Obs/gyn Term Stage 3

Front 1

What are the anatomical changes to the uterus during preg?

Back 1

o Enlarges in size to accompany growing fetus (changes from ~100 g in non-
pregnant to ~1100 g in pregnant not including the weight of fetus)
o Myometrial hypertrophy (due to progesterone; occurs up to 20 weeks) and
hyperplasia (due to progesterone)
o Blood vessel hypertrophy
o Increases in capacity (from 4ml to 4L)
o Becomes progressively softer due to increased vascularity and presence of
amniotic fluid

Front 2

What are the anatomical changes to the cervix during preg?

Back 2

o Softens and swell (due to oestradiol)
o Ripening of cervix (due to PGs and collagenase --> makes cervix easier to
dilate) – occurs late in pregnancy
o Mucous plug formation (due to progesterone)
o Increase rate of ectropions

Front 3

What are the anatomical changes to the vagina during preg?

Back 3

o Mucosa thickens, muscles hypertrophy, connective tissue alters composition
– dilates more easily (due to oestradiol)
o Increased vaginal discharge due to increased desquamation of superficial
mucosal cells and increased vascularity

Front 4

What are the anatomical changes to the vulva during preg?

Back 4

o Becomes soft
o Becomes violet in colour
o Increased oedema

Front 5

What are the anatomical changes to the ovaries during preg?

Back 5

o Increase in size due to increased vascularity and oedema

Front 6

What are the anatomical changes to the cardiovascular system during preg?

Back 6

 Uterine enlargement causes diaphragmatic elevation --> may press on heart causing
rotation on long axis to L upward position, displacing the apex beat laterally (usually
to 4 th intercostals outside midclavicular line)
 Heart size increases ~10% (due to increase myocardial mass and intra-cardiac
volume)
 Hypertrophy of smooth muscle and decrease collagen content in blood vessels
 Varicose veins (due to increased venous congestion due to pelvic mass [baby])
 Increased volume of blood (approximately 30-50 % more than when non-pregnant)

Front 7

What are the anatomical changes to the resp system during preg?

Back 7

 Capillary and pulmonary vascular engorgement -->may lead to oedema in airways and
CXR changes (increased pulmonary vascular markings)
 Elevation of diaphragm and upward displacement of ribs (due to enlarging uterus)
leads to decrease in functional residual capacity by ~20% (even more when supine)
 Abdominal muscles have decrease ton and activity during pregnancy --> means more
diaphragm/intercostal dependent respiration

Front 8

What are the anatomical changes to the renal system during preg?

Back 8

 Renal longitudinal length can increase by ~1-1.5 cm
 Renal calyces, pelvis and ureters can all dilate and elongate (increase risk of UTI)

Front 9

What are the anatomical changes to the GIT during preg?

Back 9

 Stomach pushed upward as uterus grows
 Small bowel pushed upwards and laterally
 Appendix displaced superior in R flank area

Front 10

What are the anatomical changes to the skin during preg?

Back 10

 Hyperpigmentation of the skin around central face (cholasma; butterfly
pigmentation on cheeks and nose), nipples, areola, perineum, and between
umbilicus and pubic symphysis (linea nigra). Also increased pigmentation in axilla,
vulva and recent scars
 Striae gravidarum (stretch marks): redish slightly depressed streaks appear in the
abdomen, and sometimes in breasts and thighs. Due to mechanical stretching, or
increased cortisol release resulting in rupture of elastic fibres in the dermis and
exposing vascular subcutaneous tissue.
 Spider naevi
 Palmar erythema
 Nails changes (become more brittle)
 Thickening of hair and general hirsuitism

Front 11

What are the anatomical changes to breast during preg?

Back 11

 Increase in total size of breast, along with tenderness
 Increased nodularity (as a result of hypertrophy of mammary alveoli)
 Increased vascularity
 Primary areola becomes pigmented
 Increased duct development within breast
 Increase in nipple size, as well as becoming more pigmented and more erectile
 Increased appearance of montgomery’s follicles(sebaceous glands)
 Colostrum may be expressed
 Secondary areola may develop around primary areola at 5 th month

Front 12

What are the anatomical changes to the endocrine system during preg?

Back 12

 Increase in size of thyroid

 Average weight gain 10-14 kg
o ~65% of this gain due to maternal tissues (e.g. breast, fat, blood and uterine
tissue)
o ~35% due to fetus, placenta and amniotic fluid
o May have oedema/water retention

Front 13

What are the anatomical changes to MSK during preg?

