Routine Antenatal Care

Question 1

When is booking visit done? On a booking visit what advice should be given?

Answer 1

Before 10 weeks

• History taken
• EDD
• Advice re:
  
  • Diet
  • Folic acid supplementation
  • Things to avoid (foods, alcohol smoking)

Question 2

What investigations should be done on the booking visit?

Answer 2

• BP
• BMI
• Urine dip + urinaysis (diabetes, renal disease and infection)
• Bloods:
  
  • FBC
  • Haemaglobinopathies (e.g. thalassaemias & sickle cell)
  • Red cell alloantibodies (blood type)
  • Serum antibodies (e.g. anti-D)
  • Rubella
  • Syphyllis
  • Hep B
  • HIV

Question 3

When should the second routine visit in pregnancy be and what should be done at this visit?

Answer 3

• 12 week scan (between 11 to 13+6 weeks)
• Gestation is calculated using crown rump length.
• Discuss screening results
• Blood levels of ß-hCG and PAPPA as ‘combined test’ with nucal translucency measurement for chromosomal abnormalities
• Treat Hb less than 11 (or symptomatic)

Question 4

When is the anomaly scan arranged for?

What is it used for?

Answer 4

• 18-20 weeks
• As diagnostic test
• Malformations of all organs dectable
  
  • Cardiac defects
  • NTDs
  • Abdominal wall (exomphalos, gastroschisis)
  • Chest defects
  • Gastrointestinal defects (atresias)
  • Urogential defects
  • Skeletal defects
  • Fetal hydrops

Question 5

If a women is nulliparous when should she next come in after her anomaly scan providing everything is normal?

Answer 5

• 25 weeks
• Simple check up.
• BP, urine dip and symphysis fundal height (done at every appt following this)

Question 6

What is done at the 28week appointment?

Answer 6

• Screening for anaemia and atypical
• red cell allo-antibodies (blood type)
• Anti D prophylaxis is given to rhesus -ve women

Question 7

When are the appointments in the 3rd trimester?

Answer 7

• 31 weeks*
• 34 weeks
• 36 weeks
• 38 weeks
• 40 weeks
• *Only for nulliparous women routine appt

(BP, urine dip, SFH every appointment)

Question 8

What is discussed at the 34 week appointment?

Answer 8

• Labour + birth discussed
• Give anti D prophylaxis second dose to rhesus -ve mothers
• usual BP, urine dip, SFH

Question 9

What is discussed at the 36 week appointment?

Answer 9

• Breast feeding discussed
• Vitamin K prophylaxis
• Postnatal self care discussed
• Post natal depression discussed
• usual BP, urine dip, SFH

Question 10

What happens at the 38 week appointment?

Answer 10

Usual BP, urine dip, SFH

Question 11

What happens at the 40 week appointment?

Answer 11

• Usual BP, urine dip, SFH
• give information about prolonged labour

Question 12

If a women hasn’t delivered what happens?

Answer 12

• Membrane sweep at 41 weeks (separates the membranes of the amniotic sac surrounding your baby from your cervix.)
• Induction of labour at 42 weeks

Question 13

Which of the following are recommended or not during pregnancy: Iron, folic acid, Ca, zinc, Vit A and Vit D?

Answer 13

• Iron:
  
  • not routinely taken only if there is anaemia
• Folic acid:
  
  • ​Routinely given 400micrograms/day for 1st trimester.
  • Give 5mg/day in high risk (previous neural tube defect, epileptics or diabetics)
• Ca:
  
  • supplementation not needed diet should suffice
• Zinc:
  
  • increased dietary intake is sufficient
• Vitamin A:
  
  • teratogenic in high doses, avoid every day supplements with Vitamin A, avoid eating liver (high source of vitamin A)
• Vitamin D:
  
  • 10micrograms/day throughout pregnancy recommended