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YEAR 4 REPRO > Normal Pregnancy: Antenatal care > Flashcards

Normal Pregnancy: Antenatal care Flashcards

incl screening, scans, lifestyle advice and any meds

1
Q

What happens when you receive a positive pregnancy test?

A
  • book yourself with the community midwife- called ‘the booking visit’
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2
Q

Aim of booking visit?

A
  • How baby develops during pregnancy
  • Exercise- incl pelvic floor exercises
  • Place of birth and pregancy care pathway
  • Breastfeeding, incl workshops
  • Participant- led antenatal classes- group classes
  • Further discussion and offer of all antenatal screening
  • Discussion of mental health issues- with each visit, questioning
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3
Q

When is the booking visit?

A

Ideally before 10 weeks

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4
Q

What specifics are disccused by the community midwife at the booking visit?

A

Health and lifestyle
Folic acid- 400mcg daily - preconceptually ideally but as soon as +ve pregnancy test
Food hygiene- including how to reduce risk of food- acquired infection
Smoking cessation, implications of recreational drug use and alcohol consumption in pregnancy
All antenatal screening as well as risks and benefits of the screening tests
Perform risk assessment- to categorise them as high risk or low risk–> where they will be managed

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5
Q

What food advice do you give to a pregnant woman?

A
  • drinking only pasteurised or UHT milk
  • Not eating ripened soft cheese such as camembert, brie and blue- veined cheese (no risk with hard cheeses)
  • Not eating pate (even veg pate)
  • Not eating undercooked or undercooked ready prepared meals
  • Pregnant women should be offered info on how to reduce risk of salmonella infection
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6
Q

Advice to reduce risk of salmonella?

A

Avoiding raw or partially cooked eggs or food that may contain them (e.g. mayo), avoiding raw or partially cooked meat esp poultry

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7
Q

What is the main food acquired infection to be aware of?

A

Listeriorsis

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8
Q

What is the UK CMO guidance on alcohol consumption in pregnancy?

A

If you are pregnant/ think you might become pregnant–> safest to not drink alcohol at all to keep risks to baby at min

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9
Q

Risk of alcohol on unborn baby?

A

Low birth weight
SGA
Preterm birth
May all be increased in mothers drinking about 1-2 units/day during pregnancy

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10
Q

What clinical exam do you do at the booking visit?

A
  • Measure of weight and BMI
  • Women who have no accessed UK healthcare before should be offered general clinical exam
  • Breast and pelvie exam NOT recommened (exception is FGM)
  • Look out for signs of domestic violence
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11
Q

What routine tests are offered to women at booking?

A
  • Electrophoresis + family origin questionnaire: haemoglobinopathy -sickle cell and Beta thaelassaemia
  • FBC- anaemia
  • Blood group and red cell antibody screening: rhesus status and risk of rheus isoimmunisation and non-rhesus antibodies which can result in haemolysis in maternal circulation
  • Infection screening: syphilis, hep B, HIV, asymptomatic bacteriuria
  • Urianlysis: glycosuria, proteinuria, haematuria
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12
Q

Who do you screen for gestational diabetes?

A
  • Based on risk assessment
  • BMI above 30kg/m2
  • Previous macrosomic baby weighing 4.5kg or above; previous gestational diabeted
  • Fhx of diabetes
  • Family origin with a high prevalence of diabetes- south asian, black carribean, middle eastern
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13
Q

How do you screen for pre-eclampsia?

A

BP & urinalysis check for protein at each antenatal visit to screen for pre-eclampsia

At booking apt, RF should be determined

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14
Q

RF for pre-eclampsia?

A

Age 40 or older
Nullparity
Pregnancy interval for more than 10 years
Fhx of pre-eclampsia
Previous hx of pre-eclampsia
BMI > 30kg/m2
Pre-existing vascular diesease such as hypertension
Pre-existing renal disease
Multiple pregnancy

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15
Q

What is the screening for Downs, patau and edwards?

A
  • has to be performed by the end of the first trimester (13 weeks 6 days)
  • The combined test ( NT, B-hcg, PAPP-A) 11 weeks to 13 weeks 6 days
  • If NT measurement not feasible- offer serum screening
  • Provision for screening (15-20 weeks) for late bookers- serum screening quadruple test
  • A confimatory diagnostic service by CVS/ Amnio if screen positive
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16
Q

What is nuchal transluceny?

A

Measurement of fluid at the back of babys neck in USS

17
Q

What are the screening strategies for Downs, Edward and Patau?

A

1st trimester:
* Combined method- preferred
* USS between 11+2 - 14+1 and biochemistry
2nd trimester
* If woman presents after 14+1 weeks, offer quadruple test from 14+2
* hCG, aFP, uE3 and inhibin-A- serological test
3rd trimester
* If risk assessment comes back 1/150–> offer invasive test (aminocentesis or CVS)
* NIPT- not available in NHS routinely–> maternal serum for fetal cells for trisomys–> screening test

18
Q

How often are antenatal apts?

A
  • Uncomplicated first pregnancy- 10 visits
  • Uncomplicated parous women- 7 visits
    *
19
Q

What do antenatal apts consist of?

A
  • BP and urine check at every visit
  • 24 weeks onwards- symphsyis- fundal height should be measured and recorded
  • 36 weeks onwards- check fetal presentation- USS if uncertain
  • No routine auscultation, fetal movement counting not required and routine antenatal CTG in uncomplicated pregnancy- NO BENEFIT
20
Q

What tests do you perform at the 28 week visit?

A

*Routine care: BP, urine dipstick, SFH
* Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
* GTT if indicated
* First dose of routine anti-d prophylaxis if rhesus negative

21
Q

What do you do at 36 weeks?

A
  • Info about breast feeding
  • Birth plan with their midwife- where would they like to give birth, pain relief
  • taught to recognise active labour and what to do
  • Info about looking after baby
  • Vit k prophylaxis after delivery
  • Newborn screenign tests
  • Postnatal self-care
  • Awareness of baby blues and post-natal depression
  • Risk assessment
22
Q

How do you record everything as a healthcare professional for maternity care?

A

Structured maternity records
Standardised, national maternity record with an agreed minimum data set should be developed and used–> help healthcare professionals to provide the recommended evidence- based care to pregnancy women

23
Q

When do you have scans?

A

Booking scan- between 11+ 2 and 13+ 6 weeks
20 week scan
Not routinely use scan after 24 weeks only in some cases e.g.

  • Low lying placenta at 20 weeks, will have a repeat scan at 32 weeks
  • Suspected malpresentation on clinical examination
  • From 42 weeks women who decline induction of labour should be offered USS estimation of max amniotic pool depth
    *
24
Q

What do you offer if pregnancy is continuing after 41 weeks?

A

Offer membrane sweep- released prostagladins–> encourage labour
IOL beyond 41 weeks
If IOL declined at or > 42 weeks- increased surveillance - CTG and USS

25
Q

What do you do if there is a breech presentation at term?

A

After 36 weeks: ECV- external cephalic version- 50-60% successful
95% of babys stay in this position until delivered t

26
Q

Advice to healthy woman with nausea and vomiting in pregnancy?

A

Natural remedies: ginger and acupuncture on ‘p6’ point (wrist)

Antihistamines: promethazine first line

27
Q

Advice to healthy pregnancy woman RE vitamin D?

A

Importance of vit D during pregnancy and whilst breastfeeding.

10micrograms of Vit D recommended

Particular care should be taken with at risk women (e.g. Asian, obese, poor diet)

28
Q

What conditions should screening be available for pregnant women?

A

Anaemia
Bacteriuria
Blood group, Rhesus status and anti red cell antibodies
Down’s syndrome
Fetal anomalies
Hep B
HIV
Neural tube defects
RF for pre-eclampsia

DEPENDING ON HISTORY, the following should be offered:

Placenta Praevia
Psych illness
Sickle cell disease
Tay Sachs disease
Thalassaemia

29
Q

What are the results of combined screening for Down’s syndrome?

A
  • Increased hCG
  • Decreased PAPP-A
  • Thickened Nuchal translucency

N.B Edwards and Patau give sinilar result but hCG isn’t as high

29
Q

What are the results of combined screening for Down’s syndrome?

A
  • Increased hCG
  • Decreased PAPP-A
  • Thickened Nuchal translucency

N.B Edwards and Patau give sinilar result but hCG isn’t as high

30
Q

Down’s syndrome results in Quadruple test?

A
  • Low AFP
  • Low unconjugated oestriol
  • High hCG
  • High inhibin A
31
Q

Edward’s syndrome results in quadruple test?

A
  • Low AFP
  • Low unconjugated oestriol
  • Low hCG
  • Inhibin A- either or
32
Q

Neural tube defect results in quadruple test?

A
  • High AFP
  • Uncojugated oestriol- high or low
  • hCG- high or low
  • Inhibin A- high or low

YEAR 4 REPRO (26 decks)

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