Antenatal check

Data gathering

  • Red flags – Abdominal pains, PV bleeding, Reduced fetal movements
  • Others – EDD

 

Clinical management

  • First contact – folic acid, lifestyle (diet, alcohol, smoking, travel, occupation), screening
    • Smoking – NRT. Alcohol – 1-2 units/week (avoid in first 3mo).
    • Diet – avoid raw meat, fish, eggs, liver, soft cheeses, unpasteurised milk, 2 mugs of coffee.
    • Medications – avoid NSAIDs.
    • Benefits – free prescriptions during and 12months after pregnancy
    • N&V – dry toast, small amounts often, fluids++, avoid fatty foods, anti-emetics
  • Booking
    • BMI
    • BP
    • Urine dip
    • Bloods – blood group, Rh status, FBC, haemoglobinaopathies, HBV, HIV, rubella, syphillis
  • Screening – DS (12 weeks and 20 week scans)
  • Diabetes – OGTT at 24 weeks –
    • Risk factors – BMI >30, prev big baby (>4.5kg), preg gest diabetes, FH diabetes
  • 25 weeks – BP, urine, SFH, fetal movements, PVB, abdo pain
  • 28 weeks – BP, urine, SFH, FBC, anti D (if Rh negative), birth plan, fetal movements, PVB, abdo pain
  • 36 weeks – position, breast feeding, post natal care, fetal movements, PVB, abdo pain
  • 41 weeks – membrane sweep, induction of labour, fetal movements, PVB, abdo pain

 

First contact other points:

  • Vitamins
    • Folic acid – 5mg if cardiac, DM, epilepsy, sickle cell
    • Vitamin D 10 micrograms
    • Lifestyle
    • Diet, exercise, alcohol
    • Smoking – NRT safer than smoking. Medications contraindicated.
  • N&V
    • rule out: molar pregnancy, UTI
    • urine dip: if ketones+++ – refer
    • improves by 16/40
    • lifestyle: frequent and small meals, avoid fatty/spicy foods
    • medications: cyclizine
  • Reflux
    • lifestyle: frequent and small meals
    • medications: gaviscon, ranitidine
  • Travel
    • up to 36/40
    • compression stockings, belt above+below bump