Antenatal Care

Antenatal Care Visit schedule Booking – before 14 weeks Detailed scan – 20 weks 26, 30, 34, 38, 41 Booking visit Past obstetric history - provide reassurance for previous complications & discuss recurrence risk PMH / PSH - operations, blood transfusions, HT, DM, heart/renal disease, epilepsy, asthma, thyroid FH – include thalassaemia, CF, sickle cell, chromosome disorders & congenital abnormalities Present preg – EDD (from LMP/scan) DH – any drugs taken during pregnancy, + allergies Examination – baseline for HR, BP, weight, check for murmers, paplate abdo, smear if due USS – for viability & age Urine – for protein & glucose Booking Bloods FBC – for anaemia, thrombocytopenia G&S – for ABO & Rh status & assess Ab status Rubella status – offer vaccine post natal if req Haemoglobin elecrophoresis – if ? sickle cell / thalassaemia Hep B – to alert to req for neonatal vaccine Serology for syphilis – penicillin if +ve HIV – so mother can be give ARVs Planning ? low dose aspirin if history of PET elective section for prev section / prev difficult/instrumental deliveries increased monitoring if history of IUGR/poor outcome, esp if cause unknown advice re smoking, alcohol, hazards at work etc Antenatal surveillance HT / PET – check BP & urine at every visit Fetal growth restriction – screening by fundal height measurement (& US if high risk) DM – urine checks, random blood glucose, poss glucose tolerance test Haemolytic disease – rescreen for Ab in 3rd trimester Breech – (40% at 20 weeks, 25% at 32 weeks, 3% at term) palpation / US Anaemia – controversial, usually Fe supplement if <10g/dl Polyhydramnios – US (pool > 8cm or AFI > 90th centile (à check growth, GTT, fetal wellbeing) Common Antenatal Problems Backache – due to ligaments relaxing (advise firm mattress & flat shoes) CTS - due to oedema (advise rest with arm elevates, splints, hydrocostisone injection, surgery) Constipation – due to progesterone relaxing (advise good diet, laxatives but NOT stimulants) Haemorrhoids – uterus reduces venous return à congestion + straining from constipation Heartburn – relaxation of sphincter, increased intraabdo pressure (advise sleep upright, antacids) Itching – due to infection, eczema, urticaria, scabies, rashes of pregnancy or cholestatis Leg cramps – affect 1/3 of women – beware DVT Nausea & Vomiting – usually from 6-16 weeks (can be severe = hyperemesis gravidarum), beware if not keeping food & fluid down Vaginal discharge – can become heavier but exclude infection (candida common) Varicose veins & ankle oedema – common due to impaired venous return (elevate legs) Hyperemesis Gravidarum Excessive vomiting requiring hospitalisation Mainly in 1st trimester & related to HCG levels, improves after 12-14 weeks Commoner with multiple gestations / molar pregnancy Can à dehydration, encephalopathy, GI bleeding & death Exclude infection, hyperthyroid & multiple/molar preg Management – hydration (oral/IV), assess nutrition, give antiemetics & vitamins, check U&E (high risk of low K+) Prolonged pregnancy ( >42 weeks) Offer membrane sweep à release endogenous PGs à increased incidence spontaneous labour Induction – decreases risk of fetal distress & meconium staining