Antenatal Care
Why?
- To detect and treat disorders arising out of pregnancy
- to anticipate complications of labour
- to educate women
- to optimise womens health
Setting
- hospital clinic
- GP
- midwifery clinic
When?
- 14 weeks on
- Monthly until 28 weeks
- Fortnightly 28-36 weeks
- Weekly thereafter
Pre-conception care
- optimise general health
- start folic acid
- reduce risk factors
- relevant family history
Booking visit
- thorough history and examination
- booking investigations
- categorisation of risk
- follow-up plans
Subsequent visits
- urinalysis and BP check
- ultrasound scans
- ? glucose tolerance test (GTT)
- ongoing education
Antenatal History
- Demographics
- LMP
- Regular cycle
- recent contraception
- certain of dates
- Previous obstetric history
- number of pregnancies (gravidity)
- number of pregnancies delivered after 24 weeks pr >500g (parity)
- type of deliveries
- antenatal problems
- gestational age and birth weight
- neonatal problems
- Previous gynaecological history
- miscarriages / ectopic
- genital tract abnormalities / surgery
- smear history
- polycystic ovary disease
- infertility
- Past medical and surgical history
- including past psychiatric history
- Family history
- congenital / genetic disease
- multiple pregnancies
- diabetes
- Social history
- smoking
- alcohol
- drugs of abuse
- social circumstances
- domestic violence
- Drug history
- peri-conception
- long term
- allergies
Risk Factors
- Age
- adolescents
- low birth weight, prematurity
- usually due to poorer social conditions
- older women
- increased perinatal mortality
- low birth weights
- prematurity
- pre-eclampsia
- chromosomal abnormalities
- Parity
- nulliparous - unknown quantity
- grand multiparity
- malpresentation
- primary post-partum haemorrhage
- Mode of delivery
- any recurring problems
- influences on labour management (e.g. 2 or more Caesarean sections)
- Antenatal problems
- Gestational age
- 15% recurrence of prematurity
- Birthweight
- intrauterine growth retardation and macrosomia may recur
- define cause
- Miscarriage / Ectopy
- Genital tract abnormality / surgery
- malpresentation / obstruction
- prematurity
- cervical incompetence
- uterine rupture
- Polycystic ovary disease
- risk gestational diabetes
- Infertility
- risk chromosomal abnormalities
- multiple pregnancy
- Smoking / drugs / alcohol
- intrauterine growth retardation
- perinatal mortality
- Domestic violence
- Drugs
- teratogens
- optimising therapy
Examination
- Height
- Weight
- BP
- General
- CVS / Respiratory
- Abdominal
- External signs
- striae gravidarum
- scars
- foetal movements
- Height fundus
- suprapubic at 12 weeks
- umbilicus at 20 weeks
- xiphisternum 36/37 weeks
- No. foetuses
- liquor volume
- lie
- presentation
- position
- engagement
- auscultate foetal heart
- Oedema
- (Breasts)
- (Pelvis)
Booking investigations
- FBC - repeat at 28 and 34 weeks
- Blood group and antibody screen
- Haemoglobinopathy screen
- Infection screen
- rubella immune
- syphilis
- hepatitis B
- HIV
- alpha-fetoprotein
- hCG
- Urinalysis
- Ultrasound
- at booking for dating, multiple pregnancy, nuchal translucency
- at 18-20 weeks - foetal anomalies
- ? serial growth scans
- ?amniocentesis / chorionic villus sampling
|