Prenatal counselling Flashcards
Describe the history needed for a prenatal consult
Family planning history
o Ready to start a family now
o Ever tried before? Previous conceptions?
Brief sexual history
o Frequency of sexual intercourse
o Type of sex - anal or vaginal
o Contraception
Past medical history
o Long term conditions
o Surgeries
o Cervical smears
o Menstruation - pattern of periods, LMP
o Any ejaculatory or erectile concerns in the partner
o Vaccinations
o Family history of genetic diseases
o Regular medications - are they taking folic acid and iodine
Social history
o Smoking
o Alcohol
o Recreational drug use
o Diet, exercise, and weight
o Living circumstances - support, pets
o Occupational hazards
Patient perception
o Check understanding about conceiving
o Check understanding of how to increase chances of conceiving
o Any concerns about conceiving
Things to discuss in a prenatal consult
General information
* What is needed for conception to occur –> sperm from male needs to fertilize egg in female so it can grow into a baby
* Vaginal sex with ejaculation inside the vagina –> vagina is passageway to the uterus so need to ejaculate inside the vagina (focus on vaginal sex). Aim for vaginal sex 2-3x per week without contraception
* Need to remove contraception (IUD, Jadelle) for conception - provide a timeframe for return to fertility
* Optimal timing for conception is at the time of ovulation –> mid-cycle
* 85% of couples conceive within 1 year - after this fertility support can be requested
Lifestyle changes
* Smoking –> reduced fertility, general health, baby’s growth, and development. Offer quit smoking services
* Alcohol –> IUGR, intellectual impairment, facial abnormalities, behavioral problems, general health. Important to not have alcohol in early pregnancy as this is the time of neural tube development and organogenesis. Offer support to help quit drinking
* Weight loss aiming for BMI < 25 –> increases chances of conceiving and reduces risk of pregnancy and birthing issues (pre-term delivery, GDM, C/S, VTE)
* Balanced diet –> lots of vegetables and leafy greens
* Folic acid –> 400mcg / day 3 months preconception and 1st trimester. Type of vitamin B that helps with neural tube development preventing problems like spina bifida
* Iodine
* Ensure vaccinations up to date (vaccination schedule + influenza + COVID boosters)
* Avoid people with rubella and chickenpox as can affect fetus
