Antenatal - Pregnancy overview, lifestyle advice & booking in clinic

Question 1

define Last Menstrual Period (LMP)

Answer 1

date of the first day of the most recent menstrual period

Question 2

define gestational age (GA)

Answer 2

duration of the pregnancy starting from the date of the last menstrual period

Question 3

define estimated date of delivery (EDD)

Answer 3

estimated date of delivery - 40 weeks gestation

Question 4

define gravida (G)

Answer 4

total number of pregnancies a woman has had

Question 5

define primigravida

Answer 5

patient that is pregnant for the first time

Question 6

define multigravida

Answer 6

patient that is pregnant for at least the second time

Question 7

define para (P)

Answer 7

number of times the woman has given birth after 24 weeks gestation, regardless of whether fetus was alive or stillborn

Question 8

define nuliparous (nullip)

Answer 8

a patient that has NEVER given birth after 24 weeks gestation

Question 9

define primiparous

Answer 9

a patient that has given birth after 24 weeks gestation once before

Question 10

define multiparous (multip)

Answer 10

a patient that has given birth after 24 weeks gestation 2 or more times

Question 11

what constitutes the 3 semesters

Answer 11

1st - start to 12 weeks
2nd - 13 weeks -26 weeks
3rd - 27 weeks until birth

Question 12

when do fetal movements usually start?

Answer 12

around 20 weeks gestation

Question 13

what 2 vaccines are offered to all pregnant women?

Answer 13

whooping cough - from 16 weeks gestation
influenza - when available in autumn or winter

Question 14

what vaccines should be avoided in pregnancy?

Answer 14

live vaccines such as MMR

Question 15

what are some key milestones during pregnancy

Answer 15

Question 16

what are some additional appointments that some women may require?

Answer 16

• additional appointments for high risk/complicated pregnancies
• oral glucose tolerance test in women at risk of gestational diabetes
• anti-D injections in rhesus negative women
• ultrasound scan at 32 weeks for women with placenta praevia on anomaly scan
• serial growth scans offered to women at increased risk of fetal growth restriction

Question 17

what happens are routine antenatal appointments?

Answer 17

• discuss plans for remaining pregnancy and delivery
• symphysis-fundal height measurements from 24 weeks onwards
• fetal presentation assessment from 36 weeks
• urine dipstick from protein for pre-eclampsia
• blood pressure for pre eclampsia
• urine for microscopy and culture for asymptomatic bacteriuria

Question 18

what general lifestyle advice is given to pregnant women?

Answer 18

• folic acid 400mcg from before pregnancy
• take vit D supplement
• avoid vit A supplements and eating liver or pate
• don’t smoke or drink
• avoid unpasteurised dairy or blue cheese
• avoid undercooked or raw poultry
• moderate exercise but avoid contact sports
• sex is safe
• flying increases risk of VTE
• place seat belts above or below bump not across it

Question 19

why is alcohol bad in pregnancy?

Answer 19

can cross the placenta, enter fetus and disrupt fetal development - fetal alcohol syndrome

Question 20

what are some specific risks of alcohol in early pregnancy?

Answer 20

Miscarriage

small for dates

preterm delivery

fetal alcohol syndrome

Question 21

what is fetal alcohol syndrome? and what are the features?

Answer 21

refers to certain characteristics that can occur in children of mothers that consumed alcohol during pregnancy. features:

• microcephaly
• thin upper lip
• smooth flat philtrum
• short palpebral fissure
• learning disability
• behavioural difficulties
• hearing and vision problems
• cerebral palsy

Question 22

what are the risks of smoking in pregnancy?

Answer 22

• fetal growth restriction (FGR)
• miscarriage
• stillbirth
• preterm labour and delivery
• placental abruption
• pre-eclampsia
• cleft lip or palate
• sudden infant death syndrome (SIDS)

Question 23

what is RCOG advice regarding flying in pregnancy?

Answer 23

flying is okay in uncomplicated health pregnancies up to 37 weeks in single pregnancy and 32 weeks in twins

after 28 weeks gestation most airlines need a note from a midwife/GP/obstetrician to state pregnancy is going well and there are no additional risks

Question 24

what is booking clinic and when does it?

Answer 24

initial appointment to discuss pregnancy and arrange plans for pregnancy ideally before 10 weeks gestation

meet midwife to discuss pregnancy and they will get a greenbook

Question 25

what is covered during booking clinic?

Answer 25

• What to expect at different stages of pregnancy
• Lifestyle advice in pregnancy (e.g. not smoking)
• Supplements (e.g. folic acid and vitamin D)
• Plans for birth
• Screening tests (e.g. Downs screening)
• Antenatal classes
• Breastfeeding classes
• Discuss mental health

Question 26

what blood tests are done at the booking appointment?

Answer 26

• blood group, antibodies and rhesus D status
• FBC for anaemia
• screen fro thalassaemia and stickle cell disease (if high risk)

Question 27

what infectious diseases are screened for at the booking appointment?

Answer 27

HIV

Hepatitis B

Syphilis

Question 28

name 5 things other than bloods that are assessed/checked for at the booking appoitment?

Answer 28

• weight, height, BMI
• urine for protein and bacteria
• BP
• discuss FGM
• discuss domestic violence

Question 29

women are assessed for risk factors for other conditions and plans are put in place with additional appointments booked. what conditions might these be and what needs to be done?

Answer 29

rhesus negative - book anti-D prophylaxis

gestational diabetes - book oral glucose tolerance test

fetal growth restrictions - book additional growth scans

VTE - provide prophylactic LMWH if high risk

pre-eclampsia - provide aspirin if high risk