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Flashcards in Antenatal Care Deck (15):

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)


Pre-pregnancy counselling routine screening for what?

Rubella ab, Varicella ab, Pap smear


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)

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


General advice: Pharmacological and Behavioural

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


Outline structure of first antenatal visit

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


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.


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)


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).


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)


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.


Subsequent antenatal visits - purpose?

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


Subsequent antenatal visits - frequency?

36wks (wkly);


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)


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.


Mode of birth

ideally vaginal