2 - Obs - Antenatal Care - The Booking Visit

Question 1

when should first appt be? main purpose? how is risk assessed?

Answer 1

<10 weeks gestation
screen for possible complx in mpreg, labour and puerperium
risk assessed using HX, EX, Ix

Question 2

what decision can be made with parents at first visit? also can check what? and discuss what?

Answer 2

regarding type an freq of antenatal care, and decision about delivery - constantly re-evaluated as preg proceeds

can check gestation
and discuss appropriate prenatal screening

Question 3

9 parts of the history at the booking visit

Answer 3

age
hx of present preg
past obstetric hx
past gynae hx
PMHx
drugs
FHx
immigration and language issues
SHx

Question 4

why is age important?

Answer 4

<17 + >35 have incr risk of obst and medical complx

chromosomal trisomies more common w advancing age

Question 5

what is asked about in Hc of present preg and what is it used to work out? in UK what to we do to date all pregs?

Answer 5

LMP
gestation adjusted for cycle length
early preg USS used to date all pregs in UK

Question 6

what past obst disorders are we worried about risk of recurring? 8 things

Answer 6

preterm labour, small for dates + IUGR, stillbirth, antepartum and postpartum haemorrhage, some congen anomalies, RHesus disease, preeclampsia, GDM

Question 7

past gynae Hx - what Hx also taken? 
consequences of...
-a Hx of subfertility ...?
-fertility drugs or assisted conception used...?
-previous uterine surgery...? eg?

Answer 7

cervical smear hx also

• incr perinatal risk
• incr risk of multiple preg
• eg myomectomy, usually delivered by CS

Question 8

what is screened for in PMHx?

Answer 8

HTN, DM, autoimmune disease, Hbopathy

depression

Question 9

What are the two parts of Ex done at the booking visit?

Answer 9

general health and nutritional status

abdo examination

Question 10

General health and nutritional status - 2 major things checked? why? what may occasionally be detected?

Answer 10

BP - baseline to compare if HTN later on
BMI - >30 = complx common

incidental disease eg Breast cancer may occasionally be found

Question 11

Abdo exam - before 3rd trimester it is…? once uterus palpable (when?) what can be assessed with an electronic monitor? What is not done here?

Answer 11

limited
12wks
fetal HR can be auscultated
dont need to do routine vaginal exam or pelvic cavity assessment,