The Booking Visit

Question 1

When does the booking visit happen?

Past obstetric factors to ask during booking

Answer 1

8-10 weeks

Whether the woman has been pregnant before and if so has she delivered and how did she deliver?
- Get the story of the pregnancy and the delivery (any health complications during pregnancy, any complications during or after birth, any need for induction, augmentation or assisted delivery?)

Question 2

What PMH and FH factors are important to ask?

Answer 2

PMH

• Heart disease/diabetes/HTN/asthma/epilepsy/jaundice/kidney problems/clots
• Ever had surgery?

FH

• Twins?
• How were your mothers pregnancies?
• Inherited conditions/heart problems/DM/HTN

Question 3

What can you calculate at the booking visit?

How do you calculate

Answer 3

Can give the mother an ESTIMATED DUE DATE (take the date of her LMP + 7/7 + 9/12)
- This will be updated and made more accurate at the dating scan (11+2-14+0)

Question 4

What factors of the social and drug history are important?

Answer 4

• Note ALL Drugs and medications and allergies

- Do you take folic acid?

Question 5

What advice should be given about smoking during the peri-natal period?

Answer 5

That it should be stopped for the entire pregnancy as it can lead to:
- FETAL GROWTH RESTRICTION (due to hypoxia and placental insufficiency)
- LOW BIRTH WEIGHT
- INTELLECTUAL AND EMOTIONAL IMPAIRMENT
Also associated with increased rates of:
- PREMATURE BIRTH, PLACENTAL ABRUPTION, IUD, SUDDEN INFANT DEATH

Question 6

What examinations should be done in the booking visit?

Answer 6

BP, HR, Baseline weight and height
Abdominal examination

URINE - look for proteins and glucose - infections MUST be treated

BOOKING BLOODS

Question 7

When will you first be able to palpate the funds of the uterus?

Answer 7

12 weeks

Question 8

What bloods are taken on routine booking bloods and what are you looking for?

Answer 8

• FBC (exclude anaemia and thrombocytopenia)
• Heamaglobinopathies (Hb electrophoresis)
• Blood group / Group and Save (get blood group and also ascertain Rhesus status)
• HIV
• HepB
• Syphilis
• Rubella Status

Question 9

What final thing should be discussed with the woman at booking?

Answer 9

Her preferred mode of delivery
- Discuss the benefits and risks of vaginal and CS and use her previous history to discuss the risks to her

Encourage VBAC (70-75% chance of success)

Question 10

What is a summary of everything at booking visit? (8)

Answer 10

• Calculate EDD book first dating scan
• Ensure access to maternity services
• Offer, gain informed consent for screening
• First bloods
• Complete medical, obstetric, social and mental health assessment
• Help determine safe place for birth
• Determine risk and appropriate plans
• Health education and advise vaccinations