OnG

8-10 weeks - Screening US to determine the date of pregnancy and/or check for physical problems such as heart or kidney disorders
First trimester test: 11-13 weeks
Nuchal translucency US - estimates baby's risk of DS or other chromosomal disorders + GA (by crown-rump length) + serum markers PAPP-A (pregnancy associated plasma protein-A), hCG,
Chorionic villus sampling (12 weeks - 1st tri) and amniocentesis (14 weeks - 2nd tri) available for women who screen positive
Second trimester screening: Triple test
AFP, HCG, Unconjugated oestriol, +/- Inhibin A (Quarduple)
Tests for Chromosomal abnormalities and neural tube defects
18 weeks - check for many physical problems with baby's growth, spine, heart, kidney or other organs

Hypoechoic area between the skin and soft tissues behind the cervical spine
Abnormal > 3.5mm

FBC - anaemia
Iron studies
Infection screening: HIV, HBV, HCV, Rubella, Syphillus, STIs (optional), TFTs (optional)
MSU - asymptomatic bacterirua
???? - Not sure about this

Calculate the EDD (based on LMP)
Always ask about fetal movements - muligravida - should feel >18-20weeks, primigravida should feel > 20-22 weeks
BP
Fundal symphisus height - should equal GA +/- 2 cm
Feel for lie and presentation
Auscultate fetal heart > 16 weeks NB: heart beats spontaneously at 22-23 days with blood flow by 4th week (28 days)
Enquire about thromboembolic disease
Investigations - first time
Blood group, Rh, antibodies
Infections: HBV, HCV, HIV, syphillus, rubella
MSU
Check papsmear

Left limb 9:1
Internal iliac vein Squished by iliac artery getting squished by uterus

PAPA
Beta HCG
Nuchal translucency

1 in 300
Offered invasive testing - amniocentesis (14 weeks), chorionic villus sampling (12 weeks)

Alpha fetoprotein
Free HCG
Ungonjugated Estriol
14-20 weeks
Screens for chomosomal anomalies

14-20 weeks gestation
2nd trimester
no advantage over other tests

Fetal karyotype - using FISH

CVS
placenta (transcervical and transabdominal); 1st trimester 12 weeks; reduces wait time; permits access to TOP at a safer and more discreet time - larger amount of DNA obtained - more reliable and faster
Amniocentesis
Amnion: 14 weeks;
CVS greater risk of sampling and technical failures
CVS - slightly increased risk of fetal loss

Fetal loss
Confined placental mosaicism
Infection
Damage to fetus
Pre-term birth
PROM

hCG - enters maternal circulation soon after implantation - doubles every 29-53 hours during the first 30 days
Home pregnancy test:
Detect hCG in urine using immunometric assay hCG

Urine pregnancy test
must exceed 20-50 mIU/ml

Serum pregnancy test:
Serum hCG must exceed 1-5 mIU/ml (more sensitive)
Uses radioimmunoassay technique
Ultrasound - gestational sac is usually visible 4.5-5 weeks gestation, fetal heart - 6 weeks,

Confirm fetal heart
Measure the fetal size
Assess position of placenta
Check volume of amniotic fluid
Check for fetal anomalies
Detect multiple pregnancies

Bluish discolouration of cervix and vagina (Chadwick's sign) at 6 weeks due to vascular engorgement
Softening and cyanosis of cervix at 4 weeks (Goodell's sign)
Softening of the uterus at 6 weeks (Ladin's sign)
Uterine enlargement
Breast swelling and tenderness
Linea nigra from umbilicus to pubis
Telangectasia
Palmar erythema

Amenorrhea
Breast swelling and tenderness
Hyperemesis gravidum (N/V)
Quickening - foetal movement
Weight gain in non-obese patients

Increased cardiac output via stroke volume (early) then increased HR (later)
Systemic vascular resistance drops (probably related to progesterone = vasodilation to compensate for increased blood volume) --> decreased BP

Increase in tidal volume despite decrease in lung capacity (due to rising diaphgram) --> drop in respiratory reserve capacity by 20%
Increase in minute ventilation increases O2 and blows off CO2 creating larger gradient between maternal and foetal circulations

Increase in RBC (30%), increase in plasma volume (50%)
WBC increases in pregnancy
Some thrombocytopenia not below 100 million
Hypercoaguable state = increase in fibrinogen, factor VII - X,
BUT clotting and bleeding times do not change so increase in VTE may be due to other parts of Virchow's triad - venous stasis and endothelial damage

Amniotic fluid volume - maker of chronic hypoxia all others are acute hypoxia - reassuring = fluid pocket of 2cm in 2 axes; non-reassuring = olighydramnios
Breathing - reassuring = at least 1 episode of breathing lasting at least 30 seconds
Limb movement - 3 discrete movements
Fetal tone - at least one episode of limb extension followed by flexion
reassuring = 2 points each
Non-reassuring = 0 points

0-4 - BAD - perinatal mortality 200:1000 - deliver fetus if benefits of devliery > risks
6: perinatal mortality 31:1000 - repeat in 24 hours
8: repeat as clinically indicated