Back 13

 Increased laxity of ligaments
 Widening and increased mobility of pubis and sacro-iliac joints
 Due to enlarging fetus, mother may have compensatory increase in lumbar lordosis

Front 14

What are the physiological changes to cardiovascular system during preg?

Back 14

 In first 10 weeks cardiac output increases from 5L/min to 6.5-7L/min (increase of 30-
40%). Due to :
o increasing stroke volume (increase of 10%)
o increasing pulse rate (by ~15 beats/min)

 Peripheral resistance falls (due to progesterone)
 Blood pressure (especially diastolic) falls during 2 nd trimester by ~10-20mmHg, then
rises to non-pregnant levels by term
 Increased venous distension and raised venous pressure (due to pelvic mass/baby)

Front 15

What are the physiological changes to the resp system during preg?

Back 15

 Ventilation increases 40%
o Tidal volume increases from 500 to 700 mL

 Functional residual capacity decreases by ~20% and total lung capacity decreases by
~5% (due to elevated diaphragm)
 O2 consumption increases by 20%
 Deeper breathing and increased respiratory rate (due to progesterone)
 Maternal PaCO2 setpoint is calibrated lower to allow fetus to offload CO2

Front 16

What are the physiological changes to the haem system during preg?

Back 16

 From 10 weeks pregnancy, plasma volume increases by ~50% until 32 weeks

 Red cell volume increases from ~1.4L to 1.8L (increase of ~18%)
o Therefore as red cells to not increase as much as plasma volume, get a
dilutional anaemia

 WCC and platelets increase

 ESR, cholesterol, beta-globulins, and fibrinogen are all raised

 Albumin and gamma-globulins decrease

 Urea and creatinine fall

 Increase number of venous thromboembolic events
o Due to increase level of fibrinogen, as well as increased factors VI,VII,IX,X

Front 17

What are the physiological changes to the endocrine system during preg?

Back 17

 Increased progesterone (from corpus luteum until 35 days post conception, and
from placenta therafter)
o Decreases smooth muscle excitability e.g. gut, ureters, uterus
o Raises body temperature

 Increased oestrogen (from placenta, and small amount from ovaries)
o Increases breast and nipple growth
o Water retention
o Protein synthesis

 Increased hCG
o Causes corpus luteum to increase progesterone release
o Detectable from ~9 days post conception to ~20 weeks pregnancy

 Increase human placental lactogen or human chorionic somatomammotrophin
o Produced by placenta and ensure constant nutrient supply to fetus
o Increases levels of free fatty acids
o Acts as insulin antagonist to increase insulin and protein synthesis

 Thyroid
o Enlarges in size due to increased colloid production
o Thyroid binding globulin and T4 output increase to maintain free T4 levels
o TSH may be suppressed in first trimester (as hCG mimics TSH and can lead to
negative feedback)

 Increased levels of prolactin secretion

 Increased cortisol output

Front 18

What are the physiological changes to genitals during preg?

Back 18

 Increase in size of uterus
 Increased rate of cervical ectropion (endocervis protrudes through external os and
undergoes squamous metaplasia to transform from columnar to squamous
epithelium)
 Cervical collagen decreases in late pregnancy (allows easier stretching)
 Increase in vaginal discharge (due to cell desquamation and increased mucous
production)

Front 19

What are the physiological changes to the GIT during preg?

Back 19

 Nausea and vomiting (occurs in ~70% of pregnancy and occurs up to 16 weeks)
o Can be caused by increased oestrogen, increased progesterone, increased
hCG, and decreased BSL

 Increased rate of reflux
o Due to reduced gut motility and reduced gastro-oesophageal sphincter
tone --> both due to increase in progesterone

 Increased rate of constipation
o Due to decreased gut motility, increased H2O reabsorption from the gut, as
well as pressure from enlarged uterus

 Increased haemorrhoids (due to venous congestion caused by pelvic mass)

 Gall bladder dilates, empties less completely (due to hypotonia of smooth muscle
due to progesterone)can lead to bile stasis causing increased risk of gallstones

 Increase in appetite and salivation

 Change in taste due to reduced sensitivity of taste buds. Leads to cravings/desires
for certain foods.

Front 20

What are the physiological changes to the renal system during preg?

