Antenatal Care Flashcards
What is the booking clinic and when should it be?
It is the first appointment with the midwife it should be before 10 weeks gestation
What educational topics are covered in the booking clinic?
What to expect at different stages of pregnancy
Lifestyle advice in pregnancy- not smoking, alcohol cessation, recreational drug use.
Supplements- folic acid and vit D
Birth plans
Antenatal Screening tests
Antenatal classes
Mental health
Breastfeeding classes
Exercises- pelvic floor exercises
RISK ASSESMENT
What advice would you give to a patient who is pregnant to avoid listeria?
Drinking only pasteurised or UHT milk
Not eating ripened soft cheese like Camembert, Brie, and blue veined cheese
Not eating pate
Not eating uncooked or undercooked ready prepared meals
What advice would you give to a pregnant woman to avoid getting salmonella?
Avoid raw or partially cooked eggs, or food that may contain them like mayonnaise
Avoid raw or partially cooked meat, especially poultry.
What are the risks of drinking in pregnancy?
Long term haem, the more you drink the greater the risk
. Low birth weight
. Preterm birth
. Small for gestational age
. All increased in mothers drinking above 1-2 units/ day during pregnancy
What does the examination involve in the booking clinic?
Height, weight, BMI, Urinalysis for protein and bacteria Blood pressure Discuss female genital mutilation Discuss domestic violence
What bloods are taken at the booking clinic?
Blood group, antibodies, rhesus D status
FBC for anaemia
Screening for thalassemia and sickle cell disease
Patient to will also be offered screening for infectious diseases, by testing antibodies for HIV, Hep B, syphilis.
Screening for Down’s syndrome may be initiated depending on the gestational age, bloods for the combined are taken from 11 weeks onwards l
How do you screen for Down syndrome?
Combined test is first line
Performed between 11-14 weeks gestation
Combines ultrasound and maternal blood tests
What does the combined test involve?
Maternal blood tests-
Beta- hCG (the higher the result the higher risk)
Pregnancy associated plasma protein A (lower result indicates a greater risk)
What is the triple test and what does it involve?
Between 14-20 weeks gestation
Only involves maternal blood tests
Beta hCG (Higher result indicates a greater risk)
Serum oestriol (female sex hormone- lower result indicates a greater risk)
Alpha fetoprotein- lower result indicates a greater risk
What does quadruple test mean?
Screening for Down syndrome between weeks 14 and 20, it is identical to triple test but also includes inhibin A (Higher means greater risk)
What is the verdict of the screening test for Down syndrome?
If the risk of the fetid having Down syndrome is greater than 1 in 150 then woman is offered karyotyping for a definitive answer…
- chorionic villus sampling
- amniocentesis
What is the difference between amniocentesis and chorionic villus sampling?
Chorionic villus sampling involves an ultrasound guided biopsy of the placenta, tissue, this is done earlier in pregnancy (<15 weeks)
Amniocentesis involves ultra sounded guided aspiration of the amniotic fluid, using a need,e and syringe, used later in pregnancy when there is enough amniotic fluid to take a sample.
How do you screen for pre eclampsia?
Blood pressure and urinalysis should be checked for protein at each antenatal visit
At the booking appointment pre eclampsia risk factors should be determined…
40 years or older? Null Nullparity Pregnancy interval of more than 10 years FH Previous Hx BMI 30kg/M2 or above Pre existing vascular disease- hypertension Pre existing renal disease Multiple pregnancy
How many antenatal appointments should each woman have?
Uncomplicated nulliparous- 10 appointments should be adequate
Uncomplicated Parous- 7 appointments should be adequate
When should symphysis fundal height be measured and recorded?
From 24 weeks
Should match the gestational age
What are the first, second and third trimester?
First is from start until 12 weeks gestation.
Second is 13 weeks to 26 weeks gestation
Third is 27 weeks till birth
When do foetal movements start?
20 weeks until birth
When should the booking clinic take place?
Before 10 weeks
When and what is the dating scan?
An accurate gestational age is calculated from the crown rump length and multiple pregnancies are identified
It is between 10 and 13+6
When and what is the antenatal appointment?
16 weeks
Discuss the results and plan future appointments
When and what is the anomaly scan?
An ultrasound used to identify any anomalies like heart conditions
Between 18 and 20+6
Routine antenatal appointments are at 25,28,31,34,36,38,40,41 and 42 weeks
What is done at these routine antenatal appointments?
symphysis fundal height
Fetal presentation
Urine dipstick for protein for pre eclampsia
Blood pressure for pre eclampsia
Urine for microscopy and culture for asymptomatic bacteriuria
What are the two vaccines offered for all pregnant women?
Whooping cough (pertussis) from 16 weeks gestation Influenza (flu) when available in autumn or winter.
Live vaccines like the MMR are avoided in pregnancy
What lifestyle advice should you give to pregnant women?
Take folic acid
Take vit D supplements
Avoid vit A supplements if eating pate or liver (vit A is tetarogenic in large doses)
Don’t drink alcohol
Don’t smoke
Avoid unpasteurised dairy or blue cheese (risk of listeriosis)
Avoid undercooked or raw poultry (salmonella risk)
Avoid contact sport but can continue moderate exercise
Sex is safe
Flying increases VTE risk
Place car seatbelts above and below the bump
What can alcohol in pregnancy lead to?
Miscarriage
Being small for the dates
Preterm delivery
Fetal alcohol syndrome
What is fetal alcohol syndrome?
