Antenatal care Flashcards
When is the booking appointment and what does it involve?
-Done before 10 weeks gestation, in community by midwife
GENERAL
-Calculate EDD
-General health info eg smoking, alcohol, folic acid, diet, vit D
-Book dating scan and antenatal screening (opt in)
BLOODS / URINE
-FBC, blood group, rhesus status, haemoglobinopathies
-Hep B, syphilis, HIV tests
-urine dip (asymptomatic bacteriuria)
How is the EDD calculated?
-First day of last menstrual period + 7 days + 9 months
-Less accurate than dating scan
-Less accurate if irregular cycle
How many antenatal visits should women have?
If multiparous
-8 appointments + 2 scans
If nulliparous
10 appointments + 2 scans
When should the dating scan be done?
-First trimester from 11+2 - 14+1 weeks
-Assess nuchal translucency here
When should combined screening be done?
-First trimester from 11+2 - 14+1 weeks
-An opt-in scan
-Assess nuchal translucency and measure width - if >3.5mm then high chance of chromosomal abnormalities
-Maternal blood tests for hCG + PAPPA
–PAPPA = pregnancy-associated plasma protein-A, measure of placental health
–Low levels carry increased risk of LBW baby, preterm birth, pre-eclampsia and midterm miscarriage
When should the anomaly scan occur and what does it involve?
-18+0 - 20+6 weeks
-Screen for specific anomalies eg heart defects, gastroschisis
When can Down syndrome screening be done?
-Initially in combined screening
-If missed, can be done in 2nd trimester in ‘quadruple test’
-Done between 14+2 - 20+0 weeks via blood test
-80% detection, 4% false positives
How are the results from combined screening presented and what are the next steps?
-Come as a probability - 1 in 150 chance or higher is considered a high chance of abnormality being present
-Offer either CVS or amniocentesis to formally diagnose (1% risk of miscarriage)
What is the difference between CVS and amniocentesis?
-CVS takes a sample from the placenta
-Amniocentesis takes a sample from the amniotic sac
What is NIPT?
-Non-invasive prenatal testing
-Done in private sector
-Placental DNA examined using maternal blood sample
What infectious diseases are screened for antenatally?
-HIV
–Opt-out test, aim is to optimise mother’s health and reduce vertical transmission (if +ve), also informs feeding method
-Hep B
–Vertical transmission advice, newborn may require Ig infusion at birth if mother is antibody -ve
-Syphilis
–Must receive full treatment 4 weeks prior to delivery (otherwise newborn must undergo IV therapy)
NB all screened for at booking appointment
How is Rhesus factor screened for?
-Rhesus factor and cell-free DNA testing done and anti-D is given to prevent maternal antibodies targeting Rh+ of foetus / newborn
-Prevents rhesus disease of the newborn
How are haemoglobinopathies screened for?
-Identifies sickle cell and thalassaemia carriers
-Universal screening in high-prevalence areas OR high-risk groups identified in family origin questionnaire
-If woman is a carrier –> father needs testing
-Offer antenatal diagnostic testing if baby at risk
-Postnatal testing done for sickle cell 5 days after delivery
What is considered a high BMI in pregnancy and what is your biggest concern in this?
-BMI >30 = high risk of developing gestational diabetes
What issues does smoking during pregnancy increase the risk of?
-Still birth
-LBW baby (<2.5kg)
-Sudden infant death syndrome
