Pregnancy timeline and lifestyle advice

Question 1

What does the timeline for each pregnancy depend on?

Answer 1

• start date of the last menstrual period (LMP)

- This determines the gestational age (GA) and the estimated date of delivery (EDD) of the pregnancy

Question 2

How is gestational age described?

Answer 2

• in weeks and days, e.g:

e. g 13+6 refers to 13 weeks plus 6 days

Question 3

What gravida and para would a pregnant woman with three previous deliveries at term have?

Answer 3

G4 P3

Question 4

What gravida and para would a non-pregnant woman with a previous birth of healthy twins have?

Answer 4

G1 P1

Question 5

What gravida and para would a non-pregnant woman with a previous miscarriage have?

Answer 5

G1 P0

Question 6

What gravida and para would a non-pregnant woman with a previous stillbirth (after 24 weeks gestation) have?

Answer 6

G1 P1

Question 7

When does the first trimester begin and end?

Answer 7

from the start of pregnancy until 12 weeks gestation

Question 8

When does the second trimester begin and end?

Answer 8

from 13 weeks until 26 weeks gestation

Question 9

When does the third trimester begin and end?

Answer 9

from 27 weeks gestation until birth.

Question 10

At what gestation do fetal movements start?

Answer 10

from around 20 weeks gestation, and continue until birth.

Question 11

What are the key milestones during pregnancy and when do these occur?

Answer 11

• booking clinic –> before 10 weeks
• dating scan –> between 10 and 13+6 weeks
• antenatal appointment –> 16 weeks
• anomaly scan –> between 18 and 20 + 6
• antenatal appointments –> at 25, 28, 31, 34, 36, 38, 40, 41 and 42 weeks

Question 12

What is the purpose of the booking clinic?

Answer 12

Offer a baseline assessment and plan the pregnancy

Question 13

What is the purpose of the dating scan?

Answer 13

An accurate gestational age is calculated from the crown rump length (CRL), and multiple pregnancies are identified

Question 14

What is the purpose of the antenatal appointment at 16 weeks?

Answer 14

Discuss results and plan future appointments

Question 15

What is the purpose of the anomaly scan?

Answer 15

An ultrasound to identify any anomalies, such as heart conditions

Question 16

What is the purpose of the antenatal appointments during later pregnancy?

Answer 16

Monitor the pregnancy and discuss future plans

Question 17

What are some additional milestones and why might they be done?

Answer 17

• Additional appointments for higher risk or complicated pregnancies
• Oral glucose tolerance test in women at risk of gestational diabetes (between 24 – 28 weeks)
• Anti-D injections in rhesus negative women (at 28 and 34 weeks)
• US at 32 weeks for women with placenta praevia on the anomaly scan
• Serial growth scans are offered to women at increased risk of fetal growth restriction

Question 18

What are key things that are covered in the routine antenatal appointments during pregnancy?

Answer 18

• Discuss plans for the remainder of the pregnancy and delivery
• Symphysis–fundal height measurement from 24 weeks onwards
• Fetal presentation assessment from 36 weeks onwards
• Urine dipstick for protein for pre-eclampsia
• Blood pressure for pre-eclampsia
• Urine for microscopy and culture for asymptomatic bacteriuria

Question 19

What are the two vaccines offered to all pregnant women?

Answer 19

• Whooping cough (pertussis) from 16 weeks gestation

- Influenza (flu) when available in autumn or winter

Question 20

What supplements are pregnant women generally advised to take?

Answer 20

• folic acid 400mcg from before pregnancy to 12 weeks (reduces neural tube defects)
• vit D (10mcg or 400 IU daily)

*avoid vit A supplements and eating liver or pate (vit A is teratogenic at high doses)

Question 21

What lifestyle advice is given to pregnant women?

Answer 21

• don’t drink alcohol (risk of FAS)
• don’t smoke
• avoid unpasteurised dairy or blue cheese (risk of listeriosis)
• avoid undercooked or raw poultry (risk of salmonella)
• continue moderate exercise but avoid contact sports
• sex is safe
• flying increases risk of VTE
• place car seatbelts above and below the bump

Question 22

What can alcohol in early pregnancy lead to?

Answer 22

• Miscarriage
• Small for dates
• Preterm delivery
• Fetal alcohol syndrome

Question 23

What are the features of FAS?

Answer 23

• Microcephaly (small head)
• Thin upper lip
• Smooth flat philtrum (the groove between the nose and upper lip)
• Short palpebral fissure (short horizontal distance from one side of the eye to the other)
• Learning disability
• Behavioural difficulties
• Hearing and vision problems
• Cerebral palsy

Question 24

What does smoking in pregnancy increase the risk of?

Answer 24

• Fetal growth restriction (FGR)
• Miscarriage
• Stillbirth
• Preterm labour and delivery
• Placental abruption
• Pre-eclampsia
• Cleft lip or palate
• Sudden infant death syndrome (SIDS)

Question 25

What is covered in the booking clinic before 10 weeks gestation?

Answer 25

• What to expect at different stages of pregnancy
• Lifestyle advice in pregnancy (e.g. not smoking)
• Supplements (e.g. folic acid and vitamin D)
• Plans for birth
• Screening tests (e.g. Downs screening)
• Antenatal classes
• Breastfeeding classes
• Discuss mental health

Question 26

What are the booking bloods taken in the booking clinic?

Answer 26

• Blood group, antibodies and rhesus D status
• Full blood count for anaemia
• Screening for thalassaemia (all women) and sickle cell disease (women at higher risk)

pts also offered testing antibodies for:
HIV
Hepatitis B
Syphilis

Screening for Down’s syndrome may be initiated depending on the gestational age.

Question 27

What other tests are done during the booking clinic?

Answer 27

• Weight, height and BMI
• Urine for protein and bacteria
• Blood pressure
• Discuss female genital mutilation
• Discuss domestic violence

Question 28

What conditions are women assessed for that would require additional appointments?

Answer 28

• Rhesus negative (book anti-D prophylaxis)
• Gestational diabetes (book oral glucose tolerance test)
• Fetal growth restriction (book additional growth scans)
• Venous thromboembolism (provide prophylactic LMWH if high risk)
• Pre-eclampsia (provide aspirin if high risk)

Question 29

What is the purpose of the down’s syndrome screening test in pregnancy?

Answer 29

• to decide which women should receive more invasive tests to establish a definitive diagnosis
• woman’s choice whether to go ahead with screening

Question 30

What is the first line screen test for down’s syndrome?

Answer 30

• combined test
• performed between 11 -14 weeks
• involves combining results from US and maternal blood tests