Normal Pregnancy: Antenatal care Flashcards
incl screening, scans, lifestyle advice and any meds
What happens when you receive a positive pregnancy test?
- book yourself with the community midwife- called ‘the booking visit’
Aim of booking visit?
- How baby develops during pregnancy
- Exercise- incl pelvic floor exercises
- Place of birth and pregancy care pathway
- Breastfeeding, incl workshops
- Participant- led antenatal classes- group classes
- Further discussion and offer of all antenatal screening
- Discussion of mental health issues- with each visit, questioning
When is the booking visit?
Ideally before 10 weeks
What specifics are disccused by the community midwife at the booking visit?
Health and lifestyle
Folic acid- 400mcg daily - preconceptually ideally but as soon as +ve pregnancy test
Food hygiene- including how to reduce risk of food- acquired infection
Smoking cessation, implications of recreational drug use and alcohol consumption in pregnancy
All antenatal screening as well as risks and benefits of the screening tests
Perform risk assessment- to categorise them as high risk or low risk–> where they will be managed
What food advice do you give to a pregnant woman?
- drinking only pasteurised or UHT milk
- Not eating ripened soft cheese such as camembert, brie and blue- veined cheese (no risk with hard cheeses)
- Not eating pate (even veg pate)
- Not eating undercooked or undercooked ready prepared meals
- Pregnant women should be offered info on how to reduce risk of salmonella infection
Advice to reduce risk of salmonella?
Avoiding raw or partially cooked eggs or food that may contain them (e.g. mayo), avoiding raw or partially cooked meat esp poultry
What is the main food acquired infection to be aware of?
Listeriorsis
What is the UK CMO guidance on alcohol consumption in pregnancy?
If you are pregnant/ think you might become pregnant–> safest to not drink alcohol at all to keep risks to baby at min
Risk of alcohol on unborn baby?
Low birth weight
SGA
Preterm birth
May all be increased in mothers drinking about 1-2 units/day during pregnancy
What clinical exam do you do at the booking visit?
- Measure of weight and BMI
- Women who have no accessed UK healthcare before should be offered general clinical exam
- Breast and pelvie exam NOT recommened (exception is FGM)
- Look out for signs of domestic violence
What routine tests are offered to women at booking?
- Electrophoresis + family origin questionnaire: haemoglobinopathy -sickle cell and Beta thaelassaemia
- FBC- anaemia
- Blood group and red cell antibody screening: rhesus status and risk of rheus isoimmunisation and non-rhesus antibodies which can result in haemolysis in maternal circulation
- Infection screening: syphilis, hep B, HIV, asymptomatic bacteriuria
- Urianlysis: glycosuria, proteinuria, haematuria
Who do you screen for gestational diabetes?
- Based on risk assessment
- BMI above 30kg/m2
- Previous macrosomic baby weighing 4.5kg or above; previous gestational diabeted
- Fhx of diabetes
- Family origin with a high prevalence of diabetes- south asian, black carribean, middle eastern
How do you screen for pre-eclampsia?
BP & urinalysis check for protein at each antenatal visit to screen for pre-eclampsia
At booking apt, RF should be determined
RF for pre-eclampsia?
Age 40 or older
Nullparity
Pregnancy interval for more than 10 years
Fhx of pre-eclampsia
Previous hx of pre-eclampsia
BMI > 30kg/m2
Pre-existing vascular diesease such as hypertension
Pre-existing renal disease
Multiple pregnancy
What is the screening for Downs, patau and edwards?
- has to be performed by the end of the first trimester (13 weeks 6 days)
- The combined test ( NT, B-hcg, PAPP-A) 11 weeks to 13 weeks 6 days
- If NT measurement not feasible- offer serum screening
- Provision for screening (15-20 weeks) for late bookers- serum screening quadruple test
- A confimatory diagnostic service by CVS/ Amnio if screen positive
What is nuchal transluceny?
Measurement of fluid at the back of babys neck in USS
What are the screening strategies for Downs, Edward and Patau?
