Pre-conception counselling

Question 1

A 28-year-old comes to your GP clinic to talk about having a baby. She has been on the pill for the past two years and stopped 2 months ago and has been trying to conceive since then. Discuss how you would counsel her.

Answer 1

Impression
patient of reproductive age interested in falling pregnant.

Key points of discussion:

• patient education re infertility, natural family planning
• discuss any concerns re contraception
• optimisation of maternal and fetal health

Question 2

Pre-conception counselling - History

Answer 2

History

• PC: feeling well? pain?
• menstrual history: cycle length, regularity, returned to baseline since ceasing pill?
• partner Hx (if relevant and present)
• Obstetric Hx: GTPAL, past complications
• PMHx: PCOS, HTN, diabetes, thyroid disease, autoimmune diseases
• medications: identify anty teratogenic (anti-epileptics, warfarin, etc)
• family history
• social: vaccinations up to date?
• SNAP

Question 3

Pre-conception counselling - Examination

Answer 3

Examination

• general appearance + vitals + anthropometric
• other baseline examinations if clinically relevant

Question 4

Pre-conception counselling - Investigations

Answer 4

Investigations
would conduct routine antenatal care investigations;
- haematology: FBC, UEC, LFT, blood group, antibody status, vitamin panel,
- serology: TORCH, other (HIV, syphillis, varicella)
- chronic disease screening if appropriate (diabetes, hen, etc)
- genetic screening, fertility support as necessary

Question 5

Pre-conception counselling - Management

Answer 5

Management
Patient education
- infertility is 12 months of trying with no conception (6 months if >35), approx 85% of couples will conceive in this time - it is a tricky process!
- timing of intercourse: ovulation is 14 days post-menses, can use temperature charts/tracking cervical mucus/home ovulation (urinary LH) kits to track for ovulation and target sexual activity

Contraception
- depending on what type of pill used, unless depot injections should be at baseline fertility rate pre-pill immediately after ceasing.

Optimise health

• mental health
• lifestyle changes (diet, exercise)
• discussion regarding supplementation (folic acid, vitamins, iron, etc)
• smoking, alcohol cessation
• vaccination if not already up to date (MMR and Varicella are live vaccines and can’t be given in pregnancy)