Back 20

 Increased frequency of micturition
o GFR increases by ~50-60% in early pregnancy
o In late pregnancy, fetus and uterus may compress bladder

 Serum creatinine and urea decrease by ~25%

 Progesterone and compression/hypotonia (due to progesterone) of ureter cause
dilatation of collecting system

 Increased rate of incontinence
o Relaxation of internal sphincter (due to progesterone), as well as
compression of bladder by fetus and uterus

 Note that proteinuria is ABNORMAL in pregnancy

Front 21

What are the physiological changes to the MSK system during preg?

Back 21

 The hormone relaxin causes an increase in ligatment laxity (to allow for growing
fetus/uterus)

Front 22

What are the physiological changes to the skin during preg?

Back 22

 Hyperpigmentation of umbilicus, nipples, perineum, linea nigra, and face (chloasma)
due to increase in oestrogen
 Spider naevi and palmar erythema --> due to increase oestrogen and hyperdynamic
circulation

Front 23

What are the nutritional changes during preg?

Back 23

 Increase in calorie intake by ~300kCal/day
 Increase in weight ~10-14 kg throughout pregnancy
 Increased nutritional requirements of protein, calcium, iron and folate

Front 24

Describe the urine/home beta HCG test used to confirm preg

Back 24

Urine/Home beta hCG test
 Is a qualitative test (therefore positive or negative result) that detects the presence
the beta subunit of hCG in urine. Measure beta subunit as the alpha subunit is also
present on LH, FSH and TSH.
 Urine hCG levels are lower than blood/serum levels
 Becomes positive from ~9 days post conception
 hCG levels approximately double every 48 hours
 Is positive til approximately 20weeks pregnancy, with a peak level at approximately
12 weeks
 Remain positive for ~5 days following miscarriage or fetal death. Otherwise false
positive rate is low
 Urine HCG tests ~97% accurate
 May have false negative (e.g. if test taken too early). If patient still suspects they are
pregnant, and have a negative result, should repeat test a few days later. Other
causes of false negatives include very dilute urine, certain medications (e.g. diuretics,
promethazine)

Front 25

Describe the serum beta HCG test used to confirm preg

Back 25

 Is a quantitative test that detects presence of the beta subunit of hCG in the blood
 Higher levels of hCG in blood than urine
 Test is ~99% accurate
 Similar timing, i.e. positive from ~9 days post conception, peaking at ~12 weeks after
doubling time every 48 hours.
 Ectopic pregnancies usually have longer doubling time, and those with failing
pregnancies will also have longer doubling time or falling hCG.

Front 26

Describe how ultrasound is used to confirm preg

Back 26

 Transvaginal U/S can detect gestational sac @ 5-6 weeks, and a foetal heart by 6-8
weeks
 Doppler U/S can detect audible foetal heart sounds @12 weeks.

Front 27

What are the most common trisomies among live births?

Back 27

The most common trisomies amongst live births are;
 Trisomy 21  Down syndrome
 Trisomy 18 Edwards syndrome
 Trisomy 13  Patau syndrome

Front 28

Are Trisomy 21, 18 and 13 sex-linked or autosomal?

Back 28

autosomal

Front 29

What are the sex-linked trisomies?

Back 29

 Triple X syndrome (XXX)
 Klinefelter’s syndrome (XXY)

Front 30

What are the rates of Down Syndrome by foetal age?

Back 30

The risk of foetal chromosomal abnormalities increases with increasing maternal age.
MATERNAL AGE (YEARS), RATES OF DOWN SYNDROME
20 1:1500
30 1:800
35 1:270
40 1:100
>45 1:50

Front 31

How many babies are born with Down Syndrome in NSW?

Back 31

Currently Down Syndrome affects 1 in 700 babies born in NSW.

Front 32

What is the triple test used for testing the common trisomies? Is there a risk to fetus?

Back 32

The triple test screens for these common trisomies. It involves;
1. Maternal serum PAPP-A
2. Maternal serum beta hCG
3. Nuchal translucency ultrasound
NB: No risk to the foetus from any of these tests

Front 33

Is the triple test diagnostic for Down Syndrome?

Back 33

The triple test is a screening test and thus only provides an odds ratio of having a baby with
Down Syndrome. It does NOT diagnose the foetus with Down Syndrome or any other
chromosomal abnormalities. In contrast, both chorionic villus sampling (CVS) and
amniocentesis are definitive diagnostic tests.

Front 34

What tests are diagnostic for preg?

