Normal Pregnancy Antenatal Care

Question 1

what supplements are given to all women pre-pregnancy?

Answer 1

folic acid 400mcg before conception up until 12 weeks gestation
10mg vit D during pregnancy and breastfeeding
iron supplementation isnt given routinely

Question 2

when would pregnant women be given 5mg folic acid instead of 400mcg?

Answer 2

diabetes
taking anti-epileptic meds
BMI >30
previous child with neural tube defect
personal history of neural tube defect in mother or father

Question 3

extra calories needed in pregnancy?

Answer 3

250-300

esp in last trimester

Question 4

safe alcohol limit in pregnancy?

Answer 4

no safe limit

Question 5

management of smoking in pregnancy?

Answer 5

should stop immediately
can use nicotine replacement therapy (patches, gum etc)
bupropion and varenicline not allowed

Question 6

side effects of amphetamine use in pregnancy?

Answer 6

maternal = hypertensive disorders (pre-eclampsia, abruption, stroke, arrhythmia)
fetal = prematurity, neonatal abstinence syndrome, teratogenicity, IUGR, pre-term labour, miscarriage, developmental delay, SIDS, withdrawal

Question 7

side effects of opiate use in pregnancy?

Answer 7

neonatal abstinence syndrome
IUGR
SIDS
still birth
maternal death

Question 8

side effects of cannabis use in pregnancy?

Answer 8

cognitive deficits, miscarriage, fetal growth restriction

Question 9

side effects of nicotine use in pregnancy?

Answer 9

miscarriage
pre-term labour
IUGR
SIDS
still birth
SUDI

Question 10

side effects of alcohol use in pregnancy?

Answer 10

fetal alcohol syndrome
IUGR
post-natal restricted growth
learning difficulties
miscarriage
withdrawal
wernickes encephalpathy and koraskoff synrome
microcephaly

Question 11

other consequences of substance misuse?

Answer 11

nutritional deficiency
HIV, hep B, hep C
VTE
STIs
endocarditis/sepsis
poor venous access
opiate tolerance/withdrawal
overdose/death
IUGR, stillbirth, SIDS, pre-term labour

Question 12

management of substance misuse in antenatal care?

Answer 12

consider methadone programme
child protection and social work referral
smear history
breastfeeding education (avoid if HIV +ve)
labour plan regarding analgesia and labour ward delivery
early IV access
postnatal contraception plan

Question 13

when is booking visit done?

Answer 13

10-12 weeks gestation by community midwife

Question 14

what happens at booking?

Answer 14

history
date of last menstrual period
whether pregnancy was planned
ethnicity of parents (to identify risk factors)
previous obstetric history (other pregnancies, mode of delivery, previous miscarriages or terminations)
mother blood group and Hb levels
haemoglobinopathy screening
infection screen (STD, HIV,  hep B/C)
downs syndrome screening offered

Question 15

when is foetal anomaly scan done?

Answer 15

18-20 weeks

Question 16

what is screened for at foetal anomaly scan?

Answer 16

anencephaly
open spina bifida
cleft lip
diaphragmatic hernia
gastroschisis
exomphalos
serious cardiac anomalies, bilateral renal agenesis
lethal skeletal dysplasia
edward's syndrome (trisomy 18)
patau's syndrome (trisomy 13)

Question 17

how is downs syndrome screened for in first instance?

Answer 17

combined test at 11-14 weeks

involves blood test and US scan

Question 18

blood test in combined test?

Answer 18

serum PAPP-A
AFP
bHCG
(AKA triple test)

Question 19

combined test blood results in downs syndrome?

Answer 19

PAPP-A and AFP = low

bHCG = increased

Question 20

US part of combined test?

Answer 20

nuchal thickness (amount of fluid collecting at nape of foetal neck)
normal = <3.5
increased in downs syndrome

Question 21

second stage testing ind downs syndrome?

Answer 21

done at 15-16 weeks and involved quadruple test

Question 22

what is involved in a quadruple test?

Answer 22

blood test checking AFP, inhibin, oestriol and total bHCG

Question 23

antenatal care pre-conception?

Answer 23

folic acid supplementation
avoid certain foods
avoid alcohol and drugs
discuss BMI

Question 24

maternal assessment at booking visit?

Answer 24

take history
discuss mental health
measure BP
blood tests (FBC, blood group, rhesus status, infection screen, haemoglobinopathy screen)
check immunity (chicken pox etc)

Question 25

foetal assessment at booking?

Answer 25

dating scan
US to check viability, determine gestation, site of pregnancy and number of pregnancies
nuchal thickness

Question 26

how is gestation determined at booking?

Answer 26

foetal pole measurements

Question 27

maternal care at 16 weeks?

Answer 27

offer BP and urinalysis (for protein)

Question 28

foetal care at 16 weeks?

Answer 28

information about 20 week anomaly scan given

Question 29

foetal care at 18-20 weeks?

Answer 29

US anomaly scan

check placental site on US

Question 30

maternal care at 24 weeks?

Answer 30

BP check
urinalysis
abdominal palpation to check symphyseal-fundal height
foetal heart auscultation

Question 31

maternal care at 28 weeks?

Answer 31

offer random blood glucose (gestational diabetes check)

anti D given if rhesus -ve

Question 32

maternal care at 31-32 weeks?

Answer 32

(only for primiparous women)
BP and urinalysis
abdominal palpation
position and lie of baby
foetal heart auscultation
(done weekly thereafter?)

Question 33

how many appointments will uncomplicated nulliparous women have?

Answer 33

10

Question 34

how many appointments will uncomplicated multiparous women have?

Answer 34

7

Question 35

extra screening in pre-existing diabetes or new onset gestational diabetes?

Answer 35

extra surveillance to monitor foetal growth and amniotic fluid volume
carried out between 28 and 36 weeks at monthly intervals