Normal pregnancy care

Question 1

key points preconceptual counselling (9)

Answer 1

• previous pregs and implications
• assess CV health
• smear abnormalities (do smear 3m postnatally)
• Rubella status
• chronic condition check and control
• med check eg AED
• folic acid supplementation
• lifestyle
• education on diet eg 2500 cals, listeriosis

Question 2

indications for 5mg folic acid (not 0.4) (4)

Answer 2

> 30 BMI
Sickle cell
malabsorption
AEDs

Question 3

indications for 25ug Vit d (not 10ug) (4)

Answer 3

> 30 BMI
PreE risk
afrocaribbean or S. Asian

Question 4

mx if risk of PreE

Answer 4

75mg aspirin and increase BP monitoring

Question 5

VTE risk mx

Answer 5

LMWH

Question 6

booking history key points

Answer 6

age <17, >35
hx preg
past ob hx: IUGR, SGA, prem, APH, PPH, Rh, PreE, GDM, congenital ab
past Gynae: surgery eg loop diathermy
PMHx incl psych
drugs
Fix: GDM increase if first degree released DM. also HTN, TE, preE and autoimmune

Question 7

booking visit examination

Answer 7

BMI
baseline BP
From 12 weeks can auscultate FH

Question 8

booking visit investigations

Answer 8

USS booked for 11-13+6 when also do combined test
Bloods: FBC, Anti-D antibodies (Rh), GTT if risk, stphillis, rubella immunity (vac offered postnatally), HIV and HepB screening offered
screen for chlamydia and BV
Urine MCandS, Urinalysis

Question 9

what is screened for at 20 week scan?

Answer 9

anomaly scan, most structural defects
USS cervical length measured (give PG if short)
USS of uterine artery can be used as screening for IUGR or PreE

Question 10

what is done at 28 weeks?

Answer 10

FBC and antibody assessment. repeat if tx for anaemia
GTT if RF
?NIPT for Rh

Question 11

what is measured at dating scan

Answer 11

crown-rump length dates preg (b4 14 weeks); site preg, multiple preg; combined or triple/quadruple if later

Question 12

how many appointments does NICE recommend for uncomplex nulliparous and multiparous?

Answer 12

10 and 7

Question 13

schedule of antenatal visits

Answer 13

• 10 weeks booking
• 11-13+6 dating scan and Chr testing
• 16 weeks: discuss results of booking bloods, Chu ab. triple test if missed combined
• 18-21 weeks: anomaly scan. if placenta low scan 32 weeks
• 25: nulliparous only. exclude PreE and do GTT if need
• 28: fundal height measured. FBC and antibodies checked. anti-D given to Rh neg women
• 31: fundal height in nulliparous
• 34: fundal height. FBC if Hb was low
• 36,38,40: fundal height, lie, presentation. refer for ECV if breech.
• 41: check above and offer sweep and IOL by 42 weeks

Question 14

when is it done and what is miscarriage risk

• amniocentesis
• CVS

Answer 14

Amniocentesis: 1%, 15 weeks
CVS: 1-2%, from 11 weeks

Question 15

what can amniocentesis pick up?

Answer 15

infection (too, CMV), Chr. ab, inherited disorders eg CF, sickle cell, thalassaemia

Question 16

what methods are used in amniocentesis and CVS?

Answer 16

karyotyping, FISH, microarray-CGH for Chr. abs

Question 17

how many live births are affected by Chr. abs?

Answer 17

6/1000

Question 18

what is included in

1) combined test
2) triple test
3) quadruple test

Answer 18

1) maternal age, nuchal translucency, PAPP-A, B-hCG
2) AFP, B-hCG, oestriol
3) bloods, age, AFP, total hCG, inhibin, oestriol

Question 19

diagnosis of labour

and how initiation labour starts, ss

Answer 19

painful regular contractions leading to cervical dilatation and effacement.
Braxton hicks in T3 + production PGs, decrease cervical R, release oxytocin, further stimulates contractions from pacemakers in Cornu uterus. often Get show. +/- ROM

Question 20

what is first stage of labour and how long should the active phase take.

Answer 20

from dx labour til full dilation. <16 hrs active (after 4cm). 8 null, 5 multi. average rate 1cm/hr null, 2cm/hr multi.

Question 21

what happens in active 2nd stage and how long

Answer 21

uncontrollable urge to push with contractions as head descends. <1hr. 40mins null, 20 multi.

Question 22

normal blood loss in 3rd stage

what happens in 3rd stage

Answer 22

from deliver fetus to placenta. <500ml, normally around 15 mins. active with IM syntocin/syntometrine.

Question 23

perineal trauma classification
1st degree:
2nd degree:
3rd degree:
4th degree:

Answer 23

1st: minor damage to fourchette
2nd and episiotomies: perineal muscle
3rd: anal spinchter (1%)
4th: anal mucosa