Obs & Gynae - Antenatal Care Flashcards
At what time would the Patient come in for their initial booking visit?
This visit would cover:
- General Information e.g. Diet, Alcohol, Smoking, Folic Acid, Vitamin D, Antenatal Classes
- You would check Blood Pressure, Urine Dipstick, BMI
- Take Booking Bloods
8 - 12 Weeks
Ideally < 10 Weeks
When should the Patient come in for their booking bloods?
8 - 12 Weeks
Ideally < 10 Weeks
What should be taken at the initial booking bloods/Urine (8 - 12 weeks)?
- FBC, Blood Group, Rhesus Status, Red Cell Antibodies, Haemoglobinopathies, First Anaemia Screen
- Hepatitis B, Syphilis, Rubella
- HIV test
- Urine Culture to detect asymptomatic bacteriuria
What should be offered to the Patient at 8 - 12 Weeks (ideally < 10)?
Booking Visit
Booking Bloods
When should the early scan to confirm dates/exclude multiple pregnancies occur?
10 - 13+6 Weeks
When should the Downs Syndrome Screening occur?
11 - 13+6 Weeks
How and when do we screen for Down’s Syndrome?
Combined test is now recommended (NICE 2008). It occurs at 10 - 13+6 weeks and is a combination of an USS and a blood test.
Testing involves the following:
- Nuchal Translucency Measurement (Using an Ultrasound probe the fluid at the back of baby’s neck is measured)
- Serum β-HCG (blood test)
- Pregnancy Associated Plasma Protein A (blood test)
When do we do the routine anomaly scan?
18 - 20+6 Weeks
When do we start the routine follow up appointments?
And
When are they scheduled after that?
These appointments check:
- BP, Urine Dipstick, Symphysis Fundal Height
- 25 Weeks (Initial for Primipara only)
- 28 (Initial for all other women, primipara also attends)
- 31 (Only if Primipara)
- 34
- 36
- 38
- 40 (Only if Primipara)
- 41
When do you provide the first dose of Anti-D Prophylaxis to Rhesus Negative Women?
28 Weeks
When do you provide the second dose of Anti-D Prophylaxis to Rhesus Negative Women?
34 Weeks
When do you typically offer a consultation specifically regarding labour and birth pain?
34 Weeks
When is the Second Screen for Anaemia and Atypical Red Cell Antibodies?
28 Weeks
When do we check for the presentation of the baby and complete a risk assessment for labour?
Information on breast feeding, Vitamin K and ‘Baby-Blues’ is also offered at this time
36 Weeks
When is a consultation offered specifically discussing the possibility of a prolonged pregnancy or the induction of pregnancy?
41 Weeks 40 Weeks (if Primipara)
When is the First Screen for Anaemia and Atypical Red Cell Antibodies
8 - 12 Weeks
Ideally < 10 Weeks
What should be offered at 10 - 13+6 Weeks?
Early Scan to Confirm Dates/Exclude Multiple Pregnancies
and (at 11 - 13+6 Weeks)
Down’s syndrome Screening (including Nuchal Scan)
What should be offered at 16 Weeks?
Give the Information on the Upcoming Anomaly Scan and the outcome of previous Blood Results
Routine Care: BP & Urine Dipstick
if Hb < 11 g/dL consider Iron Supplementation
What should be offered at 18 - 20+6 Weeks?
Anomaly Scan
What should be offered at 28 Weeks?
Routine care: BP, urine dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies.
If Hb < 10.5 g/dl consider iron Supplementation
First dose of anti-D prophylaxis to rhesus negative women
What should be offered at 31 Weeks?
Only if Primipara:
- BP
- Urine Dipstick
- SFH
What should be offered at 25 Weeks?
Only if Primipara:
- BP
- Urine Dipstick
- SFH
What should be offered at 34 Weeks?
Routine Care: BP, Urine Dipstick, SFH
Second Dose of Anti-D Prophylaxis to Rhesus Negative Women
At what weeks is it expected for the baby to start kicking?
Usually felt between weeks 16 and 24 of pregnancy
May be felt later if it’s the woman’s first pregnancy
During a Second pregnancy Foetal Movements can be felt as early as 13 Weeks
There’s no true guide to how frequent the baby should kick. Each mother should be able to determine a normal frequency for their specific baby. The only time for concern is if there’s a noticable change in how often the baby kicks
Once started, movements should continue up to and during labour
What is offered at 36 Weeks?
Routine Care: BP, Urine Dipstick, SFH
Check Presentation of baby - Offer external cephalic version if indicated
Information on Breast Feeding, Vitamin K and ‘Baby-Blues’
What is meant by the term ‘Baby-Blues’?
Baby-Blues usually occurs during the first week (usually day 3 - 7) after the birth.
New Mothers may report low mood, anxiety, irritability and being quick to bust into tears. Thought to affect 60-70% of women
It is different to post natal depression
PND usually occurs around 2 - 8 Weeks after delivery (although it can happen up to a year after the baby is born) and is thought to effect approximately 1 in 10 Women
They should be reassured that this is normal. It is thought to be the result of the sudden chemical and hormonal changes in their body after childbirth
These symptoms usually disappear after a few days, without needing treatment
