Antenatal care

Question 1

Schedule of appointments in routine antenatal care

Answer 1

• Booking (ideally at 10 weeks)
  
  • Identify women who may need additional care
  • Measure:
    
    • Height & weight, calculate BMI
    • BP and test urine for proteinuria (pre-eclampsia)
  • Determine risk factors for pre-eclampsia and gestational diabetes
  • Blood
    
    • Blood group, rhesus D status
    • Offer screening for:
      
      • Anaemia
      • Haemoglobinopathies
      • Hep B
      • HIV
      • Rubella
      • Syphilis
  • Offer screening for asymptomatic bacteriuria
  • Offer Down’s screening
• Dating scan (~12 weeks)
  
  • Accurately determine gestational age
  • Finalise EDD
  • Detect multiple pregnancies
• 16 weeks
  
  • Review screening test results
  • BP/urine dip
  • Investigate a Hb <11 (consider Fe supplements)
• Anomaly scan (18-20 weeks)
  
  • Ultrasound to detect structural anomalies + neural tube defects
  • Foetal echocardiography
• 25 weeks (nulliparous)
  
  • BP/urine dip
  • Measure symphysis-fundal height (SFH)
• 28 weeks
  
  • BP/urine dip/SFH
  • Second screen for anaemia + red cell antibodies
  • Anti-D prophylaxis for RhD -ve women
• 31 weeks (nulliparous)
  
  • Review previous results
  • BP/urine dip/SFH
• 34 weeks
  
  • Provide specific information on labour & birth
  • 2nd dose of prophylactic anti-D
  • BP/urine dip/SFH
• 36 weeks
  
  • Palpate foetal presentation
  • Provide specific information on:
    
    • Breastfeeding
    • Vitamin K prophylaxis
    • Postnatal care
  • BP/urine dip/SFH
• 38 weeks
  
  • Provide specific information on management of prolonged pregnancy
  • Palpate foetal presentation
  • BP/urine dip/SFH
• 40 weeks (nulliparous)
• 41 weeks
  
  • Offer a membrane sweep and induction of labour
  • Palpate foetal presentation
  • BP/urine dip/SFH

Question 2

Antenatal screening for Down’s syndrome

Answer 2

• Screening offered at booking
• Screening methods
  
  • Serum
    
    • Combined
      
      • Beta-hCG
      • PAPP-A (pregnancy-associated plasma protein A)
    • Quadruple (less accurate)
      
      • Beta-hCG
      • Alpha fetoprotein (AFP)
      • Inhibin-A
      • Unconjugated estriol (uE3)
  • Ultrasound (nuchal translucency)
• Diagnostic testing
  
  • Chorionic villous sampling
  • Amniocentesis