Antenatal Care Timetable: Key dates, Folate, VitD, Reduce pre-eclampsia/DVT/Rh Disease risk, VTE, Pre-eclampsia Flashcards
How many antenatal visits should one expect if uncomplicated?
10 - 1st pregnancy
7 - subsequent pregnancies
Will not be seen by consultant unless complicated
8-12wks
Booking visit
-diet, alcohol, smoking
-folate - 400mcg daily before conception to wk12
-VitD - 10mcg
-antenatal classes
-BP, BMI
-DVT risk assessment
Booking bloods/urine
-ABO, Rh status
-HepB, HIV, syphilis, sickle cell, thalassemia
-Fe deficiency anemia
-urinedip, culture
Blood ideally to be done before 10wks
12wks
-results interpretation
Combined test for Downs, Edwards, Patau
-nuchal translucency, BHCG, PAPPA
Downs
-High HCG, nuchal translucency
-Low PAPPA
Edwards and Patau
-High nuchal translucency
-Low HCG, PAPPA
Lower chance - 1 in 150 chance or more
Higher chance - 1 in 150 chance or less
=> offered NIPT or amniocentesis or CVS
NIPT - analysis of fragments of fetal DNA in mother’s blood
-high sensiticity and specificity for Downs and chromosomal abnormalities
20wks
Anomaly scan
28wks
2nd screen for anemia and atypical red cell alloantibodies
1st dose of anti-D to Rh-ve mothers
34wks
2nd dose of anti D to Rh-ve mothers
36wks
Check presentation - offer external cephalic version if needed
Use of folate in antenatal period
Before conception to wk12
Minimum 400mcg
High risk of NTD if
-Hx of NTD in partner, past pregnancy, FHx
-antiepileptic drugs, coeliac, DM, thalassemia trait
-obese
=> 5mg
Use of Fe in antenatal period
Anemia screening - booking and 28wks
1st - U110
2nd/3rd - U105
4th - U100
PO ferrous sulfate/ferrous fumarate
-continue for 3months after correction to replenish iron stores
Use of VitD in antenatal period
10mcg daily
Lifestyle choices in the antenatal period
Don’t drink
If smoking, consider risks - low birthweight, premature birth
-NRT can be used if they have stopped smoking
-don’t use varenicline or bupropion
Medication
-adjust prescribed meds with HCP, risk benefit discussion needed
-avoid OTCs where possible
VTE risk in antenatal period
35+
Obese BMI - 30+
Parity 3+
Smoker
Varicose veins visible
Pre-eclampsia
Immobile
FHx unprovoked VTE
Low risk thrombophilia
Multiparous
IVF pregnancy
3 risk factors => LMWH 28wks => 6wks postnatal
4+ risk factors => LMWH NOW => 6wks postnatal
Avoid DOAC and warfarin in pregnancy
Identifying risk of pre-eclampsia in pregnancy
-moderate risk factors
-high risk factors
-management
High - 1
-HTN - past pregnancy/chronic
-CKD
-AI - SLE, APS
-T1,2DM
Moderate - 2
-1st pregnancy
-40y/o+ or 10year gap between pregnancy
-BMI 35+ at 1st visit
-FHx preeclampsia
-multiple pregnancy
75-150mg aspirin daily 12wks => birth
Rhesus negative pregnancy
-pathophysiology
-prevention
Rh-ve mother and Rh+ve child’s blood mixes
=> antiD IgG AB form in mother
In later pregnancies, can cross placenta => hemolysis in fetus
Booking - D AB test in Rh-ve mothers
Anti D given at 28 and 34wks
VTE
-risk factors assessed at booking
-management of VTE prophylaxis
Age 35+, BMI 30+, Parity 3+
Multiplets, IVF pregnancy
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility
FHx unprovoked VTE
Low risk thrombophilia
4+ - immediate treatment with enox
3+ - enox 28wk-6wks post-natal
AVOID DOACS AND WARFARIN IN PREGNANCY
Gestational diabetes
-risk factors
-screening and diagnostic thresholds
-management
BMI 30+
PHx macrosomic baby (4.5kg+)
PHx GD
1st degree relative with DM
South Asian, Afro-Caribbean, Middle Eastern
OGTT
PHx GD
-ASAP after booking
-24-28wks if 1st test normal
Other risk factors
-24-28wks
Fasting glucose - 5.6+
2hour glucose - 7.8+
Newly diagnosed => joint diabetes + antenatal clinic within 1wk
-self-monitoring BMs
-low glycemic diet, exercise
FPG U7 => diet + exercise
-target not met U2wks => add metformin
-target not met => add short acting insulin
FPG 7+ => insulin
FPG 6-6.9 AND evidence of macrosomia, hydramnios => insulin