Back 34

both chorionic villus sampling (CVS) and
amniocentesis are definitive diagnostic tests.

Front 35

Are nuchal translucency US and triple test part of routine antenatal screening?

Back 35

Nuchal translucency ultrasound and the triple test is NOT part of routine antenatal
screening.

Front 36

How should a woman be counselled before nuchal translucency US and triple test are considered?

Back 36

 Practicalities of what the blood test and ultrasound involve
 The purpose of testing i.e. detecting of risk of chromosomal abnormalities including
Down Syndrome
 Implications of an increased risk result including further testing with either CVS or
amniocentesis for a definitive diagnosis. The risks of these tests including
miscarriage must be discussed. (See 1.5)
 Consideration on how a diagnosis of Down Syndrome would affect continuation of
the pregnancy. Would they consider termination?
 Do even they want to know?

Front 37

Describe the tests for PAPP-A and beta hCG

Back 37

 Maternal serum blood test at 10 weeks

 PAPP-A = pregnancy associated plasma protein
o Decreased PAPP-A associated with Down Syndrome

 Beta hCG = protein produced by placenta trophoblastic cells to maintain the corpus
leutem
o Increase beta hCG associated with Down Syndrome

Front 38

Describe nuchal translucency US screening

Back 38

 Performed between 11.3 – 14 weeks gestation (Ideally 12 weeks)
 Usually through the abdominal wall but rarely transvaginal ultrasound is necessary
 Measures Nuchal Translucency = amount of fluid in the skin at the back of the babies
neck

Front 39

How does nuchal thickness correlate with Down Syndrome risk

Back 39

NUCHAL THICKNESS, INCREASED RISK OF DOWN SYNDROME
3MM X 3 FOLD
4MM X 18 FOLD
5MM X 28 FOLD
6MM X 36 FOLD

Front 40

Other than nuchal translucency, what else does this US test?

Back 40

 Presence of foetal heart beat
 Single or multiple pregnancy
 Accurate estimation of EDC
 Some structural abnormalities

Front 41

How is Down Syndrome risk determined?

Back 41

The risk is calculated by combining the results of the blood tests with the ultrasound scan
results. An increased risk of Down Syndrome is associated with;
 Decreased PAPP-A
 Increased beta hCG
 Increased Nuchal Translucency
An increased risk is defined as a risk between 1:2 and 1:200. This triple test identifies 90% of
pregnancies in which the baby has Down’s syndrome as increased risk.

Front 42

What are a few noteworthy facts to counsel women about Down Syndrome screening

Back 42

 An increased risk of 1:200 translates to 0.5% chance the baby will have Down
syndrome and 99.5% chance they will not!

 1 in 20 women have an increased risk result but most of these pregnancies do NOT
have Down Syndrome

 A low risk does not mean there is NO risk!

 5% false positive rate --> 1 in 20 women unnecessarily undergo further invasive
testing
If the result is found to be increased risk further testing can be offered;

 CVS or amniocentesis as definite diagnostic tests

 18 week morphology scan (Detects 40% of Down syndrome)
o Part of routine screening!

Front 43

What is aneuploidy?

Back 43

an abnormal number of chromosomes

Front 44

What does amniocentesis test for?

Back 44

aneuploidy and neural tube defects

Front 45

What are indications for diagnostic testing in a preg woman?

Back 45

 Maternal age > 35 years

 Risk factors in current pregnancy
o Abnormal U/S
o Abnormal Triple Test (incl. Nuchal Translucency Ultrasound)
o Teratogen exposure

 Past history/family history
o Previous pregnancy with chromosomal abnormality
o Family hx of chromosomal anomaly, genetic disorder, birth defect or
undiagnosed mental retardation
o Either parent a known carrier of a genetic disorder or balanced translocation
o Consanguinity
o 3+ spontaneous abortions

 Particularly anxious about the risk of chromosomal abnormality

Front 46

Compare CVS outcomes with amniocentesis

Back 46

CVS, Amniocentesis:
Accuracy of prenatal
cytogenetic diagnosis
97.5% 99.8%
Detection of cytogenetic
abnormality
5.6% 3.4%
Laboratory failure 2.3% 0.1%
Risk of spontaneous abortion 1-2% 0.5%

Front 47

What is CVS used for?

Back 47

 = Placental biopsy
 Testing for Chromosomal and DNA
abnormalities

Front 48

When is CVS performed?

