Antenatal Care 2

Question 1

How many conceptions are there in the UK each year?

Answer 1

900,000

Increasing in women >25

Question 2

How many of these conceptions are to under 18s?

Answer 2

22,700 to under 18s

Question 3

What is the purpose of the booking visit?

Answer 3

First appointment should be before 10 weeks’ gestation
Purpose – screen for possible complications
Decisions about type + frequency of antenatal care + delivery
Gestation of pregnancy checked
Appropriate prenatal screening discussed
General health check
Health advice
Assess risk using history/examination

Question 4

What history should be taken at the booking visit?

Answer 4

Age <17 and >35
History of present pregnancy: LMP
Past obs history: inc preterm labour, small-for- dates + IUGR, stillbirth, haemorrhages, congenital anomlaies, rhesus disease, pre-eclampsia + diabetes
Past gynae history: inc history of subfertility, fertility drugs or assisted conception,
cervical smear
PMH: hypertension, diabetes, autoimmune disease, haemoglobinopathy,
thromboembolic disease, cardiac or renal disease or other serious illnesses
DH: change drugs contraindicated in pregnancy to those considered safe
FH: diabetes, hypertension, thromboembolic, autoimmune + pre-eclampsia
Immigration + language issues
SH: smoking, alcohol + drug, domestic violence

Question 5

What examination should be done at the booking visit?

Answer 5

BMI
Baseline BP
No need for abdo palpation/vaginal examination/clinical assessment of pelvic cavity

Question 6

What are the routine investigations needed in the booking visit?

Answer 6

US – between 11 and 13+6, date using crown-rump length <14 weeks, detect
multiple pregnancy and chromosomal abnormalities with nuchal translucency/blood
levels of beta hCG/PAPPA

Bloods – FBC (anaemia), anti-D, GTT (planned for 28 weeks), syphilis, HIV, hep B,
haemoglobin electrophoresis, sickle-cell anaemia

Screening for infections – chlamydia, BV

Urine microscopy + culture – asymptomatic bacteruria can lead to pyelonephritis

Urinalysis for glucose (diabetes) protein (renal disease) nitrites (infection)

Question 7

What are the normal weight changes in pregnancy?

Answer 7

10-15kg increase

Question 8

What are the blood volume changes in pregnancy?

Answer 8

50% increase

Question 9

What happens to red cell mass during pregnancy?

Answer 9

increases

Question 10

What happens to haemoglobin in pregnancy?

Answer 10

haemoglobin decrease

Question 11

What happens to WBC in pregnancy?

Answer 11

increases

Question 12

What happens to cardiac output in pregnancy?

Answer 12

40% increase

Question 13

What happens to peripheral resistance in pregnancy?

Answer 13

50% decrease

Question 14

What happens to BP in pregnancy?

Answer 14

small mid pregnancy fall

Question 15

What happens to tidal volume in pregnancy?

Answer 15

40% increase

Question 16

How is the gastro system affected during pregnancy?

Answer 16

delayed gastric emptying

constipation

Question 17

What happens to they thyroid during pregnancy?

Answer 17

enlarges

Question 18

How is pregnancy dated?

Answer 18

Use due date which is originally calculated from the first day of last period

Ultrasound used to confirm gestation based on crown-rump length at dating scan (8-14
weeks) or head circumference used between 14-20 weeks if no earlier scan and LMP not
known

Question 19

How is estimated delivery date worked out?

Answer 19

subtract 3 months from date of LMP, add 7 days and 1 year (or use wheel)

Question 20

What maternal blood tests can be used to assess for fetal abnormalities?

Answer 20

alpha fetoprotein - raised in NTD or gastrochisis

beta-HCG, PAPPA, AFP, oestriol and inhibin A - trisomy’s 21 (downs), 18 and 13

Question 21

How is USS used to assess for fetal abnormalities?

Answer 21

Confirm dates, pregnancy site + multiple pregnancy

Nuchal translucency at 11-14 weeks – larger the nuchal translucency, higher risk of
trisomy + other abnormalities

Question 22

What is the combined test for Downs?

Answer 22

Screening test for trisomies inc Down’s syndrome

Sensitivity 75%

Risk from maternal age, with PAPP-A and beta-hCG blood tests + nuchal translucency
measurement by US (11 weeks – 13+6)

Question 23

What are the legal rights of a pregnant employee?

Answer 23

Paid time off for antenatal care (inc classes if necessary)
Maternity leave
Maternity pay or maternity allowance
Protection against unfair treatment, discrimination or dismissal

Question 24

What are the health and safety risks at work?

Answer 24

Heavy lifting or carrying
Standing or sitting for long periods without adequate breaks
Exposure to toxic substances
Long working hours

Question 25

How is US used to diagnose fetal abnormalities?

Answer 25

anomaly scan at 18-21 weeks
detect congenital malformations of all organs and systems
repeat US is increased liquor volume and polyhydramnios

Question 26

How is fetal MRI used to diagnose fetal abnormalities?

Answer 26

diagnosis of intracranial lesions

Question 27

How is amniocentesis used in diagnosing fetal anomalies?

Answer 27

Removal of amniotic fluid using fine-gauge needle under US guidance
Safest from 15 weeks’ gestation
Diagnosis of chromosomal abnormalities, CMV, toxoplasmosis, sickle-cell,
thalassaemia, CF

Question 28

How is CVS used to diagnose fetal anomalies?

Answer 28

Biopsy of the trophoblast by passing fine-gauge needle through abdo wall/cervix into placenta
After 11 weeks
Diagnosis of chromosomal problems and autosomal dominant and recessive conditions

Question 29

When is there genetic diagnosis preimplantation?

Answer 29

in IVF
Ethical dilemmas
Diagnosis of sex linked disorders, trisomies and dominant and recessive conditions