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)
