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Summary: Antenatal Care
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1 Antenatal Care
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Down's Syndrome Screen
Combined Test from weeks 11-14
ß-hCG
PAPPA
Quad test from weeks 15-22
AFP
ß-hCG
Inhibin
E3
Nucheal translucency and age -
Medications for 1st Trimester
Folic acid 0.4mg/day until week 12
Vitamin D 10µg/day if BMI>30 or low sun exposure -
NICE Guidelines of Number of Appointments
10 for nulliparous
7 for multiparous
More frequent in high risk
Blood pressure taken
Urine checked for protein; glucose; leucocytes and nitrates -
Immune Foetal Hydrops
Rhesus isoimmunization
IgG crosses placenta causing death of foetal red blood cells
Anaemia and then hydrops can occur
Initial pregnancy IgM is formed which cannot cross placenta
Re-exposure = IgG and causes haemolytic anaemia -
Sensitising events for Rhesus disease (6)
TOP or ERPC
Ectopic
Vaginal bleeding > 12 weeks
Blunt abdominal trauma
Amniocentesis/CVS
Intrauterine death
Delivery -
Management of Rhesus Disease
Checked for antibodies at 28 & 34 weeks
Test father
If levels of antibodies are >10lU/ml then assess foetal anaemia
Can give transfusion in umbilical vein and repeat every 2 weeks
Give blood transfusion at birth -
Prevention of Rhesus (D) disease
Anti-D given at 28 weeks or 72 hours of sensitizing event
After delivery if neonate has rhesus +ve -
Non-immune foetal hydrops causes
Severe anaemia (virus; G6PD; Thalassaemia)
Cardiac (structural; tachyarrhythmia; heart block)
Chromosomal (13;18;21;45XO)
Twin-to-twin transfusion syndrome
Placental
Other infections
Other genetic
Other structural -
Investigations of non-immune foetal hydrops
Ultra-sound gives diagnosis
Can look for structure problems and anaemia by MCA velocity -
Treatment of non-immune foetal hydrops
Correct any causes if possible
Twin-to-twin = laser photocoagulation
Cardiac if possible
Deliver if in 3rd trimester
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