1st trimester:
* Combined method- preferred
* USS between 11+2 - 14+1 and biochemistry
2nd trimester
* If woman presents after 14+1 weeks, offer quadruple test from 14+2
* hCG, aFP, uE3 and inhibin-A- serological test
3rd trimester
* If risk assessment comes back 1/150–> offer invasive test (aminocentesis or CVS)
* NIPT- not available in NHS routinely–> maternal serum for fetal cells for trisomys–> screening test
How often are antenatal apts?
- Uncomplicated first pregnancy- 10 visits
- Uncomplicated parous women- 7 visits
*
What do antenatal apts consist of?
- BP and urine check at every visit
- 24 weeks onwards- symphsyis- fundal height should be measured and recorded
- 36 weeks onwards- check fetal presentation- USS if uncertain
- No routine auscultation, fetal movement counting not required and routine antenatal CTG in uncomplicated pregnancy- NO BENEFIT
What tests do you perform at the 28 week visit?
*Routine care: BP, urine dipstick, SFH
* Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
* GTT if indicated
* First dose of routine anti-d prophylaxis if rhesus negative
What do you do at 36 weeks?
- Info about breast feeding
- Birth plan with their midwife- where would they like to give birth, pain relief
- taught to recognise active labour and what to do
- Info about looking after baby
- Vit k prophylaxis after delivery
- Newborn screenign tests
- Postnatal self-care
- Awareness of baby blues and post-natal depression
- Risk assessment
How do you record everything as a healthcare professional for maternity care?
Structured maternity records
Standardised, national maternity record with an agreed minimum data set should be developed and used–> help healthcare professionals to provide the recommended evidence- based care to pregnancy women
When do you have scans?
Booking scan- between 11+ 2 and 13+ 6 weeks
20 week scan
Not routinely use scan after 24 weeks only in some cases e.g.
- Low lying placenta at 20 weeks, will have a repeat scan at 32 weeks
- Suspected malpresentation on clinical examination
- From 42 weeks women who decline induction of labour should be offered USS estimation of max amniotic pool depth
*
What do you offer if pregnancy is continuing after 41 weeks?
Offer membrane sweep- released prostagladins–> encourage labour
IOL beyond 41 weeks
If IOL declined at or > 42 weeks- increased surveillance - CTG and USS
What do you do if there is a breech presentation at term?
After 36 weeks: ECV- external cephalic version- 50-60% successful
95% of babys stay in this position until delivered t
Advice to healthy woman with nausea and vomiting in pregnancy?
Natural remedies: ginger and acupuncture on ‘p6’ point (wrist)
Antihistamines: promethazine first line
Advice to healthy pregnancy woman RE vitamin D?
Importance of vit D during pregnancy and whilst breastfeeding.
10micrograms of Vit D recommended
Particular care should be taken with at risk women (e.g. Asian, obese, poor diet)
What conditions should screening be available for pregnant women?
Anaemia
Bacteriuria
Blood group, Rhesus status and anti red cell antibodies
Down’s syndrome
Fetal anomalies
Hep B
HIV
Neural tube defects
RF for pre-eclampsia
DEPENDING ON HISTORY, the following should be offered:
Placenta Praevia
Psych illness
Sickle cell disease
Tay Sachs disease
Thalassaemia
What are the results of combined screening for Down’s syndrome?
- Increased hCG
- Decreased PAPP-A
- Thickened Nuchal translucency
N.B Edwards and Patau give sinilar result but hCG isn’t as high
What are the results of combined screening for Down’s syndrome?
- Increased hCG
- Decreased PAPP-A
- Thickened Nuchal translucency
N.B Edwards and Patau give sinilar result but hCG isn’t as high
Down’s syndrome results in Quadruple test?
- Low AFP
- Low unconjugated oestriol
- High hCG
- High inhibin A
Edward’s syndrome results in quadruple test?
- Low AFP
- Low unconjugated oestriol
- Low hCG
- Inhibin A- either or
Neural tube defect results in quadruple test?
- High AFP
- Uncojugated oestriol- high or low
- hCG- high or low
- Inhibin A- high or low
