Routine Antenatal Care + Iugr/sga

Front 1

components of Pre-Pregnancy Counselling (3)

Back 1

1. Routine screening

2. Mx of any abnormalities

3. Counselling

Front 2

aspects of pre-pregnancy counselling routine screening

Back 2

full Hx and Ex including genetic tracing of family, social Hx (drugs, alcohol, smoking)

check Pap smear, rubella Ab, varicella Ab are current; cervical abnormalities must be treated before pregnancy because latter causes increased vascularity

Front 3

medical conditions to avoid pregnancy in

Back 3

renal and heart dz including pHTN

(diabetics need to switch to insulin; epileptics may need to have Rx revised)

Front 4

pre-pregnancy counselling: counselling

Back 4

folate 0.5mg daily for 3m pre-conception; 5mg folate if previous Hx of neural tube defects

avoid xs EtOH, radiation, drugs in early embryonic period (including before missed period)

Hint 4

stop neural tube defects!

Front 5

First Antenatal Visit components (7)

Back 5

1. Confirm pregnancy
(serum beta-hCG b/c urine cross-reacts w/LH).

2. Establish gestational age.
(Naegele's or if uncertain menstrual period, do US --> crown-rump length 6-12w or neck width 12-20w. No good after 20w.)

3. Routine screening.

4. Assess and treat any relevant conditions.

5. Counselling.

6. Planning care.

7. General advice.

Front 6

First Antenatal Visit: Routine Screening

Back 6

Hx - complete (esp AGE!): obs/gyn, med/surg, Fam, Rx, Soc

Ex - weight, ht, urinalysis (protein and glc), general (incl BP, PR, thyroid, heart, abdo, pelvic)

Ix:

FBE (esp. MCV for thal), cross-match, HIV/Hep B/C, syphilis, rubella
- US at 12w (nuchal translucency) and 19w (major malformations, eg. neural tube defects, cardiac abnormalities, exomphalos)
- MSU MC&S for asymp bacteruria
- cervical cytology (if falls before 6w check)

Front 7

First Antenatal Visit: Counselling

Back 7

A. General:
diet (iron for vegetarians, Ca, vit D, vit, folate; avoid places that cause food poisoning, microwave all take-away thoroughly), avoid Listeria (shellfish, European soft cheese))

Be wary of pets (Toxoplasma).

Exercise, meds (Panadol ok), most women stop work by 32w,

Minor disorders of pregnancy.

B. Genetic:
Possibility of fetal abnormalities and relevant screening test to be discussed w/ALL women.

Front 8

Subsequent Antenatal Care: visit frequency

Back 8

every 4w until 28w

every 2w 28-36w

weekly >36w

Front 9

Subsequent Antenatal Care: hospital visits for shared care women

Back 9

1st visit, 28w, 36w, 40w, and any beyond

Front 10

Subsequent Antenatal Care: visit procedure

Back 10

Hx:
general well-being
fetal mvmts (after 18w)
edema

Ex:
- wt (?excessive wt gain)
- urinalysis (for protein & glc)
- BP
- abdo exam
- symphyseal-fundal height
- liqour, lie, presentation, and station
- auscultation of fetal heart

Ix:
28w - GTT or GCT, FBE, Rh ab (if Rh neg)
35w - GBS swab

Therapy:
28w - anti-D to non-immunised Rh-neg
35w - anti-D to non-immunised Rh-neg

Front 11

DDx for fundus LESS than dates

Back 11

wrong dates (verify w/US from first half of pregnancy)

small-for-dates

oligohydramnios (renal dz, PROM, placental insufficiency)

transverse lie

deeply engaged

Front 12

DDx for fundus LARGER than dates

Back 12

wrong dates

large-for-dates

polyhydramnios (xs urine in DM, anatomical - eg. esophageal atresia, neuro)

multiple gestation

uterine fibroids, ovarian cysts

Front 13

IUGR Mx

Back 13

confirm Dx

determine etiology

fetal karyotype only if IUGR is severe

fetal surveillance - clinical, scans, CTG

general measures - rest, delivery at appropriate time (never after 38w; earlier if fetal hypoxia)

Front 14

Mx of SGA after birth

Back 14

"warm, pink, sweet, inf'n"

- hypothermia from lack of SC fat and high SA to volume ratio
- respiratory care esp. w/meconium
- hypoglycemia from low sugar reserve and high energy consumption
- beware infection - SGA worsens already immature immune system

(also: polycythemia from in-utero hypoxia, hemorrhage from lack of liver enzymes, Mx of asphyxia)