Antenatal care of normal pregnancy

What is antenatal care for?

Detects early signs of complications followed by a timely intervention.

Educates pregnant women on topics like wellbeing, birth preparedness, complication readiness and breastfeeding.

How often do you have antenatal appointments throughout pregnancy, according to NICE?

Booking visit as early as possible.

- Every month from 16w.

- Every 2 weeks from 28w.

- Every week from 36w.

- See women in postnatal period.

What pathogens are of concern during pregnancy?

Varicella, CMV, Group B Strep, Hep B, Herpes, HIV

What questions do you think about with expecting mothers? (3)

Do they have any chronic conditions?

2. Any prev pregnancy complications?

3. Any FH or congenital abnormalities or inherited conditions?

What supplementations do expectant mothers need? (2)

1. Folic acid to reduce risk of neural tube (which closes by Day 28.) defects eg. spina bifida (400mcg daily or 5mg for high-risk groups)

2. Vitamin D - for bone mineralistion and for bowel to absorb phosphate and Ca2+. Deficiencies lead to rickets, osteomalacia and neonatal tetany.10 mcg daily, with additional supplementation for high-risk groups

Which high-risk groups need 5 mg of folic acid daily? (6)

Diabetes
2. BMI >30
3. Sickle cell disease
4. History of child with NTD or FH of NTD
5. Antiepileptic meds
6. Methotrexate

What is fortification?

Adding nutrients to food eg. folic acid to flour

What screening tests should be done before 10 weeks? (2)

Haemoglobinopathies:
1. Sickle-cell disease
2. Thalassaemia

What screening tests should be done around 8-10 weeks?

HIV
2. Hep B
3. Syphilis
4. Blood group and Rh status

What screening tests should be done around 11-14 weeks? (3)

Down's (Trisomy 21)
2. Edward's (Trisomy 18)
3. Patau's (Trisomy 13).

What is the difference between screening versus diagnostic tests?

No screening tests are perfect, and there will be true positives, negatives and same with the false.

How can you screen for blood group and Rh status?

Rh antigens are present on RBC, and 15% are Rh-ve. If she then carries a Rh+ve baby (from father), then she is given Anti-Rh Igs to mop up antigens and prevent a mounting response to any antigens she is exposed to. Without this, 16% of women can become sensitised and this can have profound consequences on future pregnancies

Screening vs Diagnostic Tests

Screening: Identifies risks (e.g., trisomies, Rhesus incompatibility).

Diagnostic: Confirms conditions (e.g., amniocentesis, chorionic villus sampling)..

types of Screening for Trisomies

• Combined Test: (10–14 weeks) Blood test + nuchal translucency ultrasound.

• Non-Invasive Prenatal Testing (NIPT):

  • Analyses cell-free DNA (10–20% from placenta).

  • Detectable at 7 weeks, cleared from circulation within 1 hour post-birth.

Screening for Rhesus Incompatibility: ??

15% of women are Rhesus negative; 40% of foetuses are also Rhesus negative.

Anti-D immunoglobulin prevents Rhesus disease (28 weeks and postpartum).

Single dose IM penicillin prevents what

congenital syphilis

Vaccination + HBV immunoglobulin reduces vertical transmission of what

Hep B

Pre-Eclampsia ?

• Affects 2–8% of pregnancies (hypertension + proteinuria after 20 weeks).

• Complications:

  • Maternal: HELLP syndrome, stroke, organ failure.

  • Foetal: Growth restriction, stillbirth, prematurity.

• Prevention: Low-dose aspirin (75 mg daily, CLASP trial).

Gestational Diabetes Mellitus (GDM) ?

• Temporary diabetes during pregnancy (affects 5% of pregnancies).

• Screen high-risk groups with oral glucose tolerance tests at 28 weeks.

• Management: Dietary adjustments, with 10% requiring insulin or metformin.

• Complications:

  • Maternal: Pre-eclampsia, prolonged labour, postpartum haemorrhage.

  • Foetal: Macrosomia, stillbirth, neonatal hypoglycaemia.

Foetal Growth Restriction (FGR) ?

• Affects 3% of pregnancies due to placental dysfunction.

• Surveillance includes measuring uterine size, monitoring BP, and testing urine.