Antenatal Care Flashcards
(42 cards)
What happens in first contact with healthcare professional post conception
WHEN PRENANCY CONFIRMED
Folic acid supplementation
Vitamin D supplement
Food hygiene - avoid shellfish, unpasteurised milk/cheeses, raw eggs, undercooked meat and tuna
Lifestyle - stop smoking, recreational drugs and alcohol
Exercise - regular activity as long as you feel comfortable and slow down as pregnancy progresses
Explain about antenatal screening and Down’s screening
What happens booking visit
8-12 WEEKS
Check BP, urine dipstick (UTI and kidney disease), BMI
Booking bloods - FBC, blood group, rhesus status, RC alloantibodies, haemoglobinopathies, hep B, syphilis, rubella, HIV
Discuss LMP (work out EDD), consider iron if Hb < 110, discuss place of birth, breastfeeding, antenatal classes, antenatal screening and mental health issues
What happens at dating scan
10-13+6 WEEKS Early scan to confirm dates (CRL) Exclude multiple pregnancies Detect neural tube defects Look at placental site
What happens at Down’s syndrome screening (Nuchal combined)
11-13+6 WEEKS
Nuchal translucency - measures pad at nape of foetal neck
- foetus must be in right position
- detects 85% of Down’s cases and other cardiac abnormalities
- depth > 3mm positive result - discuss CVS/amniocentesis
Beta-hCG
PAPP-A
What happens at Down’s syndrome screening (quadruple test)
> 14 WEEKS - only late presenting mothers who missed NCT AFP Beta-hCG Unconjugated oestriol Inhibin-A
When does GDM screening occur
16 WEEKS
OGTT for women who are high risk
What happens at the anomaly scan
18-20+6 WEEKS
Gestational age based on - biparietal diameter, head circumference, abdominal circumference, femur length
Screening for - anencephaly, open spina bifida, cleft lip, diaphragmatic hernia, gastroschisis, exomphalos, cardiac abnormalities, renal agenesis, lethal skeletal dysplasia, Edward’s syndrome, Patau’s syndrome
When do specialist foetal cardiac scans ocurr
22-24 WEEKS
Only if indicated by previous scans
When does a routine care appointment occur
28, 36 AND 38 WEEKS
AND 25, 31 AND 40 WEEKS IF PRIMIP
BP, urine dipstick, symphysis-fundal height
40 WEEKS - discuss induction
When dose a plancetal scan occur
31 WEEKS
Assess for risk of placenta praevia is concerned
When is Anti-D prophylaxis given
Given to rhesus negative women at 28 and 34 weeks
What is LGA
Large for Gestational Age
Foetus is above 97th centile
Over 9 pounds 11 at birth
Causes of LGA
Large parents
Large amount of weight mother gains
Diabetes
Problems associated with LGA
Long time for delivery Difficult birth Injury to baby during birth - damage to brachial plexus Need for C-section Hypoglycaemia in baby post birth Higher risk for birth defects Maternal trouble breathing
Investigations for LGA
USS - foetal measurements
Large weight gain in pregnacy
Management for LGA
Prevented by taking care of diabetes, watching weight and following healthcare advice
Early delivery
Blood glucose testing
Define SGA
Small for gestational age
Less than < 10th centile for gestational age
Define foetal growth restriction
Pathological process has restricted genetic growth potential
- can present with features of foetal comprise including reduced liquor volume or abnormal doppler studies
Define low birth weight
Infant with birth weight of < 2500
Define a normal (constitutionally) small growth restriction
Identified by small size at all stages but growth following the centiles
No pathology present
Contributing factors include ethnicity sex and parental height
Define placenta mediated growth restriction
Growth is usually normal initially but slows in utero
Common cause of FGR
Maternal factors include low pre-pregnancy weight, substance abuse, autoimmune disease, renal disease and chronic hypertension
Define non-placenta mediated growth restriction
Growth affected by foetal factors such as chromosomal or structural anomaly, an error in metabolism or foetal infection
Risk factors for SGA
Minor - maternal age > 35 - smoker 1-10 a day - nulliparity - BMI < 20 or > 25 - IVF singleton - previous pre-eclampsia - pregnancy interval < or > 60 - low fruit intact pre-pregnancy Major - maternal age > 40 - smoker > 11/day - maternal/paternal SGA - previous SGA - previous stillbirth - cocaine use - daily vigorous exercise - maternal disease - heavy bleeding - low PAPP-A - pregnancy associated plasma protein
Diagnosis of SGA
USS for diagnosis and surveillance
- EFW and AC plotted on personalised centile charts
Ratio of HC and AC significant
- symmetrically small foetus more likely to be constitutionally small
- asymmetrically small foetus more likely to be caused by placental insufficiency
