Week 1 – Antenatal care from 20 2: Maternal health assessment
weeks to term. ---- Tests taken every time ------
1. Describe the key components of antenatal care Blood Pressure
recommended in the last 20 weeks of pregnancy.
Timing: each visit
1: Ultrasounds ➔ Normal/ Abnormal Maternal BP
Ultrasounds – Morphology (18-22 weeks) Normal maternal BP
➔ When does it occur? SBP <140 mmHg (30 mmHg change allowed)
Morphology ultrasounds (USS) are taken at 18-22 DBP < 90 mmHg (15 mmHg change allowed)
weeks gestation.
Abnormal finding?
They are the first USS to be taken.
✓ Take 2 readings 4hrs apart.
➔ What does it assess? ✓ UNLESS >160 mmHg / >110 mmHg
Assessments of the morphology USS
1. Fetal number Weight & BMI
2. Fetal growth & abnormalities
3. Placental position ↑3cm from OS Timing: each visit
4. Cervical length > 3cm long ✓ Monitor weight gain.
Btwn 16-24 weeks – cervix is usually 35-48mm. ✓ Normal to gain weight as per chart below
Short if it is less than 25mm before 24 weeks.
5. Amniotic fluid index Baseline BMI: pre-pregnancy weight
Urine Analysis
• Cervical OS: opening in the cervix at each
end of the endocervical canal. Consists of Timing: each visit or opportunistic
the internal and external os. Abnormal findings
Additional Ultrasounds ✓ Proteins (> 2+ or recurrent 1+)
22-24 weeks → Repeat morphology. ✓ Nitrites & blood (+ve)
32-34 weeks → Placental position. Positive findings that are NOT concerning
PRN → Growth & Dopplers ✓ Leukocytes
✓ Glucose
✓ Ketones
• NS2221 TERM Property Topic title→ subtopic ① ② ③ ④ ⑤ ⑥ ⑦ ⑧ ⑨ ↓ ↑ ∴ ≈ Mnemonic
,------ Investigations @ weeks 26-28 and 34-36 ---- ➔ Risk factors for GDM
RBC Antibodies
Rh(D) -ve: prior to anti D @ 28 weeks
Rh(D) +ve: only if +ve for antibodies @ BI bloods
Full Blood Count
Tests in FBC
✓ Hb
✓ MCV (mean corpuscular volume) – average
size of RBC’s.
✓ Platelets
✓ WCC
Sexually Transmitted Diseases
➔ Abnormalities
➔ Syphilis
If Hb <105g/L or symptomatic of anaemia tx.
Tests done dependant on risk.
Includes:
✓ Iron studies – serum ferritin (>30ng/mL) ➔ Gonorrhoea & Chlamydia
✓ See QCG website for flowchart.
Test only done if high risk.
Treating STI’s in Pregnancy
Mental Health Assessment
Timing: opportunistic
Purpose: to detect possible depression in
Glucose Tolerance Test (28 weeks) pregnant women
Timing: 28 weeks Done using EDPS – Edinburgh Postnatal
Depression Scale
Taken 3 times
✓ After fasting, should be > 5.1mmol/L
✓ 1hr after 75g sugar, >10mmol/L
✓ 2hrs after 75g sugar, >8.5mmol/L
• NS2221 TERM Property Topic title→ subtopic ① ② ③ ④ ⑤ ⑥ ⑦ ⑧ ⑨ ↓ ↑ ∴ ≈ Mnemonic
,3: Fetal assessment 2. Explain how to categorise multiple
pregnancies.
Abdominal Palpation
Categorizing Multiple Pregnancies
➔ Palps at 20-30 weeks
Timing: 20-30 weeks
In early stages, investigating for:
✓ Symphysis – fundal height:
Cm = weeks (+/- 2cm)
✓ Fetal heart rate:
110-160 bpm
✓ Fetal movements
➔ 30 weeks and above
Same investigations plus more
Follow FLAPPER
4: Woman centred care
Education
Specific topics of education
✓ Smoking cessation
✓ Fetal growth restriction
✓ Decreased fetal movements
✓ Side sleeping
✓ Timing of birth
5: Multiple pregnancies
• NS2221 TERM Property Topic title→ subtopic ① ② ③ ④ ⑤ ⑥ ⑦ ⑧ ⑨ ↓ ↑ ∴ ≈ Mnemonic
, Week 2 – Cardiotocography (CTG) ➔ Normal maternal & fetal parameters (GREEN)
Effective use & Interpretation ◼ Baseline Fetal HR
1: Using & Interpreting CTG’s 110-160bpm
Cardiotocography Introduction Mean level = ‘resting’ heart rate
➔ What is a CTG?
• Cardiotocography: recording of fetal How to measure a baseline FHR
heart rate & uterine contraction. ✓ Look where there are no contractions,
✓ Horizontal plane = 1cm per minute (each line accelerations etc. occurring and the HR
is 30 seconds) hovers over an area.
✓ Vertical = 5bpm ✓ This is the fetal heart rate, the line that the
This tells us how well the fetus is doing at the HR is hovering over.
time of the CTG (but it is not a sole indicator of
fetal wellbeing)
➔ Factors that influence fetal wellbeing
Interpretation of a CTG
1. Identify normal and abnormal features of
a CTG that are unlikely to indicate fetal
compromise.
➔ Categorisation of FHR patterns
• NS2221 TERM Property Topic title→ subtopic ① ② ③ ④ ⑤ ⑥ ⑦ ⑧ ⑨ ↓ ↑ ∴ ≈ Mnemonic
weeks to term. ---- Tests taken every time ------
1. Describe the key components of antenatal care Blood Pressure
recommended in the last 20 weeks of pregnancy.
