first antenatal screen

• complete blood count

  • very low or very high

    • associated with increase foetal risk

• blood group and antibody screen

• rubella antibody status

  • >10uu/mL indicates protection from disease

  • \<15 should avoid contact

  • \<25 who have only had 1dose MMR

    • have another after delivery

• Syphilis serology

• Hepatitis B serology

  • up to 85% of infants born to mothers infected with hepatitis B

    • HBeAg positive (active infection)

    • will become carriers

    • more likely to develop chronic liver disease

  • can be prevented:

    • administration of Hep B vaccine and Ig to infant at birth

  • women who at risk of dveloping hep b recommended to be vacicnated during pregnancy

• HIV

• consider

  • varicella antibody status

    • congenital varicella syndrome

      • blindness

      • growth retardation

      • limb and cranial malformation

      • sdelayed development

      • mental retardation

      • spontaneous abortion

      • foetal death

    • if no history of varicella and exposed

      • ZIG within 96hrs or aciclovir at onset of symptoms

  • cervical smear

2nd screen: 26-28 weeks

• polycose test

  • 50g glucose tolerance test

  • if abnormal then 75g oral glucose tolerance test

  • if gestational DM then OGTT - 6-8wks after delivery

    • increase risk of developing T2DM 15yrs

    • ?HbA1c after delivery

• CBC

• blood group antibodies

• urine culture

First trimester screening 11-14/40

• Nuchal translucency scan

• blood tests for PAPP-a, bHCG (3-4 days prior)

Second trimester screening - 14-18/40

• bHCG

• AFP

• µE3

• Inhibin A

Screening for GBS

• 15-25% carriers

• 1/200 develop neonatal sepsis

• vaginorectal culture @ 35-37 wks

• risk factors;

  • pre-term labour ≤ 37wks

  • prolonged rupture of membranes ≥18hrs

  • Maternal fever ≥ 38deg

  • Previous GBS infected infant

  • GBS bacturisa during pregnancy

  -

Screening for downs

• offered to all women

• information

  • reassuracne screening voluntary

  • details of which screening options are availabe

  • limitations of the tests

  • pamphles available

    • national screening unit

• anatomy scan at 18-19+ weeks gestatoin

• chroionic vissus sampling

  • 11-12wks

• amniocentesis 14-18wks

• increase risk of harm to foetus

  • infection

  • amniotic fluid leakage

  • miscarriage