Early dating scan, Routine antenatal care, Down’s syndrome screening (NIPT), Management of pregnancy symptoms

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Obstetrics

Guiding You Through Motherhood

Comprehensive Antenatal Care

Antenatal Ultrasound Scans

Non-Invasive Prenatal Test (NIPT)

Antenatal Vaccinations

Management of pregnancy symptoms

Labour management and delivery

Delayed cord clamping

Cord blood collection

Postnatal Care and Birth Control

Comprehensive Antenatal Care

Regular visits help to monitor for baby’s well-being and for pregnancy complications. Maternal blood pressure, weight and urine to check for sugar and protein are taken each visit.

Measures carried out during the course of pregnancy:

Blood tests to check for anaemia, blood group and infectious disease.
Specialised ultrasound scans done at specific milestones pf pregnancy.
Serial growth scans to assess growth of unborn baby.
Non-Invasive prenatal tests (NIPT) to screen for genetic conditions like Down’s syndrome – optional.
Screen for diabetes in pregnancy around 24 – 28 weeks of pregnancy.
Antenatal vaccinations.

Group B Streptococcus Screening

A high vaginal swab test is done usually at 34 to 36 weeks pregnancy. Antibiotics can be given to reduce the group B Streptococcus bacterial transmission to babies in screen positive mothers. Group B Strep can cause serious infections in newborn, including sepsis, severe chest infections and meningitis.

Antenatal Ultrasound Scan

Early scan in the 11 weeks of pregnancy

Locate pregnancy
Detect fetal heart beat
Establish stage of pregnancy and confirm due date
Look for ovarian cysts and fibroids

12 to 13+ weeks scan

Detect early structural abnormalities
Measure nuchal translucency / neck thickness
Blood flow studies

20 to 22 weeks pregnancy scan

Structure and development of fetus
Location of placenta/afterbirth
Cervical length to predict of preterm delivery in pregnancy
Blood flow to predict risk of hypertension later in pregnancy

Serial growth scans in later half of pregnancy

Monitor growth of baby
Structural abnormalities that appear later
Help to plan timing and mode of delivery

Down’s Syndrome Screening (NIPT)

A non-invasive screening to screen foetuses for risk of Down’s Syndrome. This blood test can be done from 10 weeks of pregnancy. It also screens for fetal gender.

Low risk results indicate a low possibility (though not zero) of the unborn baby having Down Syndrome, or the genetic conditions indicated in the report.

High risk results means that there is a higher risk of that genetic condition, and an invasive prenatal diagnostic test may be considered to confirm the condition.

No results from NIPT after repeating a few times, prenatal diagnostic tests is recommended.

Prenatal Diagnostic tests

These are invasive tests to confirm Down’s syndrome, genetic abnormalities and other chromosomal abnormalities. They carry a small risk of miscarriage. The results generally takes about 2-3 weeks to be available.

Once a genetic disorder is diagnosed, genetic counselling is offered, so that the couple can understand the implications of the condition detected.

They are then able to make an informed decision as to whether they intend to carry on with the pregnancy, or what to expect should they decide to proceed on with pregnancy.

1. Chorionic Villus Sampling (CVS): Done as early as 12 weeks of pregnancy, where a small sample of placenta tissue is taken.

2. Amniocentesis:Done usually around 16-20 weeks pregnancy, where a small amount of amniotic fluid surrounding the fetus is sampled.

Antenatal Vaccinations

Influenza Vaccination

The inactivated vaccine is safe in all trimesters of pregnancy.
Protects both mother and baby.

Whooping cough Vaccination

Pertussis or the Tdap vaccine is safe for use in pregnancy.
Protects the newborn from serious chest infections.

Respiratory syncytial virus vaccine

RSV is the most common cause of pneumonia and bronchiolitis in babies younger than 1 year, which can lead to hospitalization.
Maternal RSV vaccine is recommended for pregnant women between 34 and 36 weeks of gestation to protect their newborn from severe RSV illness during their first months of life.

Management of common pregnancy problems

Nausea and Vomiting

Begins from 6 weeks of pregnancy and intensifies especially for those expecting twins or multiple pregnancies. Symptoms usually subside after the first trimester.

Severe vomiting/hyperemesis gravidarum can lead to dehydration and increased risk of miscarriage and low birthweight babies. Hospitalization for intravenous hydration is advisable.

Steps to take:
1. Try dry crackers or ginger biscuits.
2. Avoid starchy and greasy food.
3. Keep hydrated with soda water mixed with a little juice.
4. Have frequent small meals and a protein rich snack at bedtime.
5. Start anti-emetic medication earlier.
6. Seek medical help if unable to tolerate fluids.

Iron-Deficiency Anaemia

The commonest cause for anaemia (<11 g/dL) in pregnancy.

Problems of anaemia in pregnancy:
(1) Dizziness, shortness of breath, headaches
(2) Risk of preterm birth and low birthweight babies
(3) Increased blood loss during delivery
(4) Increased risk of postdelivery infection
(5) Poor breastmilk supply
(6) Delayed developmental milestones in the baby

Diet rich in spinach, red meat (rich in heme iron) and oral iron supplements (min elemental iron 30 mg daily) is recommended.

Gestational Diabetes

Diabetes in pregnancy usually begins from the mid second trimester of pregnancy onwards. Hence all pregnant ladies are offered screening with a sugar tolerance blood test around that stage of pregnancy.

Gestational diabetes (GDM) is diagnosed with the following criteria:

* Fasting blood sugar >5.1 mmol/L
* 1 hour post-meal sugar > 10 mmol/L
* 2 hour post-meal sugar >8.5mmol/L

Complications include birth injury and large babies that risk being born with low blood sugar after delivery. These babies will be at higher risk of diabetes and obesity later in life.

Management of gestational diabetes: