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A1. Women's Health > Antepartum care > Flashcards

Flashcards in Antepartum care Deck (21)

Name 3 investigations to do in prepregnancy counselling

Rubella and varicella serology, Pap smear


Name 3 common medications that are C/I in pregnancy and what alternative management you can use for a woman on these medications

Sulfonylureas - switch to metformin or insulin
Warfarin - switch to enoxaparin
Sodium valproate - can cease Rx if no seizure for > 2 years


Name 2 comorbid medical conditions where pregnancy is C/I (as prognosis for mother is terrible)

Pulmonary HT
Severe renal failure (creatinine > 0.3)


Name 2 pieces of pharmacological and behavioural advice to give women in prepregnancy counselling

Pharmacological - folate supplements (500mg for 3 months before pregnancy), avoid teratogenic drugs

Behavioural - how to get pregnant (frequent intercourse up to ovulation), cease alcohol/smoking etc


What are the 6 main steps in the first antenatal visit?

Confirm pregnancy
Confirm gestational age
Screen for problems
Manage problems
Give general advice
Make bookings


Name 4 things on Hx suggestive that a woman is pregnant

Missed period
Increased urinary frequency
Breast tenderness


At what gestational ages should you be able to tell that the woman is pregnant on abdominal vs vaginal exam?

Abdominally - 12 weeks
Vaginally - 8 weeks


Name 1 Ix to do in a first antenatal visit

Serum beta-HCG


Why is serum beta-HCG more accurate than urine beta-HCG?

Urine beta-HCG crossreacts with LH = greater false positives (also is only a qualitative, not quantitative reading)


What are two ways of determining the gestational age of a foetus? Which is more accurate?

Menstrual dating (Naegele's rule) - 9 months + 1 week from last normal menstrual period (to estimate delivery date)

U/S scan - more accurate, menstrual dating affected by irregular cycles or if woman is on hormonal contraception


What is Naegele's rule?

A way of estimating the gestational age of a foetus from menstrual dates - add 9 months + 1 week from last normal menstrual period to estimate delivery date


What U/S parameter is most accurate at determining the gestational age of a foetus between 6-12 weeks, and between 12-20 weeks? Why the difference?

6-12 weeks - crown rump length
12-20 weeks - biparietal diameter. CRL not as accurate as foetus starts to flex and extend head


Is U/S as accurate at determining gestational age of a foetus above 20 weeks as it is when foetus is

No - foetuses will all grow the same rate up to 20 weeks, but not beyond (depending on size of mum)


What are the 6 main types of investigations you should order for a woman in her first antenatal Hx/during the first 20 weeks of pregnancy? Give examples of each type

Blood tests (haematological) - Hb, platelets, MCV (look for thallassaemia)
Blood bank - blood grouping, screen for ITP antibodies
Microbiology/serology - rubella, varicella, syphilis, HBV, HCV, HIV, MSU MCS (asymptomatic bacteriuria)
Cytology - pap smear
Biochemistry - tests for Down Syndrome (PAPP-A and beta-HCG, or NIPT)
Imaging (U/S) - 12 week nuchal translucency and 19 week morphology


Name 7 pieces of general/lifestyle advice you can give a woman in her first antenatal visit

Diet - avoid raw poultry, mayonnaise, soft serve icecream, unpasteurised milk (risk of listeria)

Mineral/Vit supplementation - potential need for Fe, Calcium, Vit D, Folate, iodine, multivitamin supplements

Exercise - moderate exercise good, strenuous can = foetus SGA

Smoking and alcohol - no no

Sex - OK!

Work - most usually work until 34 weeks unless complication

Medications - paracetamol, metoclopromide (Maxalon), penicillins OK


What are the 3 main types of models of care in pregnancy (in public hospital)?

Normal risk - resident/midwife led care in public hospital
Shared care - between GP obstetrician and specialist
High risk - obstetrician-led care (inc. subspecialist in MFM)


Why do we have subsequent antenatal visits?

For surveillance of complications of pregnancy (pre-eclampsia, placental insufficiency, infection, foetal compromise, psychological state of mother and father etc)


What is the usual visit frequencies in antenatal care?

4 weekly until 28 weeks
2 weekly until 36 weeks
Weekly until delivery


Name 3 questions to ask on Hx in subsequent antenatal visits

General wellbeing
Foetal movements (after 20 weeks)
Oedema (especially fingers)


Name 5 examinations to do on subsequent antenatal visits

Fundal height
Abdominal exam (lie, presentation, auscultation)
Urinanalysis (proteinuria, infection)


What Ix should you do at the 28 and 36 week antenatal visits?

28 weeks - FBE (for anaemia, thrombocytopaenia), OGTT, Rh serology titres (if Rh-negative)
36 weeks - FBE, GBS swab, Rh serology