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43 Cards in this Set
- Front
- Back
When a woman presents for her first consultation in pregnancy, what are the first steps that need to be taken?
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- Ensure she really is pregnant (a positive home pregnancy test isn't enough).
- Accurately date the pregnancy as many of your next steps depend on dates. - Establish if she's going to be private or public. Refer to an obstetrician if private. - Organise Antenatal Screen. - Discuss and refer for a Nuchal Translucency Scan if consent for the latter is obtained. |
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If a woman chooses public obstetric care, what are her options for her care?
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- Midwifery care.
- Obstetrician/Medical Officer. - Shared Antenatal Care (SANC). |
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Antenatal care begins with a preconception consultation, allowing important advice to be given and relevant investigations to have been done prior to conception. What are the main things done at the pre-conception consultation?
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- Advice.
- Pap smear recommendations. - Rubella +/- Varicella serology and Blood Group. - Written information. |
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What advice needs to be given at a pre-conception consultation?
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- Folic acid and diet.
- Timing of conception. - Drug use before and after conception. - Alcohol and tobacco use. - NHMRC recommendations on immunisations (i.e. Pertussis). - Occupational advice (e.g. Day Care workers and Parvovirus). |
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What needs to be measured each visit during antenatal care?
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- Blood pressure.
- Fetal heart sounds. - Position. - Liquor volume. - Oedema. - Foetal growth. - Foetal movement. - ?Weight. |
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What investigations are often done during antenatal care?
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- FBC.
- Blood group and antibody screen. - Rubella serology. - Syphilis serology. - HIV serology. - Hep B serology. - Hep C serology. - Urine M/C/S. - Pap smear. - First or second trimester screening e.g. Nuchal Translucent Scan with PAPP A & HCG, Triple Test. - High-risk screening with Amniocentesis or CVS available. - Routine morphology scan at 18-20 weeks. - Routine glucose challenge test at 26 weeks. - Anti-D prophylaxis. - High risk US/S availab.e |
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Serology of what infectious agents is done during antenatal care?
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- Rubella.
- Syphilis. - HIV. - Hep B. - Hep C. |
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Routine morphology scan is done at how many weeks?
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18-20 weeks.
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A routine glucose test is done at how many weeks?
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26 weeks.
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What needs to be done at first antenatal contact with a GP?
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- Medical and obstetric history.
- Measure BP, record weight and height and calculate BMI. - Discuss antenatal screening and testing options, including Down syndrome screening with all women irrespective of maternal age. - Order 1st trimester combined screen (Nuchal translucency + PAPP A, HCG) if requested at 11+0 to 13+6 weeks. - Order dating scan if requested serum screening for Down syndrome (triple test done at 15-20 weeks) and presents too late for 1st trimester combined screening. - Discuss and provide referral for the 18-20 week morphology scan. - Obtain MSU for microscopy and culture. Obtain routine bloods after discussion and informed consent (FBE, blood group and antibodies, Rubella antibody titre, Hep B/C HIV, syphilis). - Perform pap smear if due. - Discuss available models for care. - Known Rh(D) negative women - discuss antenatal anti-D prophylaxis and the importance of seeking advice following any potentially sensitising events. - Refer to hospital. - General Advice. |
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At around what week is triple testing done?
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15-20 weeks.
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At around what week is morphology scanning done?
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18-20 weeks.
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What are the predominant first-trimester concerns of the expectant mother in antenatal care?
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- Morning sickness - hyperemesis.
- PV spotting - ectopic, threatened miscarriage or miscarriage (complete or incomplete). - Abnormal results - thalassaemia, anaemia, positive infection screen, negative Rubella serology. - Positive NTS. |
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Obstetrician review typically happens at how many weeks?
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16 weeks.
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SANC - The second antenatal visit typically occurs at....
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12 and 14 weeks for the book-in visit at the hospital.
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The second visit to the GP occurs at...
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18-20 weeks.
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The second visit to the GP occurs at 18-20 weeks, timed closely to...
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The morphology scan to allow for prompt referral to a maternal fetal medicine or specialist obstetrician if required.
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If the placental position is lying low during the morphology scan, then..
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A further scan for placental position at 34 weeks gestation needs to be ordered.
