Obs:Antenatal Care Flashcards
Ideally, when should the booking visit be done and between what times ?
Ideally before 10 weeks but can be done between 8 and 12 weeks
What is the purpose of the booking visit ? (4)
- 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
What is there mnemonic for routine booking investigations ?
What are the routine booking investigations? (6)
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
What is done for others ? (2)
Blood tests for sickle cell anaemia (Afro-Carribeans) and thalassaemia (Mediterranean’s and Asians) to screen partners of women are carriers
When is the USS during the booking done between ?
11+0 and 13+6 weeks
What are the types of USS ?
Dating and detailed scan
What is the purpose of the dating USS ? (3)
- Fetal viability, 2. Current gestation (using crown rump length of if less than 14 weeks) and 3. Multiple pregnancy
What is the combined test used to estimate the risk of ?
To estimate he risk of trisomy 21
What does the combined test involved ?
When is the combined test done ?
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
What is the name of the second scan ? And Between what’s weeks of pregnancy is this done between ?
Detailed anomaly scan and is done between 18+0 and 20+6
What is the purpose of the second scan ?
To detect most of fetal structural abnormalities
What are the things that the second scan detects ? (7) 😭
CNS, Cardio, Abdominal, urogenital, chest wall, skeletal and fetal hydrops
Give an example or examples of the 7 fetal anomalies detected by the anomaly scan ?
- 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
What preconception advice should be given to patients ? (4)
- 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
What is the mnemonic used to identify those at high risk pregnancy during the booking visit ?
A COP
What are the risk factors for high pregnancies ?
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
What is the structure of a booking visit history to identify a high risk pregnancy ?
Identify RFs + full obstetric including family history of congenital illnesss
What things should remember to ask about in the Drug and family history ?
DH: medications before and during pregnancy; FH: problems or illness that occur during pregnancy in the family; congenital illnesses
What is the management for low risk ?
Manage normally + preconceptual advice
What is the management for high risk ?
Referral to secondary care for specialist services care providing more intensive antenatal care during the course of pregnancy in hospital?
What 2 additional things are done for nulliparous pregnant women only in antenatal care ?
Week 25: fundal height + BP to exclude preeclampsia
Week 31: fundal height, BP and urine dip + review bloods
For all pregnant women, what is done at 22 weeks ?
If RFs, uterine artery Doppler
For all pregnant women, what is done at 28 weeks ? (3)
FBC & 1st Anti-D if rhesus negative: (3) others: fundal height, GTT if indicated, iron supplementation for anaemia
For all pregnant women, what is done at 32 weeks ?
If low-lying placenta repeated anomaly scan
For all pregnant women, what is done at 34 weeks ? (2)
FBC and 2nd Anti-D injection
For all pregnant women, what is done at 36, 38 and 40 weeks ? (2)
- Information regarding birth, 2. Check position and presentation and offer ECV if breech presentation
For all pregnant women, what is done at 41 weeks ? (2)
Fundal height and lie
Offer membrane sweep and discuss induction
For all pregnant women, what is done at 42 weeks ? (2)
Induction or regular monitoring of baby
