Obstetrics: Antenatal care and screening

Question 1

How many visits should a uncomplicated primip and uncomplicated multi receive?

Answer 1

• Primip uncomplicated: 10 antenatal visits
• Multi uncomplicated: 7 antenatal visits
• Women do not need to be seen by a consultant if pregnancy is uncomplicated

Question 2

What occurs at 8 - 12 weeks visit (ideally <10 weeks)? What checks, information and Ix are performed?

Answer 2

Booking visit

• General information (diet/alcohol, smoking, folic acid, vit D, antenatal classes.
• BP, urine dipstick, check BMI

Booking bloods/urine:

• FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
• Hep B, syphilis, rubella
• HIV test offered to all woman
• Urine culture send to detect asymptomatic bacteriuria

Question 3

What occurs at 10 - 13+6 weeks?

Answer 3

-Early scan to confirm dates and exclude multiple pregnancy

Question 4

What occurs at 11 - 13+6 weeks?

Answer 4

Down’s syndrome screening

• Combined test (standard): nuchal translucency measurement (increased in Down’s) and serum B HCG (high in Downs) and Pregnancy associated plasma protein A PAPP A (low). Tests for Downs, Edwards and Patau’s
• If women book later in pregnancy, can offer triple or quadruple test between 15-20 but this is less sensitive. These test for AFP, unconjugated oestriol, HCG +/- inhibin A

Question 5

What occurs at 16 weeks?

Answer 5

Information on the anomaly and the blood results
If HB <11g/dl consider iron supplementation
Routine care: BP and urine dipstick

Question 6

What occurs at 18 - 20+6 weeks?

Answer 6

Anomaly scan

Question 7

What occurs at 25 weeks?

Answer 7

For primips only

-Routine care: BP, urine dip, SFH measurement

Question 8

What occurs at 28 weeks?

Answer 8

Routine care: BP, urin, SFH
Second screen for anaemia and typical red cell alloantibodies. If Hb < 10.5 g/dl consider iron supplementation
1st dose of anti-D prophylaxis for rhesus negative women

Question 9

What occurs at 31 weeks?

Answer 9

For primips only

-Routine care: BP, urine dip, SFH

Question 10

What occurs at 34 weeks?

Answer 10

• Routine care: BP, urine dip, SFH
• Second of anti-D prophylaxis to rhesus negative women
• Information on labour and birth plan

Question 11

What occurs at 36 weeks?

Answer 11

• Routine care: BP, urine dip, BP
• Check presentation: offer ECV if indicated
• Information on breast feeding, vitamin K and post natal mental health

Question 12

What occurs at 38 weeks?

Answer 12

Routine care: BP, urine dip, BP

Question 13

What occurs at 40 weeks?

Answer 13

Primips only

• Routine care: BP, urine dip, BP
• Discussion about options for prolonged pregnancy

Question 14

What occurs at 41 weeks?

Answer 14

• Routine care: BP, urine, BP

- Discuss labour plans and possibility of induction

Question 15

What further testing can you offer if the screening done between 11 13+6 comes back higher risk?

Answer 15

Chorionic villous sampling

• Offered between 11 and 14 weeks
• Fine Needle aspirate from placenta: cells are tested for Downs/Edwards/Patau.
• Has risk of miscarriage but will confirm with certainty if there is/isn’t genetic abnomality

Amniocentesis
-Offered from week 15. Fine needle aspirate of amniotic fluid and cells are tested as above. Same risks as CVS

NIPT (non-invasive pre-natal testing)

• For Down’s only (not offered on NHS, must be done privately)
• Analyses free feotal DNA in maternal blood and detects 98% of babies with Down’s.
• No miscarriage risk associated with this test