Antenatal Care - Urine and bloods

Question 1

Antenatal urine tests

Answer 1

MSU at booking- MC+S

Urinalysis every visit

Question 2

what is urine screened for in antenatal urinalysis?

Answer 2

Protein: renal dx/pre-eclampsia
Persistent glycosuria: (G)DM
Nitrites: UTI (if detected send MSU for MC+S, treat if positive culture)

Question 3

Associations of asymptomatic bacteruria

Answer 3

Preterm delivery

pyelonephritis

Question 4

Mx of asymptomatic bacteruria in pregnancy

Answer 4

1. Nitrofuratoin (avoid at term) 100mg BD 7d
2. Amoxicillin (only if culture results available) 500mg TDS 7d
3. cefalexin 500mg BD 7d

Question 5

Blood pressure in pregnancy

Answer 5

Falls small amount during first trimester
Rise to pre-pregnancy levelsat end of 2nd trimester
Measurement in first trim. allows identification of undiagnosed chronic HTN (give anti-htn + aspirin)

Question 6

Booking tests in pregnancy

Answer 6

FBC - Hb, plts, MCV
MSU - Asymptomatic bacteruria
Blood grp + antibody screen - Rh and atypical
Hb-opathy screen: based on FOQ + blood test results
Infection screen: HBV, HIV, syphilis (rubella status)
Dating scan + T1 screen: accurate date, risk T 21, 18, 13, i.d. major congenital anomalies

Question 7

FBC in pregnancy

Answer 7

Looking for anaemia
If present look at MCV, order B12+Folate
If IDA trial oral iron 2 wks (retest for response)
?Thrombocytopenia

Question 8

Anaemia in pregnancy

Answer 8

T1 <110
T2+3 <105
Postpartum <100

Question 9

Women with known Hb-opathy blood tests

Answer 9

serum ferritin, offer supplements if ferritin <30ug/L

Question 10

Thrombocytopenia in pregnancy

Answer 10

ITP
Gestational TP:
- Rare T1
- more common >28w
- so low plt. T1 requires further investigation
Baseline platelets useful for dx pre-eclampsia or HELLP

Question 11

Blood group in pregnancy

Answer 11

Mainly to identify Rh-ve women

Question 12

Risks to Rh-ve women

Answer 12

Isoimmunisation and sensitisation

Question 13

What to do post Rh sensitising events?

Answer 13

Anti-D Ig

<72hrs after event (e.g. CVS, amniocent. trauma)

Question 14

Pregnancies <12 weeks where anti-D is regulated

Answer 14

Ectopic
Molar
Therapeutic TOP
Uterine bleed that is repeated, heavy or a/w abdo pn

Question 15

Minimum dose of anti-D

Answer 15

250 IU

Question 16

Prophylactic anti-D

Answer 16

Offered at 28 wks in Rh-ve

1 dose at 28 or 2 doses at 28 and 34wks

Question 17

Anti-D post partum

Answer 17

All Rh-ve mothers once baby confirmed Rh+ve on cord blood

Question 18

Blood test for GDM at booking

Answer 18

Women w/prev GDM offered GTT or random blood glucose in T1

to identify pre-existing DM developed since previous pregnancy

Question 19

Thalassaemia testing at booking

Answer 19

Family origin questionnaire
FBC results
High risk sent to fetal medicine unit for ?invasive testing

Question 20

Sickle cell screen at booking

Answer 20

Rate of sickle cell trait is 1:10 in black people
Freq. HbC trait = 1:30
Test if high risk

Question 21

First trimester infection screen

Answer 21

Rubella - not routine only if identified as not immune then advise no contact with rubella, offer MMR after delivery
Syphilis - routine
HBV - routine, 90% of babies can be born to HBV+ mothers
HCV only if high risk
HIV (offer again at 28wk if declined)

Question 22

If a baby born to woman w/active HBV

Answer 22

HBV vaccine within 12h
One dose HBV Ig within 12h
confers 95% protecion
Addiitional doses at 1+6m of vaccine

Question 23

if HIV+ at booking

Answer 23

Initiate ART by 24wk
Elective c-section at 36wk if viral load >50/ml
Exclusive formula feeds from birth

Question 24

UTI in Pregnancy

Answer 24

Ix: urine dip, MC&S

1st line: nitrofurantoin 50mg QDS or 100mg BD modified release for 7 days

Question 25

UTI in pregnancy avoid Rx in whom?

Answer 25

full term women

Question 26

UTI in pregnancy 2nd line

Answer 26

if no improvement after 48hrs

amox. + cefalexin