Week 9 Flashcards
Antenatal care ANC
Is a planned examination and observation of the woman from conception till the birth
Antenatal care is a perfect example of preventative medicine
what are we trying to prevent “maternal and perinatal mortality and morbidity”
Maternal mortality is the health indicator that shows the greatest differential between developing and industrialised countries
The lifetime risk of death as a result of pregnancy or childbirth is estimated at one in 23 for women in some countries in Africa compared with about one in 7000 for women in Northern Europe
Importance of antenatal care
To ensure that the pregnancy woman and her fetus are in the best possible health
Pregnancy is a physiological state
To detect early and treat properly complications
-identify women at risk
-low risk- midwife care
-high risk- obstetrician care
Offering education for parenthood
To prepare the woman for labour, lactation and care of her infant
Why mothers die
Thromboembolism
Pre eclampsia and eclampsia
Cardiac disease
Maternal mortality decreased rapidly after 1940: skilled attendants, antibiotics, banked blood, surgical improvements
We collect info about all women
Put them through comprehensive preconception and antenatal and newborn pathway
Eg screening for diabetes and Down syndrome
ANC pathyway in NHS
Antenatal care
Routine care for all pregnant women
Women needing additional care
-women with pre existing conditions or risk factors
-women who has problems in previous pregnancy
-diabetes in pregnancy pathway
-hypertension in pregnancy
-multiple pregnancy pathway
-pregnancy and complex social factors pathway
-interventional procedures for some complications in pregnancy
pregnancy care booklet
First few pages assess mother for risk during pregnancy
This allows you to make a decisions on whether-
-low risk: suitable for midwife care
-high risk: required obstetrician care
Social assessment booking partner details: women who have partners are at lower risk
High risk when mothers smoke, drug, alcohol and ethnic origin
Medical history and mental health also play important role
Family history of hypertension and DM have big influence
Outcomes from previous birth
Basic principles of antenatal care
Midwives and GPs should care for women with an uncomplicated pregnancy providing continuous care though out pregnancy. Obstetricians and specialist team should be involved where additional care is needed
Antenatal appointments should take place in location that women can easily access.
Maternity records should be structures, standardised, national maternity records, held by women
In an uncomplicated pregnancy 10 appointments for nulliparous women and 7 for parous women
Each antenatal appointment should have structure and. Focus. Appointments in early pregnancy should be longer to provide info and time for discussion about screening so that women can make informed decisions
If possible incorporate routine tests into the appointments to minimise inconvenience
Women should feel able to discuss sensitive issues and disclose problems. Be alert to the symptoms and signs of domestic abuse
NICE guidelines
Schedule of appointments
First contact with HCP:
-folic acid supplements
-food hygiene including how to reduce risk of food acquired infection
-lifestyle including smoking cessation, recreational drug use and alcohol consumptions
-all antenatal screening including risks, benefits, limitations of the screening tests
Vitamin D 10mcg/day
Booking appointment ideally by 10 weeks
Identify women need additional care
Measure height and weight and calculate BMI
Blood pressure test urine proteinuria
Risk factors preeclampsia and GDM
Blood tests, blood group, RhD, anaemia
Asymptomatic bacteriuria
Chlamydia
Screening Down’s syndrome
Early US for gestational age assessment and structural anomalies
FGM
Several mental illness or psychiatric treatment
Mood to identify possible depression
Occupational risks
Screening pregnancy
Screening for haematological conditions: sickle cell, thalassaemias
Screening for foetal anomalies:
Anomaly scan 18-20 weeks:
-if woman chooses US should be performