Obs - Antenatal care

Question 1

define antenatal?

Answer 1

the period during or relating to pregnancy

Question 2

where does antenatal care ideally start?

what are the components

Answer 2

Pre-conception! ;

it is so important to make sure long term health issues are well controlled, medications are reviewed and optimised / stopped WELL before conceiving!

otherwise teratogenic and other effects of such can make pregnancy complicated.

Cervical smear up to date
 Rubella status
 chronic disease optimised e.g. glucose control
 Medication optimised for pregnancy
 Routine 0.4mg daily of folic acid
 Alcohol, drug and smoking cessation advice

Question 3

what kinds of scans are done in the Antenatal care? when?

Answer 3

Dating scan: 11-13+6 weeks. routine

Anomaly scan: 20 weeks approx (18-21). routine

Growth scan: approx 23 weeks. not routine. if inidcation
of iugr

Question 4

what tests are done at booking?

Answer 4

Urine culture
Full blood count (FBC)
Antibody screen
Serological tests for syphilis
Rubella immunoglobulin G

Offer human immunodeficiency virus (HIV) and hepatitis B
Ultrasound scan
Screening for chromosomal abnormalities
±Haemoglobin electrophoresis

Question 5

what tests are carried out at the dating scan?

Answer 5

US - date with crown rump length (<14 weeks)

nuchal translucency measured

can tell if twins or more

BHCG, PAPP-A

Question 6

When is the booking visit?

Answer 6

10 weeks or before, ideally

women can book whenever

Question 7

which routine drugs are given in pregnancy and when to commence and stop?

Answer 7

folate: 6 months pre conception - 12 weeks gestation

iron

vitamin d: afrocarribean, south asian, bMI>30

Question 8

why is folate taken? why is it. stopped at 1st trimester?

Answer 8

prevent neural tube defects; anencephaly, spina bifida

neural tube closes at approx 5 weeks pregnant - > so just 1 week after realising youve missed your period.

Question 9

if pregnancy uncomplicated how many appointments will be had?

Answer 9

10 appointments approx.

Question 10

when does fetal lie and presentation become important?

Answer 10

from 36 weeks onwards.

even at 36 weeks, give it some time it may spontaneously resolve and engage.

Question 11

A woman is thought to be high risk for the following after booking results. how would you manage/mitigate?

1. Venous thromboembolism
2. Pre-eclampsia
3. Chromosomal abnormalities
4. Fetal growth restriction
5. Gestational diabetes

Answer 11

1. Venous thromboembolism:
   LMWH
2. Pre-eclampsia:
   Aspirin 75 mg + Increased blood pressure monitoring
3. Chromosomal abnormalities:
   Non-invasive prenatal diagnosis (free fetal dna from maternal blood) or invasive testing
4. Fetal growth restriction:
   Serial ultrasound of fetal growth
5. Gestational diabetes:
   Glucose tolerance test