WCS18 Perinatal Medicine, Antenatal Care And Pre-pregnant Counselling 1 Flashcards
Care during pregnancy
- Pre-pregnancy care
- Antenatal care
- Perinatal care
- Intrapartum period
- Neonatal period
Pre-pregnancy care
Aim:
1. Assess risk of getting pregnant
- Risk on mother
- Risk on baby
2. Optimise woman’s health before conception
Target patient:
1. General population
2. Women with medical disorders
3. Women with complication in previous pregnancy
Content:
1. Screening (for general population)
- **Thalassaemia carrier (MCV)
- **Rubella immune status (Rubella Ab)
- Fertility (Menstrual history, Semen analysis)
- Effect of medical disorders / medications on pregnancy + Vice versa (for women with medical disorders)
- **DM / Thyrotoxicosis
- **SLE / RA
- Post-organ transplant - Fetal abnormality / Obstetric complication (for women with complication in previous pregnancy)
- Severe pre-eclampsia
- Preterm delivery
- Pregnancy loss
- Previous baby with congenital abnormalities
Providers:
1. Physicians
2. Primary health care doctors
3. Obstetricians
When:
1. Before conception
2. Following adverse pregnancy outcome
Things to do in Pre-pregnancy counselling
- Risk assessment
- modifiable factors - Optimised control of pre-existing medical disorder
- Adjustment of medication
- Optimal timing of pregnancy
- ***Folate supplement before 12 weeks
- 0.4 mg/day (Felix Lai)
- 5 mg/day: previous infant with neural tube defect, DM patients, patients on anti-epileptic drugs (Felix)
- 5 mg/day throughout whole pregnancy: Thalassaemia trait (to prevent maternal anaemia) - Option of prenatal diagnosis
Antenatal care
Aim:
1. Conduct baseline **assessment of pregnancy
2. Detect / **Manage complications during pregnancy
3. ***Optimise condition of both mother and baby before delivery
Importance:
1. Early identification of risk factors
2. Prompt management of complications
Target patient:
1. Pregnant mother
2. Father-to-be
Provider:
1. Obstetricians
2. Midwives
3. Family physicians
4. Community care: Maternal and Child Health Centres
When:
From the time when pregnancy known —> Till onset of labour / prelabour C-section
Content:
1. Maternal screening
2. Fetal screening
3. Prenatal diagnosis
4. Regular monitoring
5. Education
6. Psychological support
7. Planning of delivery
1st Antenatal visit
***Before 14 weeks
1. Establish EDC (expected date of confinement) —> Ascertain gestational age
2. Obtain history
3. Conduct physical examination
***Frequency of antenatal visits
- Up to 28 weeks: Every 4 weeks
- 28-36 weeks: Every 2 weeks
- 37 weeks-Delivery: Every week
More frequent if risk factors / complications present
Baseline assessment in Antenatal care
- History taking
- past OG history
- past medical history
- problem with current pregnancy - Physical examination
- general exam including breast
- abdominal exam
- pelvic exam - Antenatal routine investigations
- CBC: Hb, MCV, platelet
- Blood group: Rh
- Rubella Ab
- HBsAg
- Syphilis (VDRL (Non-treponemal specific test) / EIA (Treponemal specific test))
- HIV Ab
- Cervical smear (opportunistic screening)
Blood pressure monitoring
Normal
SBP: 90-140
DBP: 60-90
1st Antenatal visit: Note baseline BP
- if on antihypertensive —> consider switching to one suitable for pregnancy
After 20 weeks: ↑ BP alerts close monitoring for Pre-eclampsia
Hb level and MCV
- Antenatal Hb level: >10.5 g/dL (< indicate anaemia)
- MCV < 82 fL: ***Fe deficiency / Thalassaemia
- Maternal MCV <82 —> Test partner’s MCV
- Couple’s MCV <82 —> Hb studies, exclude Fe deficiency +/- Molecular study for Thalassaemia
Pregnant woman / partner is carrier —> Offspring 1/2 chance being carrier
Both having SAME type of Thalassaemia—> Offspring 1/4 chance of having Thalassaemia major
Blood group (Rh factor)
Rh blood group: Majority of Han Chinese Rh+
Rh incompatibility: Haemolytic disease of fetus / newborn —> referral for prenatal diagnosis is indicated
Hepatitis B virus
Mother HBsAg +ve
—> Risk of perinatal HBV transmission
- Hep B vaccine + Hep B Ig (HBIG) asap after birth (within 12 hours)
- Antenatal antiviral e.g. Tenofovir —> ↓ vertical transmission rate in mothers with ***high HBV DNA level
Syphilis
- Positive serological testing for syphilis requires confirmation testing
- Mother-to-child transmission of syphilis in pregnancy
—> ***Congenital syphilis, Neonatal death, Stillbirth, Preterm birth - Parenteral Penicillin: effectively prevents vertical transmission of syphilis
HIV
Women with HIV infection risk transmission of HIV during
- pregnancy
- delivery
- breastfeeding
↓ risk of vertical transmission:
1. Antiretroviral therapy
2. C-section
3. Avoid breastfeeding
Fetal screening in Antenatal care
- Thalassaemia
- MCV - Down syndrome
- Maternal age
- **Nuchal translucency
- Biochemical test: Maternal serum markers
- **Fetal DNA from maternal plasma - Fetal structural abnormality
- Morphology scan (~ 20 weeks)
USG exam for screening
< 11 weeks
- Intrauterine pregnancy
- Fetal pulsation, number, size
11-13 weeks
- Nuchal translucency
- Uterus, Adnexae (to assess any abnormality)
- Viability (SpC Revision)
- Gestational age
- Major structural abnormality (e.g. anencephaly)
20 weeks
- Fetal morphology
> 30 weeks
- Fetal growth
- Placental location
- Liquor
