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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
    • race
    • age
    • occupation
  • 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 diabetes
  • Gestational age
    • 15% recurrence of prematurity
  • Birthweight
    • intrauterine growth retardation and macrosomia may recur
    • define cause
  • Miscarriage / Ectopy
    • underlying cause
  • 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
    • Chloasma
    • Spider Naevi
  • 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
      • fifths palpable
    • 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
    • MC&S
    • protein
    • glucose
  • Ultrasound
    • at booking for dating, multiple pregnancy, nuchal translucency
    • at 18-20 weeks - foetal anomalies
    • ? serial growth scans
  • ?amniocentesis / chorionic villus sampling
 

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