Obs & Gynae - Antenatal Care

Question 1

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

Answer 1

8 - 12 Weeks

Ideally < 10 Weeks

Question 2

When should the Patient come in for their booking bloods?

Answer 2

8 - 12 Weeks

Ideally < 10 Weeks

Question 3

What should be taken at the initial booking bloods/Urine (8 - 12 weeks)?

Answer 3

• FBC, Blood Group, Rhesus Status, Red Cell Antibodies, Haemoglobinopathies, First Anaemia Screen
• Hepatitis B, Syphilis, Rubella
• HIV test
• Urine Culture to detect asymptomatic bacteriuria

Question 4

What should be offered to the Patient at 8 - 12 Weeks (ideally < 10)?

Answer 4

Booking Visit

Booking Bloods

Question 5

When should the early scan to confirm dates/exclude multiple pregnancies occur?

Answer 5

10 - 13+6 Weeks

Question 6

When should the Downs Syndrome Screening occur?

Answer 6

11 - 13+6 Weeks

Question 7

How and when do we screen for Down’s Syndrome?

Answer 7

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)

Question 8

When do we do the routine anomaly scan?

Answer 8

18 - 20+6 Weeks

Question 9

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

Answer 9

• 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

Question 10

When do you provide the first dose of Anti-D Prophylaxis to Rhesus Negative Women?

Answer 10

28 Weeks

Question 11

When do you provide the second dose of Anti-D Prophylaxis to Rhesus Negative Women?

Answer 11

34 Weeks

Question 12

When do you typically offer a consultation specifically regarding labour and birth pain?

Answer 12

34 Weeks

Question 13

When is the Second Screen for Anaemia and Atypical Red Cell Antibodies?

Answer 13

28 Weeks

Question 14

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

Answer 14

36 Weeks

Question 15

When is a consultation offered specifically discussing the possibility of a prolonged pregnancy or the induction of pregnancy?

Answer 15

41 Weeks
40 Weeks (if Primipara)

Question 16

When is the First Screen for Anaemia and Atypical Red Cell Antibodies

Answer 16

8 - 12 Weeks

Ideally < 10 Weeks

Question 17

What should be offered at 10 - 13+6 Weeks?

Answer 17

Early Scan to Confirm Dates/Exclude Multiple Pregnancies

and (at 11 - 13+6 Weeks)

Down’s syndrome Screening (including Nuchal Scan)

Question 18

What should be offered at 16 Weeks?

Answer 18

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

Question 19

What should be offered at 18 - 20+6 Weeks?

Answer 19

Anomaly Scan

Question 20

What should be offered at 28 Weeks?

Answer 20

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

Question 21

What should be offered at 31 Weeks?

Answer 21

Only if Primipara:

• BP
• Urine Dipstick
• SFH

Question 22

What should be offered at 25 Weeks?

Answer 22

Only if Primipara:

• BP
• Urine Dipstick
• SFH

Question 23

What should be offered at 34 Weeks?

Answer 23

Routine Care: BP, Urine Dipstick, SFH

Second Dose of Anti-D Prophylaxis to Rhesus Negative Women

Question 24

At what weeks is it expected for the baby to start kicking?

Answer 24

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

Question 25

What is offered at 36 Weeks?

Answer 25

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’

Question 26

What is meant by the term ‘Baby-Blues’?

Answer 26

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