Obstetrics - antenatal care Flashcards
Booking appointment
8-10 weeks
Full maternal history
BMI
Bloods - rhesus status of mother, Hep B, Syphilis
Anomaly scan and what tests for
18-22 weeks (20 weeks) - identifies structural abnormalities e.g. exomphalos, NT defects, gastroschisis, congenital cardiac abnormalities
Dating scan/combined screening - and what tests for
Between 11 and 13 weeks
USS takes two measurements (crown-rump length, nuchal translucency)
Increased nuchal translucency can indicate Down’s, Edward’s, Patau’s (21, 18 13 respectively)
CRL allows dating
Can assess if multiple foetuses are present
Blood tests - beta HCG (high in Downs etc) and PAPPA (low in Downs etc)
Routine anti-D injections
28 and 34 weeks
Combined test elements and time conducted
Nuchal translucency
PAPP-A
Beta-HCG
Between 11 and 14 weeks
Things tested at routine antenatal appointments
- Symphysis fundal height (from 24 weeks)
- Foetal presentation (from 36 weeks)
- Urine dipstick and blood pressure (for pre-eclampsia)
- Urine for microscopy and culture for asymptomatic bacteriuria
- Plans for delivery and remainder of pregnancy
Vaccines offered
Whooping cough (pertussis) from 16 weeks gestation
Flu vaccine (in autumn/winter)
Live vaccines e.g. MMR - avoid in pregnancy
What test is done if the woman hasn’t had the combined test and is past 13+6 weeks?
Quadruple test - between 15 and 20 weeks
Options for invasive diagnostic testing in high risk pregnancies identified for Trisomies and the details
- Chorionic villus sampling - between 10 and 13 weeks usually, risk of miscarriage just over 1% and slightly more likely to get an inconclusive result and need repeat sampling
- Amniocentesis - after 15 weeks, slightly safer (<1% miscarry), less chance of inconclusive result
Women at risk of gestational diabetes get
Oral glucose tolerance test (between 24 and 28 weeks)
Women with placenta praevia also get
Ultrasound scan at 32 weeks
Women at increased risk of intrauterine growth restriction also get …
serial growth scans
