Normal pregnancy and antenatal care

Question 1

Normal pregnancy and antenatal care

Features

Answer 1

Features
* General well-being improves with proper supervision
* Antenatal care aims to
o Ensure optimal health
o Detect and treat disorders arising during pregnancy

• Factors influencing antenatal care:
  o Initial health and history of mother
  o Screening tests
  o Education and emotional state
  o Fetal growth monitoring
  o Maternal health throughout pregnancy

Question 2

Preconceptual and early pregnancy care

Name the type of care

Answer 2

1. Medical history
2. General measurements and practices
3. Serology and immunization
4. Cervical cytology (Papanicolaou smear = Pap smear)
5. Dietary and vitamin supplementation
6. Review maternal medications
7. Fetal anomaly

Question 3

1. Medical history

Answer 3

a. Past obstetric history
i. Mode of delivery (C-section, spontaneous, assisted)
ii. Miscarriage
iii. Antenatal complications
iv. Duration of labor
v. Birth weight of infant

Question 4

General measurements and practices

Answer 4

a. Gestational age (dating of pregnancy) – by an early ultrasound

i. Reduces risk for meconium aspiration, macrosomia and delayed labor because
early induction at week 41 can be done
b. Complete blood count

i. Performed at first visit and repeated at weeks 28 and 34

ii. Anemia and presence of infections are important
c. Abdominal and pelvic measurements
d. Urinalysis

i. UTIs
ii. Glycosuria
iii. Proteinuria

e. Blood pressure - at every visit
f. Height, weight and BMI
g. Symphysis and fundal height at every visit

Question 5

Serology and immunization

Answer 5

a. Rubella, varicella and pertussis
i. If seronegative → subcutaneous live attenuated vaccine

ii. Avoid pregnancy for 1 month after the vaccine

b. Influenza vaccine (recommended)

c. Determine blood group and RBC antibodies
i. For Rh(-) women – Rhesus antibodies test preformed in 1st trimester and
repeated at 3rd trimester.

ii. Preformed antibodies (after previous Rh(+) baby) cross placenta and cause
anemia, hydrops fetalis, jaundice and death

iii. Treatment is anti-D Ig prophylaxis at 28 and 34 weeks

d. High risk women - STDs, HIV, Hepatitis

Question 6

Syphilis

Answer 6

Wasserman complement fixation test – treponemal antibodies
* Venereal disease research laboratory (VDRL) – cardiolipin antigen
* Rapid plasma reagin (RPR) – screening and follow up of treatment
* Treponema pallidum immobilization (TPI)

Question 7

HIV

Answer 7

• Seropositive mother will always have seropositive baby (does not mean
  that the baby has the virus, only the maternal antibodies)
• Prevention: C-section, avoid breastfeeding, HAART treatment

Question 8

Dietary and vitamin supplementation

Answer 8

a. Vitamin B9 (Folic acid)

i. Reduced risk for neural tube defects and also for macrocytic anemia
ii. Dose of 400µg daily
iii. At least one month before pregnancy and for first three month of pregnancy
iv. Risk groups (obese, diabetic etc.) dose is 5mg daily

b. Iodine
i. Aids in development of fetal brain
ii. Dose of 150µg daily

c. Vitamin B12
i. Treatment for microcytic anemia

d. Iron
i. Treatment of microcytic anemia
ii. Only in case of anemia, not taken routinely

e. Nutrition
i. Malnutrition results in IUGR, anemia, prematurity and fetal malformations.
ii. Energy intake of 2000-2500 daily calories
iii. Proteins 60-80g daily
iv. Balanced diet of vegetables, fruits, meat, dairy, nuts

Question 9

Fetal anomaly

Answer 9

a. Trisomy 21 (Down’s syndrome)

i. Positive results end with either termination of pregnancy or continuation of
pregnancy that allows for better preparation for birth by the parents (for those
who want to keep the baby)

ii. Ultrasound examination of nuchal translucency and biochemical tests

Question 10

Risk factors

Answer 10

1. Smoking

a. CO has higher affinity for Hemoglobin (200 times
greater than oxygen) and shifts dissociation curve
to the left
b. Nicotine is vasoconstrictor causing narrowing of
capillaries of placenta
c. Placental structure shows thickening of
trophoblastic membrane
d. Reduces birth weight of infant and crown-heel
length.

2. Alcohol abuse
   a. Fetal alcohol syndrome
   i. Growth retardation
   ii. Structural defects (facial, cardiac and joint
   anomalies)
   b. Interferes also with recommended dietary intake
   (alcohol is only energy and not a source for
   proteins, vitamins etc.)
3. Drugs
   a. Heroine, amphetamine, cocaine cause:
   i. IUGR
   ii. Miscarriage
   iii. Placental abruption
   iv. Developmental anomalies
   v. Cardiac arrhythmias
   b. Marijuana showed to be teratogenic in animal
   studies
4. Maternal age (both extremes are bad)