Pre and antenatal care Flashcards
What dose is given of folic acid for normal healthy women with no contraindications?
400mcg
Give some examples of when women may require a dose of 5mg of folic acid instead?
BMI >30 Diabetes Previous neural tube defects in pregnancy Anti-epileptic medication FHx of neural tube defects Coeliac disease (malabsorption disease) Thalassaemia
What HbA1c level should diabetics aim for before falling pregnant?
HbA1c <48 mmol/mol
What are some medications contra-indicated in pregnancy?
ACE inhibitors
Warfarin
Mood stabilisers/anti epileptics
In patients with pre-existing diabetes mellitus, what medication should be initiated from 12 weeks gestation and why?
Aspirin 75mg
Reduces risk of pre-eclampsia
In patients with pre-existing diabetes mellitus, what medications are not appropriate and what medications are, for pregnancy?
The only medications deemed acceptably safe during pregnancy are metformin and insulin.
All other oral hypo-glycaemics are not suitable
At what date is the first booking appointment with the midwife?
10-12 weeks
What tests are done at the booking visit?
HIV / Hep B screening Thalassaemia screen urine dip and culture BP Rhesus status, FBC etc
When is the early scan to confirm dates done?
Weeks 10-13 +6
At what gestational age is the screening and nuchal scan for Downs?
Weeks 11-13+6
At what stage in the pregnancy will an anomaly scan be done?
Weeks 18-20+6
If it is a woman’s first pregnancy, how many appointments will she have with the midwife?
10
If all is uncomplicated
When is the first dose of rhesus given to negative women? What else can be done at this time?
28 weeks
Offer whooping cough vaccine and random glucose check
What is done at the 24 week visit?
Check symphyseal-fundal height
BP check
Urine check
foetal heart auscultation
Women with gestational or pre-existing diabetes are offered more appointments. True or false?
True
They get offered appointments monthly between weeks 28 and 36 to monitor foetal growth and amniotic fluid levels
Why are women with diabetes offered more scans?
They are at more risk of stillbirth, polyhydramnios and congenital malformations.
What is the main risk if a mother is rhesus D negative?
It can cause haemolytic disease of the newborn in the following pregnancy
How does the rhesus D antibody treatment work?
It is given to mothers so that the antigens from the rhesus +ve foetus can be bound to the antibodies given. This prevents them from crossing the placenta in the second pregnancy
What test can be done if you suspect there is a risk of the mother having been exposed to the fetus blood?
Kleihauer test
When can chorionic villus sampling be carried out?
Weeks 11-13+6
What are the main risks with chorionic villus sampling?
2% chance of miscarrying
Amniotic fluid embolism
Sensitisation of rhesus D -ve
What testing for foetal abnormality is carried out after week 15?
Amniocentises
Is there a risk of miscarriage in amniocentesis?
Yes roughly 1%
When might a mother be given rhesus D antibodies before week 28
If they experience a potential sensitisation incident it is usually given within 72 hours
Give some examples of sensitization incidents that can occur during pregnancy?
Vaginal bleeding after 12 weeks Placental abruption Abdominal trauma Ectopic pregnancy Abortion Foetal death Cephalic version CVS/ amniocentesis Surgical management of miscarriage <12 weeks
50% of babies born with Down’s syndrome will have a normal anomaly scan. True or false?
True
