Normal Pregnancy Antenatal Care Flashcards
what supplements are given to all women pre-pregnancy?
folic acid 400mcg before conception up until 12 weeks gestation
10mg vit D during pregnancy and breastfeeding
iron supplementation isnt given routinely
when would pregnant women be given 5mg folic acid instead of 400mcg?
diabetes taking anti-epileptic meds BMI >30 previous child with neural tube defect personal history of neural tube defect in mother or father
extra calories needed in pregnancy?
250-300
esp in last trimester
safe alcohol limit in pregnancy?
no safe limit
management of smoking in pregnancy?
should stop immediately
can use nicotine replacement therapy (patches, gum etc)
bupropion and varenicline not allowed
side effects of amphetamine use in pregnancy?
maternal = hypertensive disorders (pre-eclampsia, abruption, stroke, arrhythmia) fetal = prematurity, neonatal abstinence syndrome, teratogenicity, IUGR, pre-term labour, miscarriage, developmental delay, SIDS, withdrawal
side effects of opiate use in pregnancy?
neonatal abstinence syndrome IUGR SIDS still birth maternal death
side effects of cannabis use in pregnancy?
cognitive deficits, miscarriage, fetal growth restriction
side effects of nicotine use in pregnancy?
miscarriage pre-term labour IUGR SIDS still birth SUDI
side effects of alcohol use in pregnancy?
fetal alcohol syndrome IUGR post-natal restricted growth learning difficulties miscarriage withdrawal wernickes encephalpathy and koraskoff synrome microcephaly
other consequences of substance misuse?
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
management of substance misuse in antenatal care?
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
when is booking visit done?
10-12 weeks gestation by community midwife
what happens at booking?
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
when is foetal anomaly scan done?
18-20 weeks
what is screened for at foetal anomaly scan?
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)
how is downs syndrome screened for in first instance?
combined test at 11-14 weeks
involves blood test and US scan
blood test in combined test?
serum PAPP-A
AFP
bHCG
(AKA triple test)
combined test blood results in downs syndrome?
PAPP-A and AFP = low
bHCG = increased
US part of combined test?
nuchal thickness (amount of fluid collecting at nape of foetal neck) normal = <3.5 increased in downs syndrome
second stage testing ind downs syndrome?
done at 15-16 weeks and involved quadruple test
what is involved in a quadruple test?
blood test checking AFP, inhibin, oestriol and total bHCG
antenatal care pre-conception?
folic acid supplementation
avoid certain foods
avoid alcohol and drugs
discuss BMI
maternal assessment at booking visit?
take history discuss mental health measure BP blood tests (FBC, blood group, rhesus status, infection screen, haemoglobinopathy screen) check immunity (chicken pox etc)
foetal assessment at booking?
dating scan
US to check viability, determine gestation, site of pregnancy and number of pregnancies
nuchal thickness
how is gestation determined at booking?
foetal pole measurements
maternal care at 16 weeks?
offer BP and urinalysis (for protein)
foetal care at 16 weeks?
information about 20 week anomaly scan given
foetal care at 18-20 weeks?
US anomaly scan
check placental site on US
maternal care at 24 weeks?
BP check
urinalysis
abdominal palpation to check symphyseal-fundal height
foetal heart auscultation
maternal care at 28 weeks?
offer random blood glucose (gestational diabetes check)
anti D given if rhesus -ve
maternal care at 31-32 weeks?
(only for primiparous women) BP and urinalysis abdominal palpation position and lie of baby foetal heart auscultation (done weekly thereafter?)
how many appointments will uncomplicated nulliparous women have?
10
how many appointments will uncomplicated multiparous women have?
7
extra screening in pre-existing diabetes or new onset gestational diabetes?
extra surveillance to monitor foetal growth and amniotic fluid volume
carried out between 28 and 36 weeks at monthly intervals
