 History

Antenatal Care
Physiological changes in pregnancy
 Uterus
o 50grams-100g
o Hypertorphy
o Increased BF
 Blood
o 50% ^’d blood flow
o ^’d RBC mass
o Decreased Hb
 Most women anemic in pregnancy
 CVS
o 40% ^’d CO
o 50% decreased peripheral resistance e
Slight BP drop (5mmHg)
 GIT
o Constipation  decreased gut motility  Examination
Aims of antenatal care
 Optimize conditions for pregnancy
 Health promotion // Advise // Education
 Pre-existing maternal conditions
 Maternal complications of pregnancy
 Fetal complications of pregnancy
 Screening for congenital fetal abnormalities
 Plan delivery
 Investigations
Types of Antenatal care

Preconceptual visit
 General health  Health advice
 Rubella status  Give vaccine now  Live
vaccine and can’t be given during pregnancy
 Not menstrual dates
 Advise folic acid (0.4mg/D) before conceptions
and throughout first trimester
o Not after as NT closed Return Visits
Booking Visit  10 for uncomplicated pregnancy nulliparous // 7
 Risk assessment for multiparous
o Any complications  Review hx // physical and mental state
 Gestation checked  Fetal mvmnt + HR
 Nagle’s Rule  Weight // Bp // Urine Dipstick // Abdo exam
o Estimated due date  Subtract 3 months  Opportunity to ask questions
from the date of LMP  add 7D and 1 year  Offer advice
 General health check and advice  Reassess risk
 Prenatal screening
o Downs  Nuchal transparency
 Antenatal classes
Obstetric US  Surgical
 st
1 Trimester o Vacuum aspiration (<14/15 weeks)
 7 week scan o Dilation and evacuation (15-24 weeks)
o Location of pregnancy Cost
o Amniotic sac (fr 5wks)  2,500 euros
o Heart beat (TVUS 6 weeks // Abdo 7 weeks) Legislation
o Gestational age  5D error margin  Acknowledges the right of life of the unborn and,
 CRL <12 weeks with due regard, to the equal rights to life of the
 BOD/femur length >12wks mother ..
o Multiple pregnancy  Can’t limit freedom of travel or for information
 11 week scan  1861  Offenses against person act
o Anencephaly
o Nuchal transluecnyc When
o Chorionicity
o Cervic length
o Uterine/pelvic abormalieis
 2nd Trimester  20 weeks
o Gestational age  7D error margin
o Viability
o Multiple pregnancy
o Fetal anomaly scan
o Liqor volume
o Placental location
o ADD
 3rd Trimester
o Lie
o Presentation
o Amniotic fluid volume
o Placental site
o Biophysical profile
 HR // Movement // Tone // Breathing //
AFI ????
Screening Options
 T21  Nuchal Transleucency _ Nasal bone
measurement
o Bloods  aFP + BHG + Unconjugated
estradiol + inhibin B
Diagnostic Test
 Amniocentesis
o From week 15
 Chorionic villus sampling
o From 11 weeks
 Circulating non-invasive cell-free DNA

Abortion
 Deliberate termination of pregnancy
 Medical
o <10 weeks  Mifipristone + Misoprostole
 PG  Uterine contraction  Expel fetus
 Mifepristone  Anti-progesterone 
primes lining of uterus for expulsion
o 10-23+5 weeks  Anti-D required
 Plus stay in clinic