Back 48

Performed at 11-12 weeks ideally but may be
carried out up to 20 weeks

Front 49

How is CVS performed?

Back 49

 Usually performed trans-abdominally but may
be performed trans-vaginally if placenta is in
the lower uterine segment and difficult to
access
 Skin is injected with a local anaesthetic and a
fine needle is guided with ultrasound to
obtain biopsy

Front 50

What does CVS also test other than chromosomal and DNA abnormalities?

Back 50

The scan also assesses
o Foetal heart beat
o Placenta location
o Multiple pregnancies
o Major structural abnormalities of the foetus

Front 51

What are some side effects to the CVS test?

Back 51

 After the test may experience period-like cramps, lower abdominal pains or even leg
pains.
 Some patients also have some vaginal spotting

Front 52

How many biopsies are required for CVS? What happens if pt is Rh -ve

Back 52

 Sometimes >1 biopsy required
 If Rh negative will require Anti-D injection

Front 53

What are the advantages of CVS over amnio?

Back 53

o Enables pregnancy to be terminated earlier than with amniocentesis
o If cells fail to grow rapidly or results are uncertain, amniocentesis is still
available for definitive diagnosis
o Rapid results are available within 48 hours via fast FISH analysis(See below
for explanation)

Front 54

What are the disadvantages of CVS vs amnio?

Back 54

o Does not test for neural tube defects

o 1-2% risk of miscarriage due to infection or bleeding
 Miscarriage most likely between 24hrs and 7 days after test
 Warning signs include regular cramps and fresh red vaginal bleeding

o Risk of foetal limb injury

o 1-2% incidence of genetic mosaicism --> false negative results

Front 55

When is amniocentesis performed?

Back 55

Performed at 15-16 weeks gestation

Front 56

What is amniocentesis used to assess?

Back 56

 Detects Chromosomal and DNA
abnormalities (same as CVS) and
also open neural tube defects

 Amniocentesis can also be used in;
o Assessment of foetal lung maturity via Lecithin: Sphingomyelin ration (L/S
ratio). If >2:1 respiratory distress syndrome less likely to occur.
o Assessment of amniotic fluid bilirubin concentrations in Rh isoimmunised
pregnancies

Front 57

What is amniocentesis?

Back 57

U/S guided trans-abdominal
extraction of amniotic fluid

Front 58

What are the advantages of amniocentesis over CVS?

Back 58

o Also screens for open neural tube defects
o More accurate genetic testing than CVS
o In women > 35 years, risk of chromosomal anomaly is greater than the risk of
miscarriage from the procedure

Front 59

What are the disadvantages of amnio vs CVS?

Back 59

o 0.5% additional risk of miscarriage (Important to note the risk of spontaneous
abortion at this stage of pregnancy is 1%)
o Risk of foetal limb injury
o 0.5% have some leakage of amniotic fluid through the vagina in the 24-48
hours after the procedure
o Results take 14-28 days as cells must be cultured (See below for explanation)

Front 60

How long does it take for the results of amnio and CVS?

Back 60

 3 weeks for complete results for both CVS and Amniocentesis
 1-2 days for preliminary results in CVS (fast FISH)

Front 61

What is the standard GTG-banded chromosome analysis?

Back 61

 Standard GTG-banded chromosome analysis (karyotype) provides results in 3 weeks
o Cells are cultured for 5-8days and arrested at metaphase
o Cells are stained and the chromosome analysed down the microscope to
examine the number and morphology of each chromosome
o Insertions, deletions and translocations can be detected

Front 62

What is the fast FISH analysis?

Back 62

Fast FISH provides results in 1-2days (Only available in CVS)
o Detects the most common chromosome abnormalities of chromosomes 21,
18, 13, X and Y only
o These account for 85% of chromosomal abnormalities associated with
increased maternal aged and increased risk triple test (nuchal translucency
and maternal serum screening)
o In 1% of families polymorphisms in chromosomes give rise to false positives.
These will have a normal final karyotype patterns
o Cells do not need to be cultured so test can be done faster.
o Fluorescent tags of DNA are applied to the sample to show the specific
number of chromosomes in the cell

Front 63

What are the symptoms of early pregnancy?

