Antenatal Care Flashcards
(39 cards)
What occurs at the booking visit?
Risk assessment BMI Blood pressure USS between 11 and 13+6 Blood tests Vaginal infections Urine M+C Urinalysis - glucose, protein, nitrites
What is the combined test?
12 week USS
Blood beta hCG
Pregnancy associated plasma protein A (PAPPA)
What does the week 12 USS do?
- crown-rump length for dating
- multiple pregnancies
- nuchal translucency
What do the booking visit bloods test for?
FBC - anaemia Serum antibodies - syphilis GTT Rubella immunity HIV and hep B Hb electrophoresis Screening for chromosomal abnormalities
What lifestyle changes are advised in pregnancy?
2500 calories/day
Coitus fine unless placenta praevia
Avoid soft and blue cheese, pate, uncooked foods
Do exercise
Vit D for South Asian, Afro-Caribbean or BMI>30
What does the 20 week USS screen for?
Anomaly scan
What can be done at 23 weeks?
Doppler of uterine arteries
If OK then SGA
If reduced then IUGR or pre-eclampsia
How many appointments does a woman need?
10 for nulliparous
7 for multiparous
What investigations are done every appointment?
Ask about physical and mental state
Weighed
BP
Urine - protein, glucose, leucocyte, nitrites
What is done at 16 weeks?
Results of screening tests and booking bloods
Offer triple test
What is done at 18-21 weeks?
Anomaly scan
Repeat at 32 weeks if placenta is low
What is done at 25 weeks?
For PRIMIPS
Exclude early onset pre-eclampsia
What is done at 28 weeks?
fundal height measured
FBC and antibodies checked
GTT if indicated
Anti-D given to rhesus-negative women
What is done at 31 weeks?
For PRIMIPS
Fundal height measured
28 week blood tests are reviewed
What is done at 34 weeks?
Fundal height measured
FBC rechecked
What is done at 36, 38 and 40 weeks?
Fundal height, fetal lie and presentation is checked
Referred for ECV if breech
What is done at 41 weeks?
Membrane sweeping offered
Induction at 42 weeks
What minor conditions occur in pregnancy?
Itching- assess LFTs
Pelvic girdle pain - physiotherapy, corsets, analgesics, crutches
Abdo pain - rule out non-pregnant causes
Heartburn - antacids or ranitidine
Backache - sciatica
Constipation - exacerbated by iron
Ankle oedema - worsens at end, sudden increase is worrying
Leg cramps
Carpal tunnel syndrome - fluid retention compresses median nerve
Vaginitis - due to candidiasis, difficult to treat
What are physiological changes in pregnancy?
Weight gain 10-15 kg Uterus gets heavier 1kg Cervix softens Blood volume increases Haemoglobin decreases WBC increases CO increases Peripheral resistance decreases Blood pressure falls Thyroid enlarges
What causes congenital abnormalities?
Structural deformities Chromosomal abnormalities Inherited diseases Intrauterine infections Drug exposure
What is the difference between screening and diagnostic tests?
Screening - available for all women and gives a risk of being affected
Needs to be cheap, high sensitivity, specificity, safe
Diagnostic tests - performed on women with high risk to confirm
How are neural tube defects screened for?
AFP is produced in fetal liver and measured in maternal blood
- open neural tube defects
- gastrochisis
How is maternal blood tested for chromosomal abnormalities?
Blood markers are altered when fetus has chromosomal abnormality
- beta hCG
- PAPPA
- AFP
- Oestriol
- Inhibin A
How is USS used as a screening and diagnostic test?
Nuchal translucency measured between 11-14 weeks
Linked to cardiac abnormalities
20 week anomaly scan diagnoses most cardiac abnormalities
