Antenatal Care Screening and Diagnosis Flashcards
(28 cards)
How many appointments are there for uncomplicated nulliparous vs parous women?
For uncomplicated nulliparous women – 10 appointments
Uncomplicated parous women 7 appointments
When are SFH and presentation and lie checked from?
From 24 weeks symphysis fundal height
From 36 weeks check presentation and lie
When should the booking visit ideally occur?
Ideally 8-12 weeks
Who should be on which supplements?
Vitamin D – 10ug especially those with darker skin or who cover their skin for cultural reasons and in obesity (continue whilst breastfeeding).
Folic acid – 400mcg daily from preconception to 12 weeks, some may need higher dose (5mg) for those on antiepileptics, previous affected child, diabetes, obesity > 35 BMI, sickle cell and demonstrated folate deficiency.
What diet and lifestyle advice should be given at a booking visit?
Diet and lifestyle: food hygiene including what to avoid, smoking and alcohol cessation and assessment of drugs. Food: pasteurised milk only, avoid ripened soft cheese (e.g. brie, camembert and blue veins cheeses), no pate, be wary of undercooked or non-cooked meat (all due to listeriosis) and avoid raw or partially cooked eggs, and poultry (due to salmonella).
What general education and warnings are given during the booking visit?
What are the flying rules?
Education about pregnancy e.g. baby growth, exercise (fine but avoid high impact sports), breast feeding and mental health. Inform about maternity leave and check what their job is. Singleton low risk pregnancies – no flying after 37 weeks, uncomplicated multiple pregnancies no air travel after 32 weeks.
Which examinations and investigations take place during the booking visit?
Examination
Identify high risk pregnancies from history and examination
BMI
BP
Dipstick
Breast and pelvic examination not recommended except in FGM
Signs of domestic violence
Investigations:
Blood disorders – haemoglobinopathies, thalassaemia and clotting
FBC for anaemia
Blood grouping for Rhesus status and red cell alloantibody status
Infection screening – HIV, Hep B, Rubella and syphilis
Urinalysis – glycosuria, proteinuria, haematuria and asymptomatic bacteraemia
Which two conditions should mother be assessed for risk factors for in the booking visit?
Assess risk factors for Gestational diabetes: BMI >30, previous macrosomic baby, family history of diabetes or gestational diabetes, and family origin – south Asian, black Caribbean and middle eastern are all high risk.
Assess risk factors for pre-eclampsia: BP and urinalysis first then: Age >40, nulliparity, pregnancy interval of > 10y, family or previous personal history, BMI >30, hypertension, renal disease and multiple pregnancy.
When is the dating scan and when is the down’s syndrome screen?
10-13+6 weeks – Dating Scan - CRL used unless > 84mm then Head circumference used. Most accurate between 8 and 13 weeks. After BPD (biparietal diameter) and femur length can be used.
11-13+6 weeks – Down’s syndrome screening
What happens at the 16 week antenatal appointment?
16 weeks – review results for Down’s test and any anomalies, supplementation of results if needed and BP/urine, Often iron supplements if Hb < 11g/dl.
When does the first anomaly scan take place?
18-20+6 weeks – anomaly scan including placental location, may be repeated at 32 weeks
What happens at the 25 week antenatal appointment for nulliparous women only
25 weeks (only nulliparous) – glucose tolerance test if indicated Routine care: BP, Urine dip and SFH
What happens at the 28 week antenatal appointment?
28weeks – Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5g/dl consider iron. First dose of anti-D prophylaxis to rhesus negative women.
Routine care: BP, Urine dip and SFH
What happens at the 31 week antenatal appointment for nulliparous women only
31 weeks (nulliparous only) – Routine care: BP, Urine dip and SFH
When does the detailed anomaly scan take place if required and what does it look for?
3rd Trimester – optional 32-week detailed scan to assess growth, viability, liquor volume, anatomy, placental location, and soft markers for aneuploidy: nuchal fold, short femur, choroid plexus cysts, echogenic focus of heart, dilated renal pelvis and talipes.
What happens at the 34 week antenatal appointment?
34 weeks – Anti D second dose and prep for labour
Routine care: BP, Urine dip and SFH
What happens at the 36 week antenatal appointment?
36 weeks – presentation of baby and ECV if indicated. Offered at 37 weeks for multiparous women. Provide information for post-partum care e.g. mental health, vitamin K prophylaxis and breast feeding.
Routine care: BP, Urine dip and SFH
What happens at the 38 week antenatal appointment?
38 weeks – Routine care: BP, Urine dip and SFH
What happens at the 40 week antenatal appointment for nulliparous women only?
40 weeks (nulliparous only) – discuss prolonged pregnancy Routine care: BP, Urine dip and SFH
What happens at the 41 week antenatal appointment?
41 weeks – offer membrane sweep (to attempt to induce labour)
Routine care: BP, Urine dip and SFH
How are pregnancies dated?
Last known menstrual period – simply add 41 weeks from the end of the last menstrual period. Only really works if very regular cycles and ovulation was exactly 14 days after this LMP. – known as Nagele’s rule.
Dating ultrasound scan – between 8 and 13 weeks this is the most accurate measurement. This is done by measuring the CRL
What conditions are tested for in the maternal blood screen at the booking visit?
- Haemoglobinopathies, Thalassaemia’s and Sickle Cell disease
- VDLR screening (syphilis)
- AFP screening (produced in the liver and raised levels are associated with small bowl and associated with open neural defects, gastroschisis, cystic hygroma, congenital nephrosis, teratoma, foetal infection and oesophageal atresia).
- Combined Aneuploidy screening – 21, 18 and 13 (Down’s, Edward’s and Patau’s)
- Rhesus status
- HIV and Hep B
How is Down’s syndrome screened for?
Down’s syndrome screening
Occurs in 1st or 2nd trimester
1st Trimester – Combined test
USS and blood test looking at Papp A (low) and hCG (high). The USS and blood test combined with maternal age and gestational age to determine risk of Down’s syndrome. Should be completed between 11-13+6 weeks
USS - Nuchal translucency (increased in Down’s, cystic hygroma, cardiac malformations, abdominal wall malformation, congenital diaphragmatic hernia and congenital infections). Scan also assesses, viability, accurate dating, twin determination and chorionicity, and detection of foetal abnormalities.
2nd Trimester serum test – Only done if women book late. Can do triple or quadruple test between 15-20 weeks
Triple: AFP (low), unconjugated oestriol(low) and hCG
Quadruple: AFP, unconjugated oestriol, hCG and inhibin A (high)
If risk of Down’s is greater than 1:150 then they are offered invasive tests
What invasive procedures are available for testing?
Amniocentesis, chorionic villus sampling, cordocentesis, fetoscopy, foetal skin biopsy and aspiration of fluid filled foetal cavities.