Certain characteristics that can occur in children of mothers that consumed during pregnancy, the features include…
. Microcephaly (small head) . Thin upper lip . Smooth flat philtrum (groove between the nose and upper lip) . Behavioural difficulties . Hearing and vision problems . Cerebral palsy . Short palpebral fissure . Learning difficulties
What does smoking in pregnancy increase the risk of?
Fetal growth restriction Miscarriage Still birth Preterm labour and delivery Placental abruption Pre eclampsia Cleft lip or palate Sudden infant death syndrome
When is flying in pregnancy acceptable?
37 weeks in a single pregnancy
32 weeks in a twin pregnancy
(After 28 weeks gestation most airlines need a note from midwife, GP, obstretician to state the pregnancy is going well and there’s no additional risks)
What is the combined screening test for Downs syndrome?
It is performed between 11 and 14 weeks
Involves combining results from ultrasound and maternal blood tests
Ultrasound- measures nuchal translucency (the thickness of the back of the neck of the foetus), nuchal thickness greater than 6mm indicates Down syndrome
Blood tests-
Beta hCG (higher result means a greater risk)
pregnancy associated plasma protein A (lower result means a greater risk)
The screening test provides a risk score for the foetus having Down syndrome, at what risk is the woman then offered amniocentesis or chorionic villus sampling?
1 in 150 (occurs in around 5% of tested women)
What is the risk of hypothyroidism in pregnancy?
Miscarriage, anaemia, small for gestational age and pre eclampsia
What drugs can/ can’t be used in hypertension in a pregnant woman?
Medications that should be stopped…
. ACE- I (ramipril)
. ARBs (losartan)
. Thiazide and thiazide like diuretics
Medications which aren’t known to be harmful…
. Labetalol (bets blocker)
. Calcium channel blocker (nifedipine)
. Alpha blockers (doxasozin)
What can women who have epilepsy in pregnancy take?
Should take folic acid 5mg daily before conception to reduce the risk of neural tube defects
Levetiracetam, Iamotrigine and carbamazepine are the safer anti epileptic medications in pregnancy.
Should be well controlled in pregnancy
What medication is considered safe in pregnancy in terms of rheumatoid arthritis?
Hydroxychloroquine
Sulfasalazine
Should NSAIDS be used in pregnancy?
Generally avoided as they work by blocking prostaglandins, which soften the cervix and stimulate uterine contractions at the time of delivery
Particularly avoided in the 3rd trimester- can cause premature closure of the ductus arteriosus. Can also delay labour.
Can beta blockers be used? What effects may they have
Labetalol is the main choose to use in pre eclampsia
However they can cause…
. Foetal growth restriction
. Hypoglycaemia in the neonate
. Bradycardia in the neonate
What is congenital rubella syndrome?
Also known as German measles, caused by the maternal infection with the rubella virus in the first 20 weeks of pregnancy, the risk is highest before ten weeks gestation.
What are the signs of congenital rubella syndrome to be aware of..
Congenital deafness, cataracts, heart disease, learning disability
Why is chickenpox dangerous in pregnancy?
More severe cases in the mother- varicella pneumonitis, hepatitis, encephalitis
Fetal varicella syndrome
Severe neonatal varicella infection
What happens if the woman is exposed to chickenpox in pregnancy?
When the woman has previously had chicken pox, they are safe
When they are not sure about their immunity then varicella zoster IgG levels can be tested
When they are not immune they can be treated with IV varicella immunoglobulins as prophylaxis of developing chickenpox, should be given within ten days of exposure.
What are the typical features of congenital varicella syndrome?
Fetal growth restriction
Microcephaly, hydrocephalus and learning disability
Scars and significant skin changes located in specific dermatomes
Limb hypoplasia (underdeveloped limbs)
Cataracts and inflammation in the eye (chorioretinitis)
What is listeria typically transmitted by?
Unpasteurised dairy products, processed meats and contaminated foods. Avoid blue cheese and practise good food hygiene
What is congenital cytomegalovirus ?
Occurs due to a cytomegalovirus infection in the mother during pregnancy. The virus is mostly spread via. The infected saliva or urine of asymptomatic children. Most cases of cytomegalovirus in pregnancy do not actually cause congenital cytomegalovirus.
What are the signs of congenital CMV?
Fetal growth restriction Microcephaly Hearing loss Vision loss Learning disability Seizures
What is meant by small for gestational age?
An infant with a birth weight which is <10th centile for its gestational age
(Severe SGA <3rd centile)
What is fetal SGA?
An estimated fetal weight (EFW) or abdominal circumference <10th centile
(Severe <3rd centile)
What is fetal growth restriction?
When a pathological process has restricted genetic growth potential. This can present with features of fetal compromise including reduced liquor volume or abnormal Doppler studies.
(Likelihood of this is higher in a severe SGA foetus)
What is meant by low birth weight?
An infant who has a birth weight <2500g
What is the KLEIHAUER test?
Checks how much fetal blood has passed into the mothers blood during a sensitisation event, this can be used after any sensitising event past 20 weeks gestation, to assess whether further doses of anti D are needed.
What does the KLEIHAUER test involve?
Adding acid to a sample of the mothers blood, fetal haemoglobin is more resistant to the acid, therefore fetal haemoglobin persists in response to the added acid.
What measurements are used on ultrasound to assess the fetal size?
Estimated fetal weight
Fetal abdominal circumference