Back 63

 Amenorrheoa

 Nausea and vomiting (morning sickness)
o Nausea occurs in ~80% of pregnancies
o Vomiting occurs in ~50% of pregnancies
o Usually begins at ~4 weeks and lasts until ~16 weeks

 Breasts
o Increase in size and engorge
o Increased tenderness or experience of tingling
o Nipples enlarge (and at 12 weeks begin to darken)
o Increased vascularity
o Montgomerys tubercles become more prominent (sebaceous glands in the
areola/nipple; looks like round bumps in areola)
o May develop secondary areola (encircles primary areola)although usually
occurs ~5 months

 Increase in frequency of micturition

 Constipation and reflux

 Fatigue

 May have reported positive home pregnancy test

Front 64

What are the signs of early preg?

Back 64

 Blue/violet colour of cervix, vagina and vulva (Chadwicks sign)
 Softening of cervix at 4 weeks (Goodell’s sign)
 Softening of uterus at 6 weeks (Ladin’s sign)
 Basal body temperature rises
 Abdominal enlargement
 Breast swelling
 Hyper-pigmentation of skin
 Telangiectasias
 Palmar erythema and spider naevi

Front 65

What is Chadwick's sign?

Back 65

blue/violet colour of cervix, vagina and vulva

Front 66

What is Goodell's sign?

Back 66

softening of cervix at 4 weeks

Front 67

What is Ladin's Sign?

Back 67

Softening of uterus at 6 weeks

Front 68

What are important qs to ask in a booking hx?

Back 68

 Maternal age: extremes of maternal age are high risk
o Nullip <20: increased risk of pre-eclampsia, IUGR, maternal malnutrition
o Nullip >34, or any mother >40: increased risk of pre-eclampsia, GDM, obesity,
chromosomal abnormality, lower segment caesarean section, placenta
previa

 Modality of conception
o IVF or any other assisted reproductive technology: increases risk of multiple
gestation, preterm delivery, and low-birth weight

 Present pregnancy history
o Symptoms (discussed in 1.6)
o Ideas of childbearing and parenting. See if parent is coping with being
pregnant
o Effect of pregnancy on woman
o Last menstrual period --> use to calculate estimated date of confinement
o Any testing to date(e.g. home pregnancy test, blood hCG test, U/S)

 Previous obstetric history
o Previous pregnancies
 Number of past pregnancies
 Length of gestation
 Previous birth weights
 Foetal outcomes
 Length of labour
 Foetal presentation
 Type of delivery: e.g. LSCS, instrument (ventouse, forceps), normal
vaginal delivery, induction of labour, episiotomy. Increase risk in
future pregnancies if instrument delivery.
 Complications e.g. retained placenta, PPH, placental abruption, need
for pelvic floor repair
 Where had last pregnancy
o Any infertility problems
o Previous LSCS (increased risk in future pregnancies)
o Recurrent miscarriages (e.g. 3+ consecutive miscarriages) or stillbirth death
suggests chromosomal or cytogenetic abnormality that requires further
investigation
o Previous abortions
o Previous preterm births
o Rhesus isoimmunisation or ABO incompatibility
o Previous pre-eclampsia or gestational diabetes
o Teratogen exposure in previous pregnancies
 Drugs: e.g. alcohol, anti-epileptics, lithium, warfarin
 Infections: toxo, rubella, CMV, herpes, varicella, listeria, mycoplasma,
syphilis
 Radiation

 Medical/surgical history
o Increased risk if obese (especially if BMI>35)
o Chronic infections such as Hep B and HIV
o Diabetes
o HTN
o Cardiac disease
o Thyroid disease
o Rhesus status/rhesus antibodies

 Past psyhicatric history, including history of mood or psychotic disorders

 Allergies

 Family history
o CF, thalassaemia etc

 Social history:
o support networks for mother and child
o High risk if poor social situation
o Smoking and alcohol history. Illicit drug use

Front 69

What else can be done at a booking history visit?

Back 69

As this booking history is often at the first antenatal visit, it is an opportunity to educate the
mother with regards to nutrition and diet, exercise, what to expect throughout the
pregnancy, future antenatal appointments/scans (including nuchal translucency, fetal
anomaly scan) and any antenatal classes she may wish to attend. Also depending on
gestational age, may be appropriate to begin fetal assessment (e.g. fetal heart rate,
measurements such as fundal height, and maternal BP). Patient will get a ‘yellow card’ with
will record relevant information.

Front 70

When are routine antenatal checkups done?

Back 70

 Until 28 weeks – every 4-6 weeks
 28-36 weeks – every 2 weeks
 36 weeks --> delivery – every week