Pregnancy timeline and lifestyle advice Flashcards
What does the timeline for each pregnancy depend on?
- start date of the last menstrual period (LMP)
- This determines the gestational age (GA) and the estimated date of delivery (EDD) of the pregnancy
How is gestational age described?
- in weeks and days, e.g:
e. g 13+6 refers to 13 weeks plus 6 days
What gravida and para would a pregnant woman with three previous deliveries at term have?
G4 P3
What gravida and para would a non-pregnant woman with a previous birth of healthy twins have?
G1 P1
What gravida and para would a non-pregnant woman with a previous miscarriage have?
G1 P0
What gravida and para would a non-pregnant woman with a previous stillbirth (after 24 weeks gestation) have?
G1 P1
When does the first trimester begin and end?
from the start of pregnancy until 12 weeks gestation
When does the second trimester begin and end?
from 13 weeks until 26 weeks gestation
When does the third trimester begin and end?
from 27 weeks gestation until birth.
At what gestation do fetal movements start?
from around 20 weeks gestation, and continue until birth.
What are the key milestones during pregnancy and when do these occur?
- 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
What is the purpose of the booking clinic?
Offer a baseline assessment and plan the pregnancy
What is the purpose of the dating scan?
An accurate gestational age is calculated from the crown rump length (CRL), and multiple pregnancies are identified
What is the purpose of the antenatal appointment at 16 weeks?
Discuss results and plan future appointments
What is the purpose of the anomaly scan?
An ultrasound to identify any anomalies, such as heart conditions
What is the purpose of the antenatal appointments during later pregnancy?
Monitor the pregnancy and discuss future plans
What are some additional milestones and why might they be done?
- 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
What are key things that are covered in the routine antenatal appointments during pregnancy?
- 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
What are the two vaccines offered to all pregnant women?
- Whooping cough (pertussis) from 16 weeks gestation
- Influenza (flu) when available in autumn or winter
What supplements are pregnant women generally advised to take?
- 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)
What lifestyle advice is given to pregnant women?
- 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
What can alcohol in early pregnancy lead to?
- Miscarriage
- Small for dates
- Preterm delivery
- Fetal alcohol syndrome
What are the features of FAS?
- 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
What does smoking in pregnancy increase the risk of?
- Fetal growth restriction (FGR)
- Miscarriage
- Stillbirth
- Preterm labour and delivery
- Placental abruption
- Pre-eclampsia
- Cleft lip or palate
- Sudden infant death syndrome (SIDS)
What is covered in the booking clinic before 10 weeks gestation?
- 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
What are the booking bloods taken in the booking clinic?
- 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.
What other tests are done during the booking clinic?
- Weight, height and BMI
- Urine for protein and bacteria
- Blood pressure
- Discuss female genital mutilation
- Discuss domestic violence
What conditions are women assessed for that would require additional appointments?
- 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)
What is the purpose of the down’s syndrome screening test in pregnancy?
- to decide which women should receive more invasive tests to establish a definitive diagnosis
- woman’s choice whether to go ahead with screening
What is the first line screen test for down’s syndrome?
- combined test
- performed between 11 -14 weeks
- involves combining results from US and maternal blood tests
What is measured in combined test & what are the results in Down’s?
- Nuchal translucency using ultrasound scan (increased thickness)
- PAPP-A hormone (level reduced in pregnancy affected with Down’s syndrome)
- Beta-hCG hormone (raised in pregnancy affected by Down’s syndrome)
What is included in triple test for down’s and results?
- Beta-hCG (high)
2, AFP (reduced in pregnancies affected by Down syndrome) - uE3 (reduced in pregnancies affected by Down syndrome)
When is triple or quadruple test done?
Between 15-20 weeks
What is quadruple test and results in Down’s? mnemonic?
HIUA
-Beta-hCG (high)
-inhibin (added from triple test, high)
-uE3 (reduced in pregnancies affected by Down syndrome)
-AFP (reduced in pregnancies affected by Down syndrome)
What are the cutoffs for haemoglobin in pregnancy:
A) 1st trimester
B)2nd/3rd trimester
C) Postpartum
A) First trimester < 110 g/L
B)Second/third trimester < 105 g/L
C) Postpartum < 100 g/L
