Transcript Ante natal care - Derby GP Specialty Training Programme

Ante natal care
Sharon Wallis
Senior Matron
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Appropriate care pathway from start
Assessment of maternal & fetal well being
Early detection of pregnancy induced conditions or
exacerbation of pre exisiting ones
Appropriate & timely referral
Support women & their families
Importance of AN care
Place
of birth – hospital or
home
Choice of pain relief in labour
Continuity of care / carer
Choice, continuity & control!
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Ideally between 8 – 10 weeks gestation
Thorough social / obstetric /medical /family history
Includes mental health history
Routine enquiry into domestic abuse
Health advice – smoking / substance & alcohol misuse
/ diet / exercise
Maternity benefits
Screening / blood tests
Booking
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Support - benefits
Teenage
Safe guarding
Learning disabilities
Non English speaking / reading
Interpreters
Social history
Previous C/S
 PPH
 3rd degree tear
 IUFD / stillbirth
 Baby >4.5 kg
 IUGR
 Preterm labour
 Grand multip
 Retained placenta x 2
 Shoulder dystocia
 3 x consecutive 1st trimester miscarriage
 2nd trimester miscarriage
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Obstetric history
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Cardiac disease
Endocrine disease
Genital tract surgery
Haemaglobinopathies
BBV
BMI >35 /<18
Skeletal / spinal problems
Declines blood products
Malignancies
Severe asthma
Relevant medical history
 1st
degree relative with IDDM
 FH Pre eclampsia
 Thromboembolic disorders
 Congenital abnormalities / deafness
 FH – poor obstetric outcome
Family history
Past hx of severe MH disorders especially following
childbirth
 FH of severe MH disorders especially that required
hospitalisation
 Emphasis on early detection and referal to maternal
MH team
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Mental health
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Routine enquiry at least 3 times during pregnancy
episode
All women asked
RE + /Contact numbers highlighted
Safeguarding issues with disclosure
Domestic abuse
Smoking
 Alcohol
 Substance misuse
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Don’t do it!
Referal to Fresh start / drug and alcohol specialist
midwife if necessary
Health advice
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All women offered NT+ (combined screening)
between 11+ - 13+ weeks
FBC
Sickle + thalasaemia screening
Blood group & anti bodies
Microbiology screening
MSU
Screening
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Based on individual clinical need
As a minimum, women are seen;
At booking (8-10 weeks)
Dating scan +/- NT+ (RDH)
16 weeks
Anomaly scan (RDH)
24 weeks
28 weeks – repeat FBC / anti bodies / anti D if Rh neg
31 weeks
34 weeks – repeat FBC
36 weeks
38 weeks
Term
Manual BP / urinalysis / SF height measurement as minimum
AN visit schedule