Obstetrics - Pre-pregnancy care and counselling

Question 1

General pre-pregnancy care plan for all women

Answer 1

present prior to conception to their GP
* Risk assessment and screening
* Assessment of need for vaccination
* Folate supplementation
* General advice to optimize maternal health
* General counselling
* ± assessment of fertility

Question 2

General pre-pregnancy care plan for women with medical disorders

Answer 2

Question 3

General pre-pregnancy care plan for women with abdnormal past pregnancies

Answer 3

Question 4

List risk factors for adverse pregnancy outcomes
- Categorize maternal and fetal factors

Answer 4

Question 5

Causes of IUGR

Answer 5

Question 6

Causes of Macrosomia

Answer 6

Question 7

Outline assessments during pre-pregnancy counselling

Answer 7

Full obstetric history
Full medical/ surgical/ social/ family/ psychiatric history

Physical exam:
- General exam (Full Obstetric abdominal exam +/- Pelvic exam)
- Uterine size
- Cervical smear (opportunistic screening)

Investigations:
* Hb, MCV - for maternal thal, Fe def
* Rh - for maternal Rh -ve
* VDRL - for maternal syphilis → confirmed by FTA-Abs
* Rubella Ab - for maternal immunity
* HIV - for maternal HIV → confirmed by western blot
* HBsAg - for maternal HBV infection

Question 8

Routine supplementation and pre-conceptual care plan

Answer 8

Vaccination for rubella, varicella, measles
- Live attenuated vaccines → a/w theoretical risk of vertical transmission
- Require contraception ×28d following administration

Seasonal influenza vaccine (IM one is inactivated → no risk in pregnancy)

Lifestyle advice
- Nutritious diet
- Regular moderate exercise
- STOP smoking, drinking and use of illicit drugs

Folate supplementation
- Routine - 0.4mg QD
- ↑risk - 5mg QD, eg. those on AED, DM, Hx of NTD, thalassaemia, ↓folate levels (eg. IBD, SGS)