Antenatal Care

Question 1

What are the 3 steps of pre-pregnancy counselling?

Answer 1

• Routine screening for any problems
• Mx any problems
• General advice (pharm, behavioural)

Question 2

What routine investigations should be conducted?

Answer 2

• Rubella Ab
• Varicella Ab (in absence of definite PHx)
• Pap smear

Question 3

General advice (pharmacological) in pregnancy?

Answer 3

• Folate

- Avoid teratogens

Question 4

What are the 6 steps in the first antenatal visit?

Answer 4

1. Confirm pregnancy
2. Gestational age
3. Screening for problems
4. Mx of any problems
5. General advice
6. Booking

Question 5

How is pregnancy confirmed?

Answer 5

• Hx: missed period, urinary frequency, breast tenderness, nausea
• PEx: uterine enlargement
• Ix: serum bHCG, urinary CG

Question 6

What is the issue with urinary CG?

Answer 6

Cross reacts with LH –> FPs and FNs

Question 7

What is the most accurate measure of gestational age?

Answer 7

US:

• 6-12w CRL (+/-3 days)
• 12-20w BPD (+/-7d)

Question 8

What is Naegele’s Rule?

Answer 8

9months + 1 week from first day LNMP

• adjust up or down if cycle longer/shorter than 28d
• not reliable if cycle irregular or recently ceased OCP

Question 9

Hx screen for potential problems?

Answer 9

• Age
• PHx
• Surgical Hx
• OHx
• GHx
• Meds and allergies
• FH and SHx

Question 10

Ix screening for potential problems?

Answer 10

• Haematology: Hb, plt, MCV (anaemia, thalassemia)
• Blood bank: group, Abs
• Microbiology: Rubella, VZV, syphilis, Hep B/C, HIV, MSU MCS
• Cytology: pap smear
• Biochemistry: serum screen T21
• Imaging: 12w nuchal (T21)translucency, 19w morphology

Question 11

General advice during pregnancy?

Answer 11

• Diet
• Vitamin and mineral supplementation (iron, Ca, Vit D, folate)
• Exercise (moderate ok)
• Smoking
• Alcohol
• Sex
• working (usu cease ~34w)
• Medication (paracetamol, maxalon, penicillin OK)

Question 12

what is the purpose of subsequent ante natal visits?

Answer 12

Early diagnosis and treatment of complications, especially:

• Pre eclampsia: HTN, proteinuria, oedema
• Placental insufficiency (poor growth, movements)

Question 13

Antenatal visit frequency?

Answer 13

• Pre 28 weeks: 4 weekly
• 28-36 weeks: 2 weekly
• 36 weeks: weekly

Question 14

PEx specifics subsequent antenatal visits?

Answer 14

• Weight gain
• BP
• Fundal height: symphysis to top of fundus
• LIe and presentation
• Auscultation
• Urinalysis

Question 15

Ix at 28w?

Answer 15

• FBE
• OGTT or OGCT
• +/- RHab and Anti D (if RH-ve)

Question 16

Ix at 36w?

Answer 16

• FBE
• GBS swap
• Anti D if Rh Neg