Obs:Antenatal Care

Question 1

Ideally, when should the booking visit be done and between what times ?

Answer 1

Ideally before 10 weeks but can be done between 8 and 12 weeks

Question 2

What is the purpose of the booking visit ? (4)

Answer 2

1. Yo identify women that are high risk and require additional care; 2. Measure maternal height, BP and BMI; 3. Routine booking investigation and 4. Others

Question 3

What is there mnemonic for routine booking investigations ?

What are the routine booking investigations? (6)

Answer 3

BUS SHIVR HB
Bloods: FB (pre-existing anaemia) and antibody screen and rhesus status (both repeated at weeks 28 & 34)
Urinalysis (protein: asymptomatic UTI, glucose: hyperglycaemia and symptomatic bacteria)
USS, screening for chromosomal abnormalities
Serological tests for syphilis, hep B, HIV & rubella immunity check
Hb electrophoresis in those that are high risk

Question 4

What is done for others ? (2)

Answer 4

Blood tests for sickle cell anaemia (Afro-Carribeans) and thalassaemia (Mediterranean’s and Asians) to screen partners of women are carriers

Question 5

When is the USS during the booking done between ?

Answer 5

11+0 and 13+6 weeks

Question 6

What are the types of USS ?

Answer 6

Dating and detailed scan

Question 7

What is the purpose of the dating USS ? (3)

Answer 7

1. Fetal viability, 2. Current gestation (using crown rump length of if less than 14 weeks) and 3. Multiple pregnancy

Question 8

What is the combined test used to estimate the risk of ?

Answer 8

To estimate he risk of trisomy 21

Question 9

What does the combined test involved ?

When is the combined test done ?

Answer 9

The combined test involves USS, nuchal translucency, serum markers: PAPP-A (pregnancy associated plasma protein A) and h-BCG and maternal * previous obstetric history
This is done during the dating scan

Question 10

What is the name of the second scan ? And Between what’s weeks of pregnancy is this done between ?

Answer 10

Detailed anomaly scan and is done between 18+0 and 20+6

Question 11

What is the purpose of the second scan ?

Answer 11

To detect most of fetal structural abnormalities

Question 12

What are the things that the second scan detects ? (7) 😭

Answer 12

CNS, Cardio, Abdominal, urogenital, chest wall, skeletal and fetal hydrops

Question 13

Give an example or examples of the 7 fetal anomalies detected by the anomaly scan ?

Answer 13

1. CNS: spina bifida, anencephaly, 2. Cardio: ASD, TOF; 3. Abdo: Gastrochesis; 4. Chest wall defects: diaphragmatic hernia; 5. Urogenital: hydrocephalus, 6. Skeletal dysplasia and 7. Fetal hydrops: pleural effusion and skin oedema

Question 14

What preconception advice should be given to patients ? (4)

Answer 14

1. Folic acid, vitamin D and C supplementation; 2. Lifestyle advice: lose weight if overweight, stop smoking and Alcohol (FAS); 3. Review education and 4. Leaflets about pregnancy and antenatal classes

Question 15

What is the mnemonic used to identify those at high risk pregnancy during the booking visit ?

Answer 15

A COP

Question 16

What are the risk factors for high pregnancies ?

Answer 16

Age < 15: teen pregnancy and > 35: elderly first time pregnancy
Commodities: 5 main ones: 1. Hypertension, diabetes, renal disease, cardiovascular disease and thromboembolic disease; 2 others: autoimmune disease and infection(HIV)
Others: SAD: 1. Smoking, 2. Alcohol and 3. Drugs
Previous pregnancies: MPG: 1. Multiple pregnancy, 2. Pre-ecamplsia/eclampsia/Hypertension and 3. Gestational diabetes

Question 17

What is the structure of a booking visit history to identify a high risk pregnancy ?

Answer 17

Identify RFs + full obstetric including family history of congenital illnesss

Question 18

What things should remember to ask about in the Drug and family history ?

Answer 18

DH: medications before and during pregnancy; FH: problems or illness that occur during pregnancy in the family; congenital illnesses

Question 19

What is the management for low risk ?

Answer 19

Manage normally + preconceptual advice

Question 20

What is the management for high risk ?

Answer 20

Referral to secondary care for specialist services care providing more intensive antenatal care during the course of pregnancy in hospital?

Question 21

What 2 additional things are done for nulliparous pregnant women only in antenatal care ?

Answer 21

Week 25: fundal height + BP to exclude preeclampsia

Week 31: fundal height, BP and urine dip + review bloods

Question 22

For all pregnant women, what is done at 22 weeks ?

Answer 22

If RFs, uterine artery Doppler

Question 23

For all pregnant women, what is done at 28 weeks ? (3)

Answer 23

FBC & 1st Anti-D if rhesus negative: (3) others: fundal height, GTT if indicated, iron supplementation for anaemia

Question 24

For all pregnant women, what is done at 32 weeks ?

Answer 24

If low-lying placenta repeated anomaly scan

Question 25

For all pregnant women, what is done at 34 weeks ? (2)

Answer 25

FBC and 2nd Anti-D injection

Question 26

For all pregnant women, what is done at 36, 38 and 40 weeks ? (2)

Answer 26

1. Information regarding birth, 2. Check position and presentation and offer ECV if breech presentation

Question 27

For all pregnant women, what is done at 41 weeks ? (2)

Answer 27

Fundal height and lie

Offer membrane sweep and discuss induction

Question 28

For all pregnant women, what is done at 42 weeks ? (2)

Answer 28

Induction or regular monitoring of baby