antenatal care Flashcards
(25 cards)
what nutritional supplements should be taken in the antenatal period
- folic acid 400mcg - from before conception until 12wks
- vit D 10mcg daily
supplementation that should eb avoided
iron (not routinely offered)
vit A - teratogenic
–> Liver high in vit A - avoid
food to be avoided in pregnancy
listeriosis - unpasteurised milk, ripened soft cheeses, pate or undercooked meat
salmonella - raw or partially cooked eggs + meat - esp poultry
air travel during pregnancy
singleton preg +no other risk factors = >37wks
uncomplicated, multiple preg = >32wks
assoc with VTE, compression socks
booking visit
8-12wks (ideally <10)
- general info - diet, smoke/drink, folic acid, vit D
- BP, urine dip, BMI
booking bloods/urine
- urine culture to detect asymptomatic bacteruria
booking bloods
- FBC
- Blood group, Rhesus status
- red cell alloantibodies
- hepatitis B, syphilis
- HIV test offered to all women
urine culture - to detect asymptomatic bacteruria
antenatal appointment at 10-13+6wks
early scan to confirm dates
+ exclude multiple pregnancy
when is down syndrome screening done
11-13+6wks
(including nuchal scan)
when is the anomaly scan
18-20+6wk
routine care dates during antenatal period
16 - +info if anomaly of booking bloods
25 - only if primip + symphysis=fundal height
28wks - + screen for anaemia + atypical red cell alloantibodies
31 - only if primip
34wks - + info on birth plan
36 + 38
routine care = BP, urine dip
when are doses of Anti-D prophylaxis given in rhesus negative women
1st = 28wks
2nd = 34wks
when is presentation of baby finally checked
36wks - offer external cephalic version if indicated
conditions all women are offered screening for
hep B
HIV
syphilis
NOT: chlamydia, CMV, hep C, group B strep
causes of increased nuchal transluceny
downs
congenital heart defects
abdo wall defects
(done at 11-13wks)
causes of hyperechogenic bowel
cystic fibrosis
downs
cytomegalovirus infection
symphysis-fundal height (SFH)
top of pubic bone to top of uterus
should match gestational age in weeks within 2cm
eg - 20 weeks normal SFH = 22-26cm
Rhesus pathophys
if RH-ve mother delivers a Rh+ve child a leak of fetal red blood cells may occur
–> causes anti-D IgG antibodies to form in mother
in later pregnancies these can cross placenta to cause haemolysis in fetus
(can also occur in 1st preg due to leaks)
Rhesus prevention
test for anti-D at booking
anti-D to non sensitised Rh-ve at 28-34wks
if event is in 2nd/3rd tri - give large dose anti-D + perform Kliehauer test
–> determines proportion of fetal RBCs present
what situations require ASAP (within 72hrs) anti-D immunoglobulin
- delivery of Rh+ve infant, live or dead
- any TOP
- miscarriage if gestation is >12wks
- ectopic (if managed surgically)
- external cephalic version
- antepartum haemorrhage
- amniocentesis, CVS, fetal blood sampling
- abdo trauma
tests for babies born to Rh -ve mothers
cord blood taken at delivery for:
- FBC
- blood group
- direct Coombs test
presentation + management of fetus affected by rhesus D
oedematous
jaundice, anaemia, hepatosplenomegaly
heart failure
kernicterus (brain damage due to severe jaundice)
mx = transfusions, UV therapy
causes of folic acid deficiency
phenytoin
methotrexate
pregnancy
alcohol excess
folic acid
is converted to THF
- green, leafy veg is good source
THF plays key role in synthesis of DNA + RNA
consequences of folic acid deficiency
macrocytic, megaloblastic anaemia
neural tube defects
