Antenatal Care and Maternity Services Quiz

Continuity of Care

• Better postnatal and perinatal mental health care is a goal
• A fairer payment system for various care types is desired
• Safer care, with multiprofessional working and training is needed
• Performance measurement using routinely collected data is important

Overview of Antenatal Care

• Aims to optimize pregnancy outcomes for women and babies
• Aims to prevent and manage factors that adversely affect health of mother and baby
• Provides advice, reassurance, education, and support for the woman and her family
• Deals with minor ailments of pregnancy
• Provides general health screening

Antenatal Care Focus

• Women should be treated with kindness and dignity
• Respect personal, cultural, and religious beliefs
• Services are to be readily accessible
• Continuity of care is needed
• High-quality, culturally appropriate verbal and written information should be available for women to make informed choices
• Informed decision-making, led by the woman, is essential

Maternity Care Delivery Models

• UK and many countries use a community-based team of midwives and family practitioners (e.g., GPs), a hospital consultant team, or a combination
• Some women with complex pregnancies receive consultant care from a hospital-based obstetric team
• Other women with uncomplicated pregnancies have community-based care (midwifery care)
• Some have risk factors requiring obstetric input, but routine care provided by the community team (shared care)

Advice, Reassurance, and Education

• Pregnancy is a time of uncertainty and stress, compounded by physical changes (nausea, heartburn, constipation, shortness of breath, etc.)
• Information on smoking, alcohol, and drug use during pregnancy is crucial, as these factors can negatively affect fetal development
• Antenatal care promotes healthy behaviors like limiting harmful habits
• Parentcraft education provides formal group discussions on pregnancy, labor, delivery, and newborn care
• Sessions create a support network for couples and lessen anxiety.

First Trimester

• Booking visit is the initial interaction with health services
• Detailed history, physical examination, and routine investigations are conducted (with consent)
• Referral to specialist services may occur if risk factors are identified.

Body Mass Index and Weight Assessment

• Height and weight are measured at the booking visit
• BMI is calculated and assessed and women are counselled accordingly
• Women with BMI >35 kg/m² are reviewed by an obstetric consultant or other professional
• Institute of Medicine provides guidelines on recommended weight gain during pregnancy
• Appropriate weight gain based on BMI is important and discussed with the woman

General Pregnancy Dietary Advice

• Maintain normal portion sizes and avoid excessive snacking
• Eat high-fiber foods (oats, beans, lentils, grains, fruits, vegetables)
• Base meals on starchy foods (potatoes, rice, pasta), choosing whole grains
• Limit fried foods, added sugars, and high-fat foods
• Emphasize consumption of fruit and vegetables

General Exercise Advice

• Aerobic and strength conditioning exercises in pregnancy is safe and beneficial

• Avoid contact sports

• Tailor exercise programs based on specific needs or conditions

• Pelvic floor exercises help reduce incontinence

Maternal and Neonatal Complications Associated with Increased BMI in Pregnancy

• Listed in a detailed table

Antenatal Urine Tests

• Asymptomatic bacteriuria increases preterm delivery risk and pyelonephritis risk
• Midstream urine (MSU) specimen for culture and sensitivity at the booking visit
• Urinalysis for protein, glucose, and nitrites are routinely performed to detect potential complications.

Blood Pressure Assessment

• Blood pressure typically falls slightly in the first trimester then returns to pre-pregnancy levels by the end of the second trimester
• Assessment allows detection of unrecognized chronic hypertension, prompting early treatment to reduce episodes of severe hypertension in mother and decreased perinatal mortality.

Booking Tests in Pregnancy

• Full blood count (FBC) identifies potential anemia requiring treatment early
• Checking for anemia, Hb <110, <105, <100 g/l in different trimesters.

First Trimester Dating and Screening

• Accurate dating is crucial to avoid inaccurate identification of growth restriction or unnecessary induction of labor for postdates pregnancy

• First trimester ultrasound, nuchal translucency (NT) measurement, maternal free human chorionic gonadotrophin (β-hCG), and pregnancy-associated plasma protein (PAPP-A) help assess risk for various conditions.

• The quadruple test helps assess trisomy risks.

• Newer technologies (non-invasive prenatal testing) identify conditions and are highly sensitive.

Identification of High-Risk Women

• Women with a history of hypertension, chronic kidney disease, autoimmune diseases, type 1 or type 2 diabetes, are at increased risk of pre-eclampsia

• Women with moderate risk factors (primiparity, advanced maternal age, higher BMI, family history of pre-eclampsia or multifetal pregnancy).

• All women screened regularly for pre-eclampsia via blood pressure and proteinuria checks

Women at High Risk of Preterm Birth

• Women with previous preterm births, late miscarriages, multifetal pregnancies, and previous cervical surgery are at increased risk.

• Screening with cervical length measurement and fetal fibronectin can help detect increased risk

• Syhmphis-fundal height (SFH) measurements from 24 weeks onwards is useful for monitoring fetal growth

Vitamin D Deficiency

• No routine screening for vitamin D deficiency is recommended
• Screening only for high-risk women who may be at higher risk of deficiency based on skin color, obesity, pre-eclampsia risk, or gastrointestinal conditions impacting fat absorption

Second Trimester Care

• Anomaly scan between 20 and 22 weeks to assess fetal anatomy
• Scan is used to detect conditions like spina bifida, major congenital anomalies, diaphragmatic hernia, and renal agenesis

Gestational Diabetes Mellitus

• Universal screening for GDM is available in some countries, but risk-based screening is recommended in the UK. Diabetes is diagnosed based on fasting and 2-hour plasma glucose levels
• Women with risk factors (previous GDM, macrosomia, high BMI, specific ethnicities) are screened earlier

Maternal Care Governance

• NICE and other organizations drive standards and procedures for maternity care
• Guidelines for the provision of care are frequently evaluated based on current best evidence
• Consumer groups are involved in improving access and quality of care.

Breastfeeding Education

• Breastfeeding offers health benefits and is recommended for the first 6 months of life, and continued beyond
• Education during pregnancy is advocated to improve rates of initiation and continuation of breastfeeding.

Booking Tests - Summary

• Comprehensive table summarizing investigations, including indication for each.

Infections Screening

• Rubella: Screening for rubella immunity is no longer routine in the UK
• Syphilis: Screening is important due to potential miscarriage, stillbirth, and congenital syphilis.
• Hepatitis B: Screening important because it can be transmitted to the newborn; vaccination and globulin are important aspects of the protocol.
• Hepatitis C screening often is not routine but is recommended for high-risk women like those with IV drug use history
• HIV: Screening is performed and appropriate intervention is vital

Test your knowledge on the various aspects of antenatal care and maternity services. This quiz covers topics such as the aims of antenatal care, types of care for complex pregnancies, and common pregnancy symptoms. Evaluate your understanding of essential practices and concepts crucial for supporting pregnant women.