Timing: each visit
1: Ultrasounds ➔ Normal/ Abnormal Maternal BP
Ultrasounds – Morphology (18-22 weeks) Normal maternal BP
➔ When does it occur? SBP <140 mmHg (30 mmHg change allowed)
Morphology ultrasounds (USS) are taken at 18-22 DBP < 90 mmHg (15 mmHg change allowed)
weeks gestation.
Abnormal finding?
They are the first USS to be taken.
✓ Take 2 readings 4hrs apart.
➔ What does it assess? ✓ UNLESS >160 mmHg / >110 mmHg
Assessments of the morphology USS
1. Fetal number Weight & BMI
2. Fetal growth & abnormalities
3. Placental position ↑3cm from OS Timing: each visit
4. Cervical length > 3cm long ✓ Monitor weight gain.
Btwn 16-24 weeks – cervix is usually 35-48mm. ✓ Normal to gain weight as per chart below
Short if it is less than 25mm before 24 weeks.
5. Amniotic fluid index Baseline BMI: pre-pregnancy weight
Urine Analysis
• Cervical OS: opening in the cervix at each
end of the endocervical canal. Consists of Timing: each visit or opportunistic
the internal and external os. Abnormal findings
Additional Ultrasounds ✓ Proteins (> 2+ or recurrent 1+)
22-24 weeks → Repeat morphology. ✓ Nitrites & blood (+ve)
32-34 weeks → Placental position. Positive findings that are NOT concerning
PRN → Growth & Dopplers ✓ Leukocytes
✓ Glucose
✓ Ketones
• NS2221 TERM Property Topic title→ subtopic ① ② ③ ④ ⑤ ⑥ ⑦ ⑧ ⑨ ↓ ↑ ∴ ≈ Mnemonic
,------ Investigations @ weeks 26-28 and 34-36 ---- ➔ Risk factors for GDM
RBC Antibodies
Rh(D) -ve: prior to anti D @ 28 weeks
Rh(D) +ve: only if +ve for antibodies @ BI bloods
Full Blood Count
Tests in FBC
✓ Hb
✓ MCV (mean corpuscular volume) – average
size of RBC’s.
✓ Platelets
✓ WCC
Sexually Transmitted Diseases
➔ Abnormalities
➔ Syphilis
If Hb <105g/L or symptomatic of anaemia tx.
Tests done dependant on risk.
Includes:
✓ Iron studies – serum ferritin (>30ng/mL) ➔ Gonorrhoea & Chlamydia
✓ See QCG website for flowchart.
Test only done if high risk.
Treating STI’s in Pregnancy
Mental Health Assessment
Timing: opportunistic
Purpose: to detect possible depression in
Glucose Tolerance Test (28 weeks) pregnant women
Timing: 28 weeks Done using EDPS – Edinburgh Postnatal
Depression Scale
Taken 3 times
✓ After fasting, should be > 5.1mmol/L
✓ 1hr after 75g sugar, >10mmol/L
✓ 2hrs after 75g sugar, >8.5mmol/L
• NS2221 TERM Property Topic title→ subtopic ① ② ③ ④ ⑤ ⑥ ⑦ ⑧ ⑨ ↓ ↑ ∴ ≈ Mnemonic
,3: Fetal assessment 2. Explain how to categorise multiple
pregnancies.
Abdominal Palpation
Categorizing Multiple Pregnancies
➔ Palps at 20-30 weeks
Timing: 20-30 weeks
In early stages, investigating for:
✓ Symphysis – fundal height:
Cm = weeks (+/- 2cm)
✓ Fetal heart rate:
110-160 bpm
✓ Fetal movements
➔ 30 weeks and above
Same investigations plus more
Follow FLAPPER
4: Woman centred care
Education
Specific topics of education
✓ Smoking cessation
✓ Fetal growth restriction
✓ Decreased fetal movements
✓ Side sleeping
✓ Timing of birth
5: Multiple pregnancies
• NS2221 TERM Property Topic title→ subtopic ① ② ③ ④ ⑤ ⑥ ⑦ ⑧ ⑨ ↓ ↑ ∴ ≈ Mnemonic
, Week 2 – Cardiotocography (CTG) ➔ Normal maternal & fetal parameters (GREEN)
Effective use & Interpretation ◼ Baseline Fetal HR
1: Using & Interpreting CTG’s 110-160bpm
Cardiotocography Introduction Mean level = ‘resting’ heart rate
➔ What is a CTG?
• Cardiotocography: recording of fetal How to measure a baseline FHR
heart rate & uterine contraction. ✓ Look where there are no contractions,
✓ Horizontal plane = 1cm per minute (each line accelerations etc. occurring and the HR
is 30 seconds) hovers over an area.
✓ Vertical = 5bpm ✓ This is the fetal heart rate, the line that the
This tells us how well the fetus is doing at the HR is hovering over.
time of the CTG (but it is not a sole indicator of
fetal wellbeing)
➔ Factors that influence fetal wellbeing
Interpretation of a CTG
1. Identify normal and abnormal features of
a CTG that are unlikely to indicate fetal
compromise.
➔ Categorisation of FHR patterns
• NS2221 TERM Property Topic title→ subtopic ① ② ③ ④ ⑤ ⑥ ⑦ ⑧ ⑨ ↓ ↑ ∴ ≈ Mnemonic
