Screening
Antenatal: (allows termination or assessment for intervention/planning for tertiary delivery)
- full blood count
- glucose challenges for diabetes ultrasound to check for dates, number of fetuses and development
- blood group and antibodies
- midstream urine
- random blood glucose
- syphilis
- rubella
- HBV
- hepatitis C
- HIV antibodies
- (?CMV)
- Chlamydia screening
- sickle cell and Thalassaemia (Haemoglobinopathy) screening for at risk women (Ethnic groups at high risk – Mediterranean, Middle Eastern, African, Asian, Pacific Islander, South American, New Zealand Maori)
- T13 (1: 4800) /18 (1:2000) /21 (Down 1:380)
- first trimester = Bloods at 12w: free B-hCG and PAPP-A (9-13+6) AND transabdo/vaginal US (11-13+6)
- combines mums age/wt/gestation and results to estimate risk
- T21: not increased (<1:300) one in 25 are increased (but only 1:380 have it)
- OR second trimester = bloods (maternal serum screen (MSS) aka the triple test) NOT US
- 16w (14-18w): estriol, free B-hCG (T21) and alpha fetoprotein > Neural tube defects (1:700) increase risk is >1:128
- Morphology scan 18-20w (accuracy effected by pt wt, gest age, lie, equipment, operator, radiologist)
- Check position of placenta
- Check amniotic fluid level
- Check Growth
- heart, limbs, abdomen, bones, brain, spine and kidneys
If FHx of T21 might elect for CVS/amnio even if screening negative
US 6-8w to confirm gestational age: crown- rump length or biparietal diameter
Genetic counsellor
Delivery
- screening speculum exam for HSV
Hearing (0.3% prevalence)
- if SNHL > screen newborn for CMV (test Guthrie if >3w old)
Guthrie taken between 48-72hrs old (0.1% prev)
- CF 1:2,500
- Cong. ↓ thyroid 1:3,500 (TSH is the screen, nb surge at 24-36h so needs to be taken after 48h)
- Metabolic
- Phenylketonuria
- Galactosaemia
- Aminoacidopathies
- Organic acidaemia
- fatty acid oxidation defects
SNAP (Smoking, Nutrition, Alcohol, Physical exercise)
S - every visit from 10y
N - q2y from 10y
A - q2y from 15y
P - q2y from 10y
Skin check - q1y from 12yo
Depression - every visit from 12yo
Sexual health - q1y from 15yo
Preconception care - 15yo - 50yo
BP - q2h from 18yo
Fasting BSL - q3y from 40yo
Cholesterol - q5y from 45yo
Osteoporosis - q1y from 45yo
Breast/FOB - q2y from 50yo
Falls/vision/hearing - q1y from 65yo
PAP - q2y from 18yo - 69yo
DV - opportunistically