Routine Antenatal Care Flashcards
The booking appointment should ideally be completed by when?
10 weeks
The fundus of a pregnant uterus is usually palpable by when for a singleton pregnancy?
12 weeks
What urine tests should be performed at the booking visit?
Urinalysis and MSSU for microscopy, culture and sensitivity
At booking, what conditions should a mother be screened for?
Anaemia, HIV, hep B, syphilis and rubella
When should the early ultrasound scan be performed?
11 - 14 weeks
What part of the early ultrasound scan can be used for Down’s syndrome screening?
Nuchal translucency
What measurement on the early ultrasound scan can be used to assess gestational age between 10 and 13+6 weeks?
Crown rump length
If the crown rump length is > 84mm or if the pregnancy is beyond 14 weeks, what measurement should be used to estimate the gestational age?
Head circumference
What are the most important parts of a history that should be discussed at every antenatal visit?
Physical and mental health and foetal movements
What investigations should be performed at every antenatal visit?
BP and urinalysis
Symphyseal fundal height should be measured at every antenatal visit from what gestation?
24 weeks
At what gestation is the foetal anomaly scan performed?
18 - 20+6 weeks
When should gestational diabetes screening be done in women who are deemed to be high risk?
24 - 28 weeks
When should a second blood test for anaemia and atypical antibodies be performed in routine antenatal screening?
28 weeks
When should the first dose of anti-D be offered to Rh negative women?
28 weeks
If a woman is found to have a low lying placenta at the anomaly scan, when should they undergo a second scan?
32 weeks
When should the second dose of anti-D be offered to Rh negative women?
34 weeks
What additional examination should be performed at the 36 week antenatal visit?
Assess position of the baby, and offer external cephalic version if the baby is in breech position
What should be offered to women who have not yet given birth by 41 weeks?
Membrane sweep and induction of labour
What is the most common cause of anaemia in pregnancy and how can this be treated?
Iron deficiency- treat with iron supplements
If an HIV test is decline at booking, it should be offered again to women at which antenatal visit?
28 weeks
When can the sex of the baby be determined?
At the 18 - 20+6 week anomaly scan
When can the ‘combined test’ for Down’s syndrome be performed?
11 - 14 weeks
What are the two areas of the combined test for Down’s syndrome screening?
Ultrasound scan for nuchal translucency and bloods for PAPP-A and HCG
When the crown rump length is 45-84mm, what would a normal nuchal translucency be?
< 3.5
What happens to concentrations of PAPP-A and HCG in Down’s syndrome?
PAPP-A is low and HCG is high
At what gestation can second trimester screening for Down’s syndrome be done?
15 - 20 weeks
What blood tests are measured in second trimester screening for Down’s syndrome?
HCG, AFP, unconjugated oestradiol, inhibin-A
Which blood tests in second trimester screening will be high in Down’s syndrome?
HCG and inhibin-A
Which blood tests in second trimester screening will be low in Down’s syndrome?
AFP and unconjugated oestradiol
An isolated raised AFP is suggestive of what complication?
Neural tube defect
The results of both first and second trimester Down’s syndrome screening are combined with what other two factors to create a personalised risk?
Gestational age and maternal age
Further investigation is required if Down’s syndrome screening is deemed high risk. A likelihood of more than what is considered to be high risk?
> 1 in 150
What method is used to obtain a sample for Down’s syndrome testing from 11-14 weeks?
Chorionic villus sampling
What method is used to obtain a sample for Down’s syndrome testing > 15 week?
Amniocentesis
Which contains a slightly higher risk of iatrogenic miscarriage- chorionic villus sampling or amniocentesis?
Chorionic villus sampling
The sample obtained for Down’s syndrome testing from CVS or amniocentesis is sent for analysis via what? How soon should the results come back?
PCR, in 48 hours
Non-invasive prenatal testing can be used for Down’s syndrome screening after what gestation?
10 weeks
Foetal growth and wellbeing is assessed at each antenatal visit by assessing what two things?
Foetal movements and symphyseal-fundal height
If the foetal growth is less than expected at an antenatal visit, what investigation should be done next?
US assessment of foetal weight and amniotic fluid volume
When measuring symphyseal-fundal height, the fundus should reach the umbilicus by what gestation?
20 weeks
When measuring symphyseal-fundal height, the fundus should reach the xiphisternum by what gestation?
36 weeks
Foetal movements are usually felt from around what gestation?
20 weeks
If a change in foetal movements is reported, what further investigation is required?
CTG +/- ultrasound
If breech presentation is suspected on abdominal palpation, what investigation should be used to confirm this?
Ultrasound
What maternal condition should be being screened for at the foetal anomaly scan?
Placenta praevia
What condition is being screened for by doing urinalysis and BP at every antenatal visit?
Pre-eclampsia
What are some conditions predisposing to pre-eclampsia?
Hypertension, diabetes, CKD, autoimmune disease
Any woman who is deemed high risk for pre-eclampsia should be given what medication?
75mg aspirin daily from 12 weeks onwards
What is the screening test for gestational diabetes?
2 hour oral glucose tolerance test
All women should take what supplement for the first 12 weeks of pregnancy? What is the purpose of this?
Folic acid, to reduce the risk of neural tube defects
What is the normal dose of folic acid?
0.4mg
What dose of folic acid is given to women who are deemed high risk of having a baby with neural tube defects?
5mg
Other than folic acid, what other vitamin supplement is routinely recommended to pregnant women?
10mcg vitamin D
Women who smoke in pregnancy undergo what additional tests?
Carbon monoxide testing and serial growth scans
