Antenatal screening + changes in pregnancy

Question 1

what advice would you provide a pregnant woman with at first point of contact?

Answer 1

• folic acid
• vitamin D
• avoid shellfish, unpasteurised milk, tuna
• stop smoking, recreational drugs and alcohol
• regular activity advised
• pelvic floor exercises
• antenatal screening

Question 2

when is the booking visit?

Answer 2

8-12 weeks (ideally before 10w)

Question 3

what is checked at the booking visit?

Answer 3

BP
urine dip
BMI
FBC, blood group, rhesus
hep B, syphilis, HIV
urine culture for asymptomatic bacteriuria

*work out EDD, birth plans etc

Question 4

when is the dating scan?

Answer 4

10-13+6 weeks
*crown rump length, exclude multiple, neural tube defects, placental site etc

Question 5

when is the combined test offered for down’s?

Answer 5

11-13+6 weeks

*nuchal translucency, PAPP-A, B-HCG

Question 6

what happen if combined suggestive of down’s?

Answer 6

If abnormal, offer a specialist foetal cardiac scan at 22-24 weeks

If high risk of Down’s, consider amniocentesis or NIPT
- tests for DNA fragments from placental cells (identical to baby cells) to assess chromosomal abnormlaities 99% sensitive for trisomy 21

Question 7

when is the quadruple test offered for DS?

Answer 7

> 14 weeks (only late presenting mothers who missed NCT)

*AFP, B-HCG, unconjugated oestriol, inhibin-A

Question 8

when is screening done for GDM?

Answer 8

not for all
- booking if previous GDM and again at 22-24w if first normal
- 22-24w if risk factors present
- OGTT preferred

Question 9

when is the detailed foetal anomaly scan done?

Answer 9

18-20+6 weeks

Gestational age based on: biparietal diameter, head circumference, abdominal circumference, femur length

Screening for: anencephaly, open spina bifida, cleft lip, diaphragmatic hernia, gastroschisis, exomphalos, cardiac abnormalities, renal agenesis, lethal skeletal dysplasia, Edward’s syndrome, Patau’s syndrome

Question 10

at what other routine points are appointments offered?

Answer 10

25w for primi
28w
31w for primi
36w
38w
40w primi
41w

*check BP, urine dipstick, symphysis-fundal height

Question 11

when is anti-D prophylaxis offered?

Answer 11

34w

Question 12

what are some common symptoms of pregnancy to ask about?

Answer 12

N+V
dyspepsia
constipation
haemorrhoids
varicose veins
vaginal discharge

Question 13

how do you monitor foetal growth?

Answer 13

symphysis-fundal height from 24 w at each appt
USS estimation of size
routine doppler not in low risk
foetal presentation by abdo palpation at 36w

Question 14

what are some physiological changes happening to the female body in pregnancy?

Answer 14

• vulva and vagina increased vascularity with oestrogen
• uterine hypertrophy
• increase in metabolism
• increased iron demand
• increased CVS load with oxygen demand
• peripheral vascular resistance decreases
• pressure on diaphragm
• bladder irritation
• increased cortisone