Routine Antenatal Care

Question 1

When is booking visit?

Answer 1

9-11 weeks’ gestation.

Question 2

Purpose of booking visit?

Answer 2

screen for possible complications that may arise during pregnancy, labour and the puerperium –> risk assessment –> direct to appropriate care

Gestation of pregnancy is checked (EDD calculated), appropriate antenatal screening discussed (consent), general health check (medical, obstetric, mental health, social) – health education (flu vaccine, folic acid, vitamin D, smoking cessation etc)

Question 3

Bloods at booking visit?

Answer 3

• FBC
• Haemoglobinopathies (sickle cell, thalassaemia) 
• Blood group/antibody screen
• HIV
• Hep B
(Syphillis/rubella no longer routine)

Question 4

Outline rhesus prophylaxis?

Answer 4

o All rhesus negative women offered Anti-D immunoglobulin IV at 28 and 34 weeks and after any bleeding or sensitising event.
o It neutralises (mops up) fetal Rh D + antigens which would have entered maternal blood and prevents creation of antibodies – prevents Rhesus’ disease of the newborn in SUBSEQUENT child.
o Another IM injection of Anti-D (within 72 hours) after the delivery if baby is Rhesus positive (cord blood test at birth)

Question 5

What are the routinely offered screening tests?

Answer 5

1. Foetal anomalies
   (Early scan –> combined test, Anomaly scan later)
2. Infectious diseases (HIV, Hepatitis B, Syphilis)
3. Rhesus negative
4. Haemoglobinopathies

Rubella recently stopped

NOT hep C, chlamydia or group B strep

Question 6

When are early scan and anomaly scan?

Answer 6

Early scan = 11+2 - 14+1

Anomaly scan = 18+0 - 20+6

Question 7

Antenatal visits for multiparous and nulliparous women?

Answer 7

• Multiparous = 8 appointments – booking then 16, 28, 34, 36, 38, 40, 41 wks
• Nulliparous = 10 appointments – booking then 16, 25, 28, 31, 34, 36, 38, 40, 41 wks

Question 8

What is the combined test?

Answer 8

• Opt-in test – 11+2 to 14+1
• Looks for Down’s syndrome, Edward’s syndrome and Patau’s syndrome.
• Consists of: Nuchal translucency scan and Maternal blood test for hCG (↑down’s, ↓Edward’s/Patau’s) and PAPPA (pregnancy-associated plasma protein A)

• Results = risk factor (‘increased chance’ of abnormality) – cut off = 1 in 150

Question 9

What is detection rate of combined test?

Answer 9

85%

Question 10

What is the quadruple test?

Answer 10

• Less accurate than combined – reserved for after 14 weeks (14+2 to 20+0)
• Blood test only – 80% detection rate

Question 11

What is chronic villous sampling?

Answer 11

• Diagnostic test - Biopsy of trophoblast – small needle through abdominal wall or cervix into placenta
• From 11 weeks.
• Advantage = faster than amniocentesis and can be done at time when abortion can be done without GA.
• Disadvantage = miscarriage rate higher than amnio (1%)

Question 12

What is amniocentesis?

Answer 12

• Diagnostic test - Removal of amniotic fluid using fine gauge needle under USS guidance.
• Performed from 15 weeks’ gestation
• 0.8% miscarriage rate

Question 13

Dating scan?

Answer 13

• Between 13 and 14 weeks – offered to all pregnant women.
• Between 7 and 14 weeks – crown-rump length
• Between 14 and 20 weeks – biparietal diameter or femur length

Question 14

When is anomaly/anatomy scan?

Answer 14

20 weeks – enables detection of structural foetal abnormalities.

Question 15

What are BPD, HC, AC, FL?

Answer 15

Biparietal diameter
Head circumference
Abdominal circumference
Femur length

Question 16

Growth scans?

Answer 16

o Serial measurements to assess growth velocity – plot against normal growth

Question 17

What is head sparing effect?

Answer 17

if growth restricted, baby can redirect blood flow to brain/chest (head circumference would be normal, other measurements abnormal).

Question 18

What is BPP?

Answer 18

Biophysical profile (BPP) (score out of 8)

• Foetal breathing movements (rehearsing muscles for when they actually need to breathe – but don’t do this if not getting sufficient oxygen)
• Foetal movements (less when not getting sufficient oxygen)
• Foetal tone
• Amniotic fluid volume (less urine if growth restricted because less blood to kidneys)

Question 19

How is placental function assessed?

Answer 19

• Appearance
• Blood flow characteristics (Doppler studies) – looks at waveform of blood flow through placenta (should be a low resistance sieve) – screening test for intrauterine growth restriction and pre-eclampsia.
o Foetal to placenta – umbilical
o Mother to placenta – uterine

Question 20

Name some social issues in pregnancy?

Answer 20

Teenage pregnancy
Poor SE conditions
Alcohol intake
Substance abuse

Question 21

Medications in prego?

Answer 21

Avoid in first trimester. Regular medication should be adjusted preconceptually.

Question 22

Diet in prego?

Answer 22

Should be well-balanced. Daily intake of 2500 calories.

Question 23

Supplementation in prego?

Answer 23

Supplementation – 0.4mg/day for at least 12 weeks.
Vitamin D for women who are not exposed to a lot of sunlight
Iron supplementation not routine.

Question 24

Coitus in prego?

Answer 24

Not contraindicated – except in placenta praevia or membrane rupture.

Question 25

Alcohol in prego?

Answer 25

Best avoided – max of 1 unit/day

Question 26

Smoking in prego?

Answer 26

Advice, group sessions and behavioural therapy

Question 27

Avoidance of infection in prego?

Answer 27

Drink only pasteurised or UHT milk, avoid soft/blue cheeses, paté and uncooked or partially cooked food.

Question 28

Exercise in prego?

Answer 28

Advised – swimming ideal, heavy contact sports avoided.

Question 29

Travel in prego?

Answer 29

Most airlines only take women at <34-36w – risk of VTE reduced by hydration and compression stockings.
In car, seatbelt should be worn above and below bump.