Antenatal booking

Question 1

focussed current pregnancy questions

Answer 1

how & when was pregnancy confirmed

planned/unplanned

first date LMP

regular partner - safe & happy in relationship

symptoms - N/V, tiredness, headaches, visual changes, abdo pain, PV bleeding

Question 2

quick general hx survey

Answer 2

gynae hx
menstrual hx
obs hx - pregs // children: termination & miscarriage
contraception hx
cervical smear hx
PMH - epilepsy, DM, HTN, STIs, MH
DH + allergies - anticonvulsants, ACEi, lithium
FH
SH

Question 3

general pregnancy advice

Answer 3

avoid smoking/alcohol

folate supplements until 12 weeks

iron/vitD supplements

healthy diet (avoid pate, soft cheese, vitamin A, raw meat/eggs/shellfish)

regular exercise

Question 4

outline plan for future of pregnancy

Answer 4

<10 weeks - sickle cell & thalassaemia

8-12 week booking appt - blood group, Rh status, FBC, rubella, HIV/HepB/Syphillis

8-14 week dating scan

18-21 week anomaly scan

Down’s screening - 11-14 week combined vs 14-20 week quadruple

3-weekly appointments starting at 25w

BP & urine check at every appt (including today’s)

Discuss birthing options & midwifery vs consultant led

Question 5

conditions we test for

Answer 5

pre-eclampsia at every appointment

GD at booking & 28w

Question 6

Vaccinations to offer pregnant women

Answer 6

whooping cough (>16w)

influenza

Question 7

avoid this vaccine

Answer 7

MMR // rotavirus (live)

Question 8

routine examinations at booking appt

Answer 8

FBC // ferritin
BMI measurment
urine dipstick
red cell alloantibodies
HepB//HIV//syphillus

Question 9

meds cannot take

Answer 9

NSAIDs - esp in 3rd trimester: ibuprofen // paracetamol

BBs (except labetolol/methyldopa) - neo hypo // IUGR // neo bradycardia

ACEi/ARB/Thiazides

Opiates - neo abstinence syndrome if mum withdrawal

Warfarin // isoterintoin - teratogens

Lithium - esp first trimester

sodium valproate // phenytoin

Question 10

meds safe to use

Answer 10

lamotrigine // levetiracetam // carbamazepine

SSRIs & levothyroxine - benefits v risks

Question 11

EXTRA
brief counselling on sickle cell

Answer 11

attacks of severe pain
serious/life-threatening
anaemic
lifelong med

Question 12

EXTRA
brief counselling on thalassaemia

Answer 12

autosomal recessive
need 4-6 weekly transfusions
lifelong
RFs: mediterranean, african, middle eastern, SE Asia, s america
diagnosed during preg. & heel prick at 5-8 days

Question 13

EXTRA
brief counselling if HIV +ve

Answer 13

if +ve –> partner & children should be tested

having test doesn’t affect insurance, but result might

Question 14

we do NOT routinely screen for

Answer 14

hep C // chlamydia // GBS