To review and act on the results of the screening or special investigations done at the booking visit. 2. To perform the second assessment for risk factors. If possible, all the results of the screening tests should be obtained at the first visit.

1. Antenatal assessment:
Second visit
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2. Aims of the
second antenatal visit
• 1. To review and act on the results of the
screening or special investigations done at
the booking visit.
• 2. To perform the second assessment
for risk factors.
– If possible, all the results of the screening
tests should be obtained at the first visit.
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3. Assessing the results of the screening investigations:
How to interpret the results of the VDRL or RPR screening tests for syphilis
• If either the VDRL (Venereal Disease Research
Laboratory), or RPR (Rapid Plasmin Reagin) test is
negative, the patient does not have syphilis and no
further tests for syphilis are needed.
• If the VDRL or RPR titre is 1:16 or higher, the patient
has syphilis and must be treated.
• If the VDRL or RPR titre is 1:8 or lower (or the titre is not
known), the laboratory should test the same blood
sample by means of the TPHA (Treponema Pallidum
Haemagglutin Assay) or FTA (Fluorescent Treponemal
Antibody) test:
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4. Assessing the results of the screening investigations
How to interpret the results of the VDRL or RPR screening tests for syphilis
• If the TPHA or FTA is also positive, the patient has
syphilis and must be fully treated.
• If the TPHA or FTA is negative, then the patient does
not have syphilis and, therefore, need not be treated.
• If a TPHA or FTA test cannot be done, and the patient
has not been fully treated for syphilis in the past 3
months, she must be given a full course of treatment.
• A syphilis rapid test can be done instead of a TPHA or
FTA test.
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5. How should the results of the
syphilis rapid test be
interpreted?
• If the test is negative the patient does not have syphilis.
• If the test is positive the person either has active
(untreated) syphilis or was infected in the past and no
longer has active disease. The diagnosis of active
syphilis must be confirmed or rejected by a VDRL or RPR
test. It is advisable that treatment for syphilis be started
immediately while waiting for the result of the RPR or
VDRL test. If the laboratory test is negative, treatment
can be stopped as it is an old infection that was fully
treated. If the test is positive, irrespective of the titre,
the full treatment course must be completed.
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6. Treatment of syphilis in
pregnancy
• The treatment of choice is benzathine penicillin.
• 2.4 million units intramuscularly weekly for 3 weeks.
• At each visit 1.2 million units is given into each
buttock.
• Painful
• Compliance
• Treats the fetus
• Allergic?
– Erythromycin 500 mg 6-hourly orally for 14 days
• Fetus
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8. The results of the rapid HIV test
and interpretation thereof
• Rapid test Neg- small chance that the patient is HIV
pos
• Inform patient
• Counsel
• Maintain neg status
• Rapid test pos-2nd rapid test done (diff manufacturer)
• 2nd test will conclude
• Results
• Post test counselling
• FDC
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9. The results of the rapid HIV test
and interpretation thereof
• 1st test positive & 2nd neg- uncertain
• ELISA test positive-the patient is pos
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10. What should you do if the cervical
cytology result is abnormal?
• A patient whose smear shows an infiltrating cervical carcinoma must
immediately be referred to the nearest gynaecological oncology
clinic (level 3 hospital). The duration of pregnancy is very important,
and this information (determined as accurately as possible) must be
available when the unit is phoned.
• A patient with a smear showing a low grade CIL (cervical intra-
epithelial lesion) such as CIN I (cervical intra-epithelial neoplasia),
atypia or only condylomatous changes is checked after 9 months, or
as recommended on the cytology report.
• A patient with a smear showing a high grade CIL, such as CIN II or
III or atypical condylomatous changes, must get an appointment at
the nearest gynaecology or cytology clinic.
• Abnormal vaginal flora is only treated if the patient is symptomatic.
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11. What should you do if the patient’s
blood group is Rh negative?
• Between 5 and 15% of patients are Rhesus
negative (i.e. they do not have the Rhesus D
antigen on their red cells).
• The blood grouping laboratory will look for
Rhesus anti-D antibodies in these patients. If the
Rh card test was used, blood must be sent to
the blood grouping laboratory to confirm the
result and look for Rhesus anti-D antibodies.
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12. What should you do if the patient’s
blood group is Rh negative?
• No anti-D antibodies present, the patient is not
sensitized
• Blood must be taken at 26, 32 and 38 weeks of
pregnancy
• Anti-D antibodies are present, the patient has been
sensitised to the Rhesus D antigen.
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13. What should you do if the ultrasound
findings do not agree with the patient’s
dates?
• Between 18 and 24 weeks:
• If the duration of pregnancy, as suggested by the
patient’s menstrual dates, falls within the range
of the duration of pregnancy, as given by the
ultrasonographer (usually 3 to 4 weeks), the
dates should be accepted as correct.
• However, if the dates fall outside the range of
the ultrasound assessment, then the dates must
be regarded as incorrect.
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14. What should you do if the ultrasound
findings do not agree with the patient’s
dates?
• If the ultrasound examination is done in the first
trimester (14 weeks or less), the error in
determining the gestational age is only 1 week
(range 2 weeks).
• If the ultrasound examination is done in the
second trimester the error is 2 weeks (range 4
weeks).
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15. What action should you take if an
ultrasound examination at 18 to 24
weeks shows a placenta praevia?
• In most cases the placenta moves as the
pregnancy progresses
• Follow up ultrasound must be arranged at 32
weeks
• Then, assess
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16. What should you do if the
ultrasound examination shows a
possible fetal abnormality?
• The patient must be referred to a level 3
hospital for detailed ultrasound evaluation
and a decision about further management.
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17. There are three risk categories
1. A low-risk patient
2. An intermediate-risk patient
3. A high-risk patient
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18. Subsequent visits
• General principles:
– The subsequent visits must be problem oriented.
– All antenatal visits are important. At all visits,
complications specifically associated with the duration
of pregnancy are looked for.
– From 28 weeks onwards the fetus is viable and the
fetal condition must, therefore, be regularly assessed.
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19. When should a patient return for
further antenatal visits?
• If a patient books in the first trimester, and is found to be
at low risk, her subsequent visits can be arranged as
follows:
• Every 6 weeks until 26 weeks.
• The next 2 visits are 4 weeks apart at 30 and 34 weeks.
• Subsequently every 2 weeks from 36 weeks to 40
weeks.
• At 40 weeks a date for induction of labour will be given if
spontaneous onset of labour has not occurred when the
41st week has been completed.
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20. Which patients should have
more frequent antenatal visits?
• If a complication develops, the risk grading will
change. This change must be clearly recorded
on the patient’s antenatal record. Subsequent
visits will now be more frequent, depending on
the nature of the risk factor.
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21. REFERENCE LIST
• https://www.contemporaryobgyn.net/view/s
yphilis-in-pregnancy
• https://www.emedicinehealth.com/rapid_or
al_hiv_test/article_em.htm
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