g/dL then consider iron
2. Later measured at 28 weeks - if <10.5 g/dl then consider iron here

Question 12

When does the second screening for atypical red cell alloantibodies and anaemia occur?

Answer 12

28 weeks

Question 13

When is the second dose of anti-D prophylaxis given to rhesus negative women? Is this necessary?

Answer 13

34 weeks

Evidence base suggests that there is little difference in the efficacy of single-dose (at 28 weeks) and double-dose regimes (at 28 & 34 weeks). For this reason the RCOG in 2011 advised that either regime could be used ‘depending on local factors’

Question 14

What happens at the 34 week visit?

Answer 14

• Routine care (BP, urine dip, SFH)
• Check presentation - offer external cephalic version if indicated
• Information on breast feeding, vitamin K, ‘baby-blues’

Question 15

What happens at the 38 week visit?

Answer 15

Routine care

Question 16

What happens at the 41 week visit?

Answer 16

Routine care as above
Discuss labour plans and possibility of induction

Question 17

What is the significance of a high vs low serum alpha-fetoprotein?

Answer 17

Increased:

• Neural tube defects (meningocele, myelomeningocele and anencephaly)
• Abdominal wall defects (omphalocele and gastroschisis)
• Multiple pregnancy

Decreased:

• Down’s syndrome
• Trisomy 18
• Maternal diabetes mellitus

Question 18

Where is AFP produced?

Answer 18

This is a protein produced by the developing fetus

Question 19

What are the causes of raised AFP?

Answer 19

• Neural tube defects (meningocele, myelomeningocele and anencephaly)
• Abdominal wall defects (omphalocele and gastroschisis)
• Multiple pregnancy

Question 20

What are the causes of decreased AFP?

Answer 20

• Down’s syndrome
• Trisomy 18
• Maternal diabetes mellitus

Question 21

What does the combined test involve? When is this done?

Answer 21

• Nuchal translucency
• Serum bHCG
• PAPP-A

These tests should be done between 11 - 13+6 weeks

Question 22

Which combined test results suggest Downs syndrome? What about trisomy 13 and 18?

Answer 22

Down’s syndrome is suggested by:

• ↑ HCG,
• ↓ PAPP-A,
• thickened nuchal translucency

Trisomy 18 (Edward syndrome) and 13 (Patau syndrome) give similar results but the hCG tends to lower

Question 23

What are the indications for the triple test and quadruple test for Down’s syndrome?

Answer 23

triple test:

• alpha-fetoprotein,
• unconjugated oestriol,
• human chorionic gonadotrophin

quadruple test:

• alpha-fetoprotein,
• unconjugated oestriol,
• human chorionic gonadotrophin
• inhibin-A