Antepartum Care Flashcards
Antepartum care
- Preconception counseling
- Initial prental visit
- Nausea and vomiting
- Hyperemesis gravidarum
- Subsequent prenatal visits
- prenatal screening and diagnostic tests
Antepartum care
- provided by obstetrician, family doctor, midwife, or multidisciplinary team (based on patient preference and risk factors)
- Antenatal Records (province speci c)
Preconception counseling
- 3-8 wk GA is a critical period of organogenesis, so early preparation is vital
- past medical history
- supplementation
- risk modification
Preconception counseling:
- past medical history:
optimize illnesses and medications prior to pregnancy (see Medical
Complications of Pregnancy, OB26, and Medications in Pregnancy, OB11)
Preconception counseling:
- supplementation:
- folic acid: encourage diet rich in folic acid and supplement 8-12 wk preconception until end
of T1 to prevent NTDs
—- 0.4-1 mg daily in all women; 5 mg if previous NTD, antiepileptic medications, DM, or
BMI >35 kg/m2
- iron supplementation, prenatal vitamins
Preconception counseling:
- risk modification:
- lifestyle: balanced nutrition and physical tness
- medications: discuss teratogenicity of medications so they may be adjusted or stopped if
necessary - infection screening: rubella, HBsAg, VDRL, Pap smear, gonorrhea/chlamydia, HIV
- genetic testing as appropriate for high risk groups (see Prenatal Screening, Table 2); consider
genetics referral in known carriers, recurrent pregnancy loss/stillbirth, family members with
developmental delay or birth anomalies - social: alcohol, smoking, street drugs, domestic violence (see Family Medicine, FM11, FM13,
FM27)
Initial parental visit
- usually within 8- 12 wk of the rst day of LMP or earlier if <20 or >35 yr old, bleeding, very nauseous, or other risk factors present
- Antenatal Records are lled out on the rst prenatal visit
different part of Initial parental visit
- History
- physical exam
- investigations
Initial parental visit:
- History
- gestational age by dates from the rst day of the LMP
- if LMP unreliable, get a dating ultrasound which could coincide with nuchal translucency at ~12 wks
- dates should change if T1 U/S is greater than 5 days in di erence from LMP due date
- – Naegle’s rule: 1st day of LMP + 7 d – 3 mo
- –e.g. LMP = 1 Apr 2014, EDC = 8 Jan 2015 (modify if cycle >28 d by adding number of d >28)
- history of present pregnancy (e.g. bleeding, N/V) and all previous pregnancies
- past medical, surgical, and gynecological history
- prescription and non-prescription medications
- family history: genetic diseases, birth defects, multiple gestation, consanguinity
- social history: smoking, alcohol, drug use, domestic violence (see Family Medicine, FM11, FM13, FM27)
Initial parental visit:
- Physical exam
- complete physical exam to obtain baseline patient information
- BP and weight important for interpreting subsequent changes
- pelvic exam
Initial parental visit:
- investigations
- blood work
- urine R&M, midstream urine C&S
- pelvic exam
Initial parental visit:
- investigations
- Blood work
CBC, blood group and Rh status, antibody screen, infection screening as per preconception
counselling
Initial parental visit:
- investigations
- urine R&M, midstream urine C&S
screen for bacteriuria and proteinuria
Initial parental visit:
- investigations
- pelvic exam
Pap smear (only if required according to patient history and provincial screening guidelines), cervical or urine PCR for N. gonorrhoeae (GC) and C. trachomatis