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By 18-20 weeks, the woman may well have noticed...
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Foetal movement.
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By 18-20 weeks, the uterus is generally at the level of....
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The umbilicus.
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Clinical measurements at 18-20 weeks include...
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- BP.
- Foetal heart sounds. - Uterine Size. - Review triple test result if taken and action as appropriate. |
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At the third SANC visit at 24 weeks, the routine AN assessment comprises what?
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- BP.
- Oedema. - Foetal heart sounds. - Liquor volume. - Assessment of fundal height to measure foetal growth. - Reassess planned care and identify women who need additional care. (i.e. extra GP or obstetric visits, physiotherapy, social worker review). - Organise routine bloods (FBC, antibody screen, Gestational diabetes screen). - Arrange for prophylactic anti-D if required. - Document in hand held and medical record. |
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What routine bloods need to be taken at 24 weeks?
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- FBC.
- Antibody screen. - Gestational diabetes screen. |
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What are some of the more important second trimester concerns?
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- Abnormal triple test.
- Abnormal morphology scan (?Will need repeating in or referral to a tertiary centre). - Hyperemesis. - Intra-Uterine Foetal Death (IUFD). - Abnormal/Positive Diabetes Screen. |
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The 4th visit at 28 weeks: What is the routine AN assessment?
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- BP.
- Oedema. - Foetal heart. - Liquor volume. - Fundal height. - Fetal growth and wellbeing. - Review and document results of bloods and take action if abnormal. |
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The 4th visit at 28 weeks:
What do you do if the mother is Rh(d) negative? |
Ensure the antibody screen has been taken BEFORE offering administration of 625 IU Anti-D immunoglobulin intramuscularly.
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When is the 4th visit usually at?
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28 weeks.
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When is the 5th visit usually at?
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31 weeks.
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When is the 6th visit usually at?
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34 weeks.
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The sixth visit at 34 weeks:
If the woman is Rh(d) negative, what do you need to do? |
Recommend and administer 625 IU Anti-D immunoglobulin IM.
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The sixth visit at 34 weeks:
What additional investigation is to be done that was not done at the 5th visit? |
Organise FBC.
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The sixth visit at 34 weeks:
If morphology scan results in low lying placenta, what should be done first? |
Repeat ultrasound scan.
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When is the 7th visit?
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38 weeks.
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When is the 8th and final visit?
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40 weeks.
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The 7th (38 weeks) visit:
What needs to be discussed with the expectant mother? |
- Confirm understanding of signs of labour and indications for admission to hospital.
- Provide additional information as required. - Discuss preparations for breast feeding, arrangements for family/care for other children. |
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What do you need to remind your patient to do if she does not go into spontaneous labour by 41 weeks?
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She will need to book a visit with the AN clinic.
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What are the third trimester concerns of antenatal care?
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- IUFD.
- Hypertension. - Pre Eclampsia. - Unstable lie or breech presentation. - Abnormal growth. - Back or abdominal pain. - Haemorrhoids and/or varicosities. - Anaemia. - Placenta praevia. |
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Routine neonatal examination occurs around _____ after the birth.
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5-10 days.
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At the routine neonatal examination, what needs to be done?
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- Length.
- Head circumference. - Weight. - Check that neonatal screening test has been performed. - Check that hearing test has been performed. - Ensure Vitamin K and Hep B injections have been given. - Complete general neonatal examination. |
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What structures and physiological/pathological processes would you look for on the neonatal examination?
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- Jaundice.
- Eye and red reflex. - Face/ears. - Palate. - Fontanelles/sutures. - Cardiac and respiratory examination. - Abdomen. - Umbilicus. - Femoral pulses. - Genitalia. - Anus (meconium passed within 24 hours?) - Spine. - Limbs. - Tone. - Reflexes. - Hips. |
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What are some post-partum concerns?
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- Kernicterus.
- Abnormal clinical examination. - Difficulty breast feeding. - Haemorrhage. |
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When is the second neonatal examination?
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6 weeks after birth.
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What are the main postpartum concerns?
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- Abnormal clinical examination.
- Difficulty breast feeding. - Haemorrhage. - Postpartum depression. - Postpartum psychosis. - Altered self image. - Dyspareunia. |