Antenatal Care

Question 1

Options of care for a pregnant lady

Answer 1

Low risk: midwifes, shared or complete GP care, private obstetrician
High risk: hospital clinic, obstetrician

Question 2

Typical clinic visits in first pregnancy

Answer 2

Booking visit, 19-20, 24, 28, 32, 36, 38, 40, 41

Question 3

Typical number of antenatal visits

Answer 3

Approx 8 in first pregnancy

Fewer in subsequent pregnancies if healthy (e.g. 5-8)

Question 4

Booking visit timing

Answer 4

10 weeks GA

Question 5

Booking visit things to complete (10)

Answer 5

• Complete SAPR
• Perinatal anxiety/depression screening
• Smoke-free pregnancy assessment
• Calculate EDD
• Medical examination
• Booking bloods
• MSSU
• Offer FTS
• Morphology scan at 18 weeks
• +/- other targeted investigations

Question 6

Booking bloods (5)

Answer 6

CBE
Blood group and antibody screen
TORCH viruses
Syphilis screen
Hepatitis B screen
Hepatitis C screen
HIV test

Question 7

Perinatal anxiety and depression screening tools

Answer 7

Edinburgh Postnatal Depression Scale (EPDS)

Antenatal risk questionnaire (ANRQ)

Question 8

Timing of first trimester screening

Answer 8

11+0 - 13+6

Question 9

Optional screening tests to offer high risk women at early pregnancy (6)

Answer 9

Haemoglobinopathies
Chlamydia
Bacterial vaginosis
Ferritin
Vitamin D
Mantoux skin test

Question 10

Pregnant women recommended to screen for chlamydia

Answer 10

All women under 25y and those from areas with high STI prevalence

Question 11

Pregnant women who should be screened for bacterial vaginosis

Answer 11

Those with previous preterm birth (treatment before 20 weeks may be beneficial)

Question 12

Pregnant women who should be screened for vitamin D deficiency

Answer 12

Dark skinned or veiled women

Question 13

Components of physical examination in booking visit for pregnancy (5)

Answer 13

Booking BP (right arm, seated)
Weight and height
Cervical smear if overdue
Heart and lungs assessment
Breast awareness

Question 14

Components of subsequent antenatal visits

Answer 14

SFH in cm
Weight
BP (right arm, seated)
Presentation and station (after 30 weeks)
Foetal heart rate
Foetal movements
Lab test results

Question 15

After what gestational age should presentation and station be determined at antenatal visits

Answer 15

30 weeks

Question 16

Special components of antenatal visit at 19-20 weeks

Answer 16

Morphology ultrasound

Calculate final EDD

Question 17

What is to be completed at 28 weeks antenatally

Answer 17

CBE
OGTT
Antibodies
Prophylactic anti D to Rh-ve woman
Discussion/education re breastfeeding

Question 18

What is to be completed at 34 weeks antenatally

Answer 18

2nd dose of prophylactic anti D

Repeat CBE if at risk of anaemia

Question 19

What occurs at 41 weeks antenatal check (in addition to standard)

Answer 19

Discuss induction of labour

Question 20

Folic acid supplementation in pregnancy (all women and increased risk)

Answer 20

All women 500mcg daily for 1 month pre-conception to 12w

Increased risk of folate def or NTD: 5mg daily throughout pregnancy

Question 21

Associations with folic acid deficiency in pregnancy

Answer 21

Neural tube defects (+ other birth defects)

Megaloblastic anaemia

Question 22

Indications for measurement of folic acid in pregnancy

Answer 22

Raised MCV
Poor diet
Prolonged hyperemesis/poor oral intake
GIT pathology (Crohn’s, celiac, bypass)

Question 23

Highest risk women for folate deficiency or NTD in pregnancy

Answer 23

Women taking liver-inducing anticonvulsatns
Pre-existing DM
Multiple pregnancy
Haemolytic anaemia
BMI higher than 30
Family history of NTD or previous child with NTD
Women with known MTHFR mutation

Question 24

Vitamin B12 supplementation in pregnancy

Answer 24

Consider for women who are vegetarian or vegan (causes irreversible neurological damage to breastfed infant)

Question 25

Indications for measurement of vitamin B12 in pregnancy

Answer 25

``` Raised MCV long-term vegan/vegetarian diet GIT pathology Family history of B12 def or pernicious anaemia Falling PLT count less than 100 ```

Question 26

General vitamin B12 supplementation for pregnant vegans (not severe symptomatic deficiency)

Answer 26

250-500mcg/day oral | OR 3 monthly IM 1000mcg injections

Question 27

Vitamin D supplementation for at risk women in pregnancy

Answer 27

ALL high risk women - test at booking visit and begin on 1000 units (25mcg of something) cholecalciferol IF higher than 60 at booking, discontinue supplement at next visit, otherwise TEST AGAIN IF still less than 60, increase to 2000 units/day, stay at 1000 units if higher than 60

Question 28

Indications for vitamin K administration during pregnancy

Answer 28

Women on enzyme-inducing anticonvulsants - to be given at 36 weeks May be administered to women with proven cholestasis due to reduced vitamin K absorption

Question 29

Iron supplementation in pregnancy

Answer 29

``` Not routinely recommended Should be started in women at particular risk e.g. - vegetarians - multiple pregnancy - GIT pathology ```

Question 30

Calcium supplementation in pregnancy

Answer 30

Unlikely to be required in absence of vitamin D deficiency | 1200mg/day

Question 31

Iodine supplementation in pregnancy

Answer 31

Recommended for all pregnant or breastfeeding women | 150mcg/day (can be taken in form of multivitamin containing RDI of iodine)

Question 32

Dating a pregnancy

Answer 32

Naegele's Rule | Ultrasound: crown-rump length

Question 33

Naegele's rule

Answer 33

Calculate from FIRST day of LMP + 7 days + 9 months (or -3 months + 1 year) If longer/shorter than 28 day cycle +/- added or lost days

Question 34

What to do if discrepancy between dates according to LMP and USS

Answer 34

IF menstrual dates are sure and discrepancy in less than 7 days, use dates PROVIDED: regular, recorded 28 day cycle with no contraception use 3 months before if over 7 days, use CRL and 8-13 weeks Nuchal translucency age will go by scanned GA not calculated

Question 35

Sensitivity of USS in dating pregnancy

Answer 35

Most sensitive in first trimester | CRL at 12w GA will be within 4 days of date in 90%