Case 1 - Antenatal Booking visit

Question 1

What are the main risk factors we look for in the antenatal booking visit? (to see early obstetrician consultation) and why are they risk factors?

(around 10 weeks)

Answer 1

HTN 
DM
Heart disease
epilepsy 
renal disease 
Asthma 
Obesity 
Resus negative 
Anaemia 
Haematological disorders - VTE, ITP 
Bowel disease - UC, crohns
Thyroid disease
Uternine/cervical surgery 
SLE/antiphospholipid syndrom
Smoking/alcohol/drugs
Mental health disorders
Infectious disease 
history of anaesthetic problems

Question 2

What is the role of the first trimester scan? (4-13 weeks)

Answer 2

-Viable pregnancy (miscarriage)
-location of pregnancy (ectopic)
-Dating (crown rump length)
-detect multiple pregnancies
11-13 weeks - screen for nuchal transulcency (risk of trisomy 13,18,21)
-early morphology

Question 3

Role of the 18-20 week anatomy scan?

Answer 3

• Done at 18 weeks to detect abnormalities in organ systems, so termination of pregnancy is still viable before 20week cut of period
• Adv - can detect 50% fetal anomalies in low risk population
• Dis - cannot detect all anormalies, some structures are not fully developed

Question 4

What lab tests in booking visit? what do the results mean?

know for osce!!

Answer 4

Haemoglobin (anaemia)
MCV (anaemia - thallasaemia, iron)
Platelet count (thrombocytopaenia)
-Blood group, antibodies (haemolytic disease of newborn - anti-D prophylaxis)
-Rubella antibody status (can harm fetus, especially in first trimester)
-Hep B,C, syphilis (transfered to child hep B) (syphilis - increase risk of stillborn)
-HIV (counselling)
-glycated haemoglobin
-cervical smear if due
-chlamydia vaginal swab
-midstream urine (UTI, pylelonephritis, low birth weight, preterm birth)

Question 5

Why is regular antenatal care an important predictor of pregnancy outcome?

Answer 5

• Early detection of risk factors allows timing for interventions
• antenatal education on normal pregnancy and birth
• disease prevention
• screening for maternal and fetal compicaltions
• lack of regular antenatal care can mean important aspects of babys development are missed e.g sga, htn, diabetes leading to poorer outcoems

Question 6

Why is regular antenatal care an important predictor of pregnancy outcome?

Answer 6

There is data to show that women who dont plan antenatal care have poorer outcomes in pregnnacy.

• Early detection of risk factors allows timing for interventions
• antenatal education on normal pregnancy and birth
• disease prevention
• screening for maternal and fetal compilations
• lack of regular antenatal care can mean important aspects of babys development are missed e.g sga, htn, diabetes leading to poorer outcomes

Question 7

How might BMI influence pregnancy and health outcomes?

Answer 7

-Gestational DM, pre eclampsia, LGA or SGA.

Increased risk of fetal and maternal complications,
Women with excess weight should be encouraged to lose weight prior to pregnancy. Obesity related pregnancy risks can be reduced by healthy eating, exercise, limiting gestational weight gain.

Fetal
-miscariage, fetal anomaly, preterm birht, SGA, LGA, birth trauma, admision to neonatal uni, stillbirth and neonatal death

Maternal
-GD, GHTM, preeclampsia, caesarean section, postpartum haemorrhage, VTE, wound infections

Question 8

Risk factors antenatal, intrapartum, postpartum and maternal and fetal implications of risk factors

Answer 8

1. What are pregnancy ‘risk factors’? (*from chart on ANC wall) a. Pre-pregnancy:
2. Complicated obstetric/gynae PHx (recurrent miscarriage, preterm birth, C-section, difficult instrumental vaginal delivery, perinatal death, shoulder dystocia, 3rd/4th degree tear, smear Hx: abnormal/no previous smear/overdue)
3. Maternal mental health, including depression (including history postpartum)
4. Anaemia
5. Rhesus –ve
6. Obesity (Polynesian >37, Asian/Indian 27-32, others 30-35)
7. Diabetes (preexisting DMI and DMII)
8. HTN (preexisting)
9. Maternal age <20, >35 years
10. Substance use (alcohol, smoking, drugs)

b. Antenatal/intra-partum:
1. Anaemia
2. APH
3. Breech >= 36 weeks
4. Diabetes (GDM)
5. Gestational HTN
6. Hyperemesis
7. Late booking
8. Multiple pregnancy
9. Refusal of blood products
10. IVF pregnancy
11. Preeclampsia
12. PPROM
13. Placenta praevia
14. PPH risk
15. Prolonged pregnancy >=41 weeks

c. Complications due to pregnancy:
1. Macrosomia (>90th)
2. SGA/SGA risk
3. Premature delivery

Question 9

Examination in booking visit

Answer 9

weight, height, BMI
BP pulse
breasts
chest mumur
abdo - scars, masses
vulva and perineum 
speculum - if abnormal bleeding or smear
legs - varicose viens
-urinalysis  + midstream urine 
-systems exam