Management of uncomplicated pregnancy

Question 1

How many routine appointments are there for parous and nulli parious women.

Answer 1

There are:
8 Routine appointments for parous women
11 routine appointments for nulliparous women

+/- 41 Week appointment if she hasnt delievered yet

Question 2

When are the routine appointments carried out?

Answer 2

1. 8-12 weeks - Booking Appointment
2. 11- 13 wks +6 - Dating Scan
3. 16 weeks - Blood Pa & Urinalysis
4. 18-20 wks +6 - Anatomical Anomaly Ultrasound
5. (Nulliparous) 25 weeks - Bp, urinalysis, Symphyseal fundal height SFH
6. 28 wks - OGTT + Rhs - + Anti D injection (1st dose)
7. (Nulliparous) 31 weeks - BP Urinalysis, and SFH
8. 34 weeks- BP, urinalysis and SFH + Anti D injection (2nd dose)
9. 36 Weeks - BP, Urinalysis, SFH + palpate for risk of breech
10. 38 Weeks- BP, Urinalysis, SFH
11. (Nulliparious) 40 weeks BP, Urinalysis, SFH
12. 41 weeks - ‘’ / induction of labour?

Question 3

In the BOOKING appointment what is considered?

Answer 3

Height and Weight measurment
BP and urinalysis
Screening: GDM, Pre-eclampsia, FGR (foetal growth restriction), VTE, FGM
Patient health status (mentally and physically)
Social status
OFFER VACCINATIONS and SCREENING programs

Question 4

In the DATING SCAN what is considered?

Answer 4

11-14 WEEKS
Foetal anomaly screening
estimating gestational age
assess for multiple pregnancy

Question 5

In the ANATOMICAL ANOMALY SCAN - what is considered?

Answer 5

18-20 weeks + 6
Foetal movements ? (+ at this time)
position of placenta (low-lying / praevia)
Anatomical anomalies -
meningocele (congenital neural tube defect)
exomphalos (intestinal prolapse)
anencephaly (Brain/skull loss)

Question 6

Whats first second and third trimester

Answer 6

First Trimester (0 to 12 weeks)
Second Trimester (13 to 26 weeks)
Third Trimester (27 till birth)

Question 7

When are the two doses of Anti-D given

Answer 7

First dose is given at 28 weeks and then second is at 34 weeks.

Question 8

What do pregnancy screening look out for?

Answer 8

3 Elements // all offered on booking appointment

1. Infectious diseases - HIV / SYPHILLIS / HEP-B
2. Sickle Cell & Thalassaemia
3. foetal anomaly: Trisomy - Downs (21), Edwards (18), Pataus (13)

Question 9

How are fetal anomlies such as trisomies screened for?

Answer 9

Combined Test
1. Maternal Age
2. B-hCG, PAPP-A (pregnancy associated plasma protein-A
3. USS Scan:
Nuchal Translucency NT (amount of fluid at the back of an
unborn baby’s neck )
Crown-Rump Length CRL (Head-Bottom length)

Question 10

If mother is late to intial booking appointment, how is screening for DOWNs offered?

Answer 10

Quadruple test:
1. Maternal Age
2. B-hCG
3. Alpha feto-protein AFP
4. Inhibin A
5. Unconjugated oestriol E3

Question 11

How would increased risk of Down present on screening?

Answer 11

HIGH b-hCG
low PAPPA-A
High NT
//
Low AFP
High Inhibin A
Low unconjugated oestriol E3

Question 12

How would increased risk of Edward syndrome present on screening?

Answer 12

Low b-hCG
Low - PAPP-A
High NT (>3.5mm)

Question 13

How would increased risk of patau’s syndrome present on screening?

Answer 13

Low b-hCG
Low - PAPP-A
High NT (>3.5mm)

Question 14

Why is maternal age associated with increased risk of genetic disorders?

Answer 14

Limited eggs depletes overtime.

Question 15

If screening suspects high risk (>1/150), what are the next steps

Answer 15

1. DO NOTHING
2. NIPT- Non invasive prenatal testing (placental cell-free DNA)
3. Prenatal diagnosis PNT -
   Chorionic villus sampling (11-14 weeks),
   amniocentesis 15+ weeks

Question 16

What advise is given to all new pregnancies??

Answer 16

Vit D supplementation
Folic Acid for first trimester
Smoking cessation
stop alcohol
Healthy diet and lifestyle