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Flashcards in Antenatal Care Deck (15):
1

Outline structure of a pre-pregnancy counselling structure.

- Routine screening for any problems (Hx, Ex, Ix)
- Mx of any problems (Dx, Rx, Px)
- General advice (Pharmacological, behavioural)

2

Pre-pregnancy counselling routine screening for what?

Rubella ab, Varicella ab, Pap smear

3

Pre-pregnancy counselling mx of problems e.g. DM, epilepsy, anticoag?

DM use insulin, not oral hypoglycemics.
Epilepsy, dial back on the drugs (valproate v. bad)
Anticoag: NO WARFARIN

AND no pregnancy if appalling prognosis (e.g. renal failure creatinine > 0.3 or pulm HT)

4

General advice: Pharmacological and Behavioural

Pharmacological: Foalte 0.5mg, avoid teratogens
Behavour: get pregnant sex frequently before and after ovulation, alcohol, smoking

5

Outline structure of first antenatal visit

-confirm pregnancy
-gestational age
-screening for problems
-mx of any problems
- general advice
- booking

6

First antenatal visit: Confirmation of pregnancy?
Why is urinary Bhcg less reliable compared to serum?

Hx: missed period, nausea, breast tender, urinary f
Ex: uterine enlargement abdo 12wks/vaginal 8wks
Ix: serum B hCG v. reliable, urinary CG not as good as reacts with LH.

7

First antenatal visit: Determination of gestational age by?

Ultrasound scan most accurate (6-12wks CRL)
12-20wks BPD

Menstrual Dates: Naegele's Rule is LNMP-3months+1yr 1 wk + (cycle days - 28)

8

First antenatal visit: Screening for potential problems

Hx: age POH, PGH etc.
Ex: gen appearance, gynae (speculum, bimanual)
Ix: haematology (Hb, Platelets, MCV; anaemia thalassaemia), blood bank (Gp, Ab; red cell iso immunisation), microbiology (Rubella, Varicella, Syphyllis, HepB, HepC, HIV, MSU), cytology (Pap Smear), biochem (serum screen T21), imaging (12wk nuchal translucency, 19sk morphology).

9

First antenatal visit: General advice

-diet (nutrition, Listeria)
-Mineral & vitamin supplements (iron,Ca,VitD,folate,iodine,multivitamin)
- exercise (moderate)
-alcohol and smoking (teratogenic, IUGR)
- sex (ok)
-working (usual up to 34 wks)
-medication (paracetamol ok, maxalon nausea, penicillin/amoxy ok)

10

First antenatal visit: Booking

Models of care: public for normal risk = residents midwives, GP shared care, public hospital high risk (specialist obstetrician/registrar). Or private obstetrician.

11

Subsequent antenatal visits - purpose?

Early diagnosis and treatment (preeclampsia, placental insufficiency wk 19)

12

Subsequent antenatal visits - frequency?

36wks (wkly);

13

Subsequent antenatal visits - outline.

hx (gen well being, fetal movements, oedema)

ex (weight gain, BP, fundal height, lie px auscultation, urinalysis)

ix (28wks FBE, OGTT, Rh ab & anti-D administration if Rh -ve) (36wks FBE, GBS swab, antiD administration if Rh-ve)

14

Timing of birth

- spontaneous labour ~40wks
- 1/400 perinatal death or disability as consequence of event after maturity (38wks), no. higher if complications - preeclampsia, placental insufficiency, twins etc.

15

Mode of birth

ideally vaginal