Obs - Antenatal care

Question 1

A 32yo G1P0 attend a booking visit at 12/40. She discloses that she has a PMH of 2 DVTs in the last 5yrs.

How should she be managed?

Answer 1

1. refer to haem/obs team in ANC

2. start LMWH e.g. DALTEPARIN asap and continue for remainder of pregnancy and for minimum 7/7 postpartum

Question 2

Suggest risk factors that should be taken into account when assessing antenatal VTE risk.

Answer 2

1. previous VTE 4pts
2. previous VTE provoked by major surgery 3pts
3. known high risk thrombophilia 3pts
4. medical disorder e.g. nephrotic syndrome, SCD, heart or lung disease, SLE, IVDU, cancer, myeloproliferative disorder 3pts
5. aged 40+ 1pt
6. BMI 30+ 1pt
7. BMI 40+ 2pts
8. parity 3+ 1pt
9. smoker 1pt
10. gross varicose veins 1pt
11. 1st degree FHx of unprovoked or Oe-related VTE 1pt
12. known low risk thrombophilia 1pt
13. assisted conception 1pt

Score 4+: start LMWH asap
Score 3: start LMWH at 28/40

Question 3

When does the booking visit take place?

Answer 3

8-12/40 (ideally <10/40)

Question 4

When does Down’s screening take place?

Answer 4

1. 11+0 to 13+6: combined test

2. 15+0 to 20+0: serum screening

Question 5

When are USS normally offered to pregnant women?

Answer 5

1. Dating scan: 8+0 to 13+6 (can include nuchal translucency)
2. Anomaly scan: 18+0 to 20+6

Question 6

Which risk factors increase risk of pre-eclampsia? How should high risk women be managed?

Answer 6

High risk factors:

• hypertensive disease during prev. pregnancy
• CKD
• autoimmune disease e.g. SLE or APS
• T1DM or T2DM
• chronic HTN

Moderate risk factors:

• 1st preg.
• age 40+
• preg. interval >10yrs
• BMI 35+ at 1st visit
• FHx of pre-eclampsia
• multiple pregnancy

If 1+ high RF or 2+ moderate RF: ASPIRIN 75-150mg OD from 12/40 until birth

Question 7

When should a woman be offered screening for gestational diabetes?

Answer 7

Assess risk factors at booking visit and offer testing if any 1 is present:

• BMI >30
• prev. macrosomic baby (4.5+ kg) or prev. gestational diabetes
• FHx of diabetes
• family origin with high prevalence of diabetes (South Asian, Black Caribbean, Middle Eastern)

Question 8

Name 2 supplements all pregnant women should take and explain why and how much.

Answer 8

1. FOLIC ACID from 1/12 prior to conception to 12/40 to reduce risk of NTDs:
   - 400ug OD for most women
   - 5mg for women with previous child with NTD, FHx of NTD or T1/2 DM
2. VITAMIN D for health of woman + baby:
   - 10ug OD form most women
   - 25ug OD for women with limited sunlight exposure, ethnicity (South Asian, African, Caribbean or Middle Eastern), BMI 30+ or high risk of pre-eclampsia
   (Caution in women with sarcoidosis or renal disease)

Question 9

When should rhesus -ve women receive prophylaxis?

Answer 9

Anti-D at 28/40 +/- 34/40

Question 10

Which blood tests are offered at the booking visit?

Answer 10

Bloods:

• FBC
• blood group + rhesus status
• red cell alloantibodies

Screening:

• HIV
• syphillis
• HepB