Routine antenatal assessment in the absence of complications (RANZCOG) Flashcards
1
Q
First antenatal visit:
- Gestation
- Aims of visit
A
Review by 10/40
Aim of visit:
- Confirm pregnancy and establish best estimate of gestational age/dates
- If dates known and low risk pregnancy, USS not required prior to 12/40
- Identify any medical/obstetric/fetal/psychosocial concerns and create a plan for the management of any identified concerns
- General advice regarding common issues of concern in early pregnancy
- Plan schedule for antenatal visits
2
Q
What is involved in first clinical assessment?
A
- Height, weight, BMI and booking BP
- FBC
- G&H with antibody screen
- Rubella antibody screen
- Syphillis serology
- MSU
- Selective testing for chlamydia and gonorrhoea
- HIV
- Hep B and C
- Varicella
- Cervical screening
3
Q
What other tests can be considered?
A
- Haemaglobinopathies if high risk or low MCV on FBC
- Maternal mental health screening
- Family violence screen
4
Q
What general advice should women be given?
A
- Avoid potential teratogens (alcohol, high dose X-rays, certain medications)
- Lifestyle advice: Stop smoking, alcohol use, recreational drugs.
- Dietary advice for optimal weight gain, exercise
- Travel/work precautions
- Influenza and pertussis vaccinations (20-32/40)
- Vitamin and mineral supplements
- Prevention of CMV and other teratogenic infections
- model of care, expected frequency etc
- sleeping on side from 28/40
- Labour plan from 36/40
5
Q
How to monitor growth in low risk pregnancy?
A
SFH measurement, plot on CGC and refer for growth scans if abnormal
6
Q
What USS are recommended for all women in pregnancy?
A
- 12-13+6/40: confirm gestation, location, number of fetuses, NT and gross fetal anatomy
- 20/40: fetal morphology and placental location
7
Q
When should Hb and plt count be repeated?
A
28/40
8
Q
Tests of fetal wellbeing after 41/40?
A
Lack of good evidence to support but:
- Counsel re monitoring of FM
- Consider 2x weekly CTG
- consider growth and LV
