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43 Cards in this Set

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  • Back
When a woman presents for her first consultation in pregnancy, what are the first steps that need to be taken?
- 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.
If a woman chooses public obstetric care, what are her options for her care?
- Midwifery care.
- Obstetrician/Medical Officer.
- Shared Antenatal Care (SANC).
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?
- Advice.
- Pap smear recommendations.
- Rubella +/- Varicella serology and Blood Group.
- Written information.
What advice needs to be given at a pre-conception consultation?
- 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).
What needs to be measured each visit during antenatal care?
- Blood pressure.
- Fetal heart sounds.
- Position.
- Liquor volume.
- Oedema.
- Foetal growth.
- Foetal movement.
- ?Weight.
What investigations are often done during antenatal care?
- 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
Serology of what infectious agents is done during antenatal care?
- Rubella.
- Syphilis.
- HIV.
- Hep B.
- Hep C.
Routine morphology scan is done at how many weeks?
18-20 weeks.
A routine glucose test is done at how many weeks?
26 weeks.
What needs to be done at first antenatal contact with a GP?
- 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.
At around what week is triple testing done?
15-20 weeks.
At around what week is morphology scanning done?
18-20 weeks.
What are the predominant first-trimester concerns of the expectant mother in antenatal care?
- 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.
Obstetrician review typically happens at how many weeks?
16 weeks.
SANC - The second antenatal visit typically occurs at....
12 and 14 weeks for the book-in visit at the hospital.
The second visit to the GP occurs at...
18-20 weeks.
The second visit to the GP occurs at 18-20 weeks, timed closely to...
The morphology scan to allow for prompt referral to a maternal fetal medicine or specialist obstetrician if required.
If the placental position is lying low during the morphology scan, then..
A further scan for placental position at 34 weeks gestation needs to be ordered.
By 18-20 weeks, the woman may well have noticed...
Foetal movement.
By 18-20 weeks, the uterus is generally at the level of....
The umbilicus.
Clinical measurements at 18-20 weeks include...
- BP.
- Foetal heart sounds.
- Uterine Size.
- Review triple test result if taken and action as appropriate.
At the third SANC visit at 24 weeks, the routine AN assessment comprises what?
- 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.
What routine bloods need to be taken at 24 weeks?
- FBC.
- Antibody screen.
- Gestational diabetes screen.
What are some of the more important second trimester concerns?
- 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.
The 4th visit at 28 weeks: What is the routine AN assessment?
- BP.
- Oedema.
- Foetal heart.
- Liquor volume.
- Fundal height.
- Fetal growth and wellbeing.
- Review and document results of bloods and take action if abnormal.
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.
When is the 4th visit usually at?
28 weeks.
When is the 5th visit usually at?
31 weeks.
When is the 6th visit usually at?
34 weeks.
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.
The sixth visit at 34 weeks:
What additional investigation is to be done that was not done at the 5th visit?
Organise FBC.
The sixth visit at 34 weeks:
If morphology scan results in low lying placenta, what should be done first?
Repeat ultrasound scan.
When is the 7th visit?
38 weeks.
When is the 8th and final visit?
40 weeks.
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.
What do you need to remind your patient to do if she does not go into spontaneous labour by 41 weeks?
She will need to book a visit with the AN clinic.
What are the third trimester concerns of antenatal care?
- Hypertension.
- Pre Eclampsia.
- Unstable lie or breech presentation.
- Abnormal growth.
- Back or abdominal pain.
- Haemorrhoids and/or varicosities.
- Anaemia.
- Placenta praevia.
Routine neonatal examination occurs around _____ after the birth.
5-10 days.
At the routine neonatal examination, what needs to be done?
- 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.
What structures and physiological/pathological processes would you look for on the neonatal examination?
- 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.
What are some post-partum concerns?
- Kernicterus.
- Abnormal clinical examination.
- Difficulty breast feeding.
- Haemorrhage.
When is the second neonatal examination?
6 weeks after birth.
What are the main postpartum concerns?
- Abnormal clinical examination.
- Difficulty breast feeding.
- Haemorrhage.
- Postpartum depression.
- Postpartum psychosis.
- Altered self image.
- Dyspareunia.