Antenatal Care Timetable: Key dates, Folate, VitD, Reduce pre-eclampsia/DVT/Rh Disease risk

Question 1

How many antenatal visits should one expect if uncomplicated?

Answer 1

10 - 1st pregnancy
7 - subsequent pregnancies
Will not be seen my consultant unless complicated

Question 2

8-12wks

Answer 2

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

Question 3

12wks
-results interpretation

Answer 3

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

Question 4

20wks

Answer 4

Anomaly scan

Question 5

28wks

Answer 5

2nd screen for anemia and atypical red cell alloantibodies

1st dose of anti-D to Rh-ve mothers

Question 6

34wks

Answer 6

2nd dose of anti D to Rh-ve mothers

Question 7

36wks

Answer 7

Check presentation - offer external cephalic version if needed

Question 8

Use of folate in antenatal period

Answer 8

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

Question 9

Use of Fe in antenatal period

Answer 9

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

Question 10

Use of VitD in antenatal period

Answer 10

10mcg daily

Question 11

Lifestyle choices in the antenatal period

Answer 11

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

Question 12

VTE risk in antenatal period

Answer 12

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

Question 13

Identifying risk of pre-eclampsia in pregnancy
-moderate risk factors
-high risk factors
-management

Answer 13

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

Question 14

Rhesus negative pregnancy
-pathophysiology
-prevention

Answer 14

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