Pre and Antenatal Care Flashcards
PRE-CONCEPTION VISIT
✔️ who
✔️ when
✔️ what / components
WHO: GP
WHEN: prior to conception
WHAT:
- PMHx, PSHx and medications
- Past obstetric history
✔️ previous pregnancies (including ectopic, miscarriages and abortions)
✔️ previous deliveries (including mode and indications)
✔️ current children
✔️ previous complications during pregnancy (e.g. gestation HTN, GDM, pre-eclampsia, APH) - Past gynaecological history
✔️ LMP
✔️ cycle length, regularity, bleeding patterns etc.
✔️ previous CST results
✔️ previous gynaecological problems (being and malignant)
✔️ sexual history (particularly previous STIs and PID) - Examination
5. General lifestyle advice ✔️ nutrition ✔️ physical activity ✔️ smoking and alcohol cessation ✔️ weight optimisation / BMI
6. TORCH infections --> information sheet provided!! ✔️ toxoplasma gondii ✔️ others ✔️ rubella ✔️ CMV ✔️ HIV
- Folic acid supplementation
- Vaccinations
✔️ whooping cough (given during pregnancy)
✔️ influenza (given during pregnancy)
FIRST ANTENATAL VISIT
✔️ who
✔️ when
✔️ what
WHO: GP
WHEN: within 12 weeks of pregnancy
WHAT:
1. LMP
- Estimate EDD –> LMP + 280 days
- Confirm with serum beta-hCG levels
- Arrange pregnancy bloods (FBC, UECs, eLFTs, coags, maternal blood group, HIV, HepB, HepC and syphillus serology
- Arrange follow up tests:
✔️ NTT (11 to 13 weeks)
✔️ morphology scan (18 to 20 weeks) - Discuss ongoing care
✔️ midwives / GP shared care
✔️ private obstetrician
✔️ public obstetrician - Arrange influenza vaccine
- Discuss normal changes associated with pregnancy
✔️ weight gain (4.5 to 13kg over the entire pregnancy)
✔️ increased nutritional requirements (300kCal / day in second and third trimester)
✔️ cardiovascular changes (hypotension leading to dizziness and headache)
✔️ swelling in ankles (later)
✔️ morning sickness (hyperemesis gravardium)
✔️ haematological changes (IDA)
✔️ gastrointestinal changes (GORD)
✔️ MSK changes (lower back pain, carpal tunnel disease) - Answer any questions.
MIDWIFE BOOKING IN APPOINTMENT
✔️ who
✔️ when
✔️ what
WHO: midwives
WHEN: 12 to 18 weeks
WHAT: 1. Ask about symptoms of pregnancy ✔️ nausea and vomiting ✔️ weight gain ✔️ appetite ✔️ headache and blurred vision ✔️ swelling of ankles ✔️ foetal movements
- Measure:
✔️ maternal BP
✔️ foetal HR
✔️ maternal urine dipstick - Review blood tests
- Review NTT
- Order Maternal Serum Alpha Feto Protein (MS-AFP)
ONG BOOKING IN APPOINTMENT
✔️ who
✔️ when
✔️ what
WHO: obstetrician
WHEN: 20 weeks
WHAT: 1. Ask about symptoms of pregnancy ✔️ nausea and vomiting ✔️ weight gain ✔️ appetite ✔️ headache and blurred vision ✔️ swelling of ankles ✔️ foetal movements
- Measure:
✔️ maternal BP
✔️ foetal HR
✔️ maternal urine dipstick - Review morphology results
- Review maternal serum alpha foetal protein
- Order OGTT (for 24 to 28 weeks)
- Order Quadruple tests (AFP, ostrodial, inhibin, Beta-HCG)
24-WEEK APPOINTMENT
✔️ what
1. Discuss: ✔️ foetal movements ✔️ headache and dizziness ✔️ visual changes ✔️ swelling
- Measure:
✔️ fundal height
✔️ maternal HR and BP
✔️ foetal BP - Discuss OGTT results
✔️ fasting < 5.1 mmol / L
✔️ post 1 hour < 10.0 mmol / L
✔️ post 2 hour < 8.5 mmol / L
28-WEEK APPOINTMENT
✔️ what
1. Discuss: ✔️ foetal movements ✔️ headache and dizziness ✔️ visual changes ✔️ swelling
- Measure:
✔️ fundal height
✔️ maternal HR and BP
✔️ foetal BP - Discuss OGTT results
✔️ fasting < 5.1 mmol / L
✔️ post 1 hour < 10.0 mmol / L
✔️ post 2 hour < 8.5 mmol / L - Arrange dTPA vaccination.
- Give anti-D if required.
32 WEEK APPOINTMENT
1. Discuss: ✔️ foetal movements ✔️ headache and dizziness ✔️ visual changes ✔️ swelling
- Measure:
✔️ fundal height
✔️ maternal HR and BP
✔️ foetal BP - Give anti-D if required (second dose).
- Begin discussing maternal wishes for delivery.
36 WEEK APPOINTMENT
1. Discuss: ✔️ foetal movements ✔️ headache and dizziness ✔️ visual changes ✔️ swelling
- Measure:
✔️ fundal height
✔️ maternal HR and BP
✔️ foetal BP - Test GBS status.
- Continue discussing maternal wishes for delivery.
40 WEEK APPOINTMENT
1. Discuss: ✔️ foetal movements ✔️ headache and dizziness ✔️ visual changes ✔️ swelling
- Measure:
✔️ fundal height
✔️ maternal HR and BP
✔️ foetal BP - Foetal position and lie, head engagement etc.
- Induce labour at 40 + 1.
What is the most appropriate regime for antenatal visits?
Pre-conception counselling
Initial GP Visit < 12 weeks
Midwife Booking In Appointment 12 to 18 weeks
ONG Booking In Appointment 20 Weeks
20 to 32 Weeks: every 4 weeks
32 to 36 Weeks: every 2 weeks
36 to 40 Weeks: every one week
When is RhD given (if required)?
28 and 34 weeks.
Indications:
✔️ maternal RhD -ve
✔️ unknown RhD status
When is GBS tested for?
36 weeks.
Define HYPEREMESIS GRAVIDARUM.
Severe form of morning sickness characterised by ketosis and > 5 % weight loss.
Describe some management strategies for HYPEREMESIS.
✔️ anti-emetic (e.g. metoclopramide, ondansetron)
✔️ IV fluids
✔️ electrolyte and vitamin replacement (thiamine, Vitamin B, Vitamin C, Vitamin E)
✔️ monitoring baby
Define INTRAUTERINE GROWTH RESTRICTION.
IUGR is defined as a foetus measuring <10th centile for its age.
It may also be considered when fundal height is greater than 4cm less than expected (e.g. 28 cm at 32 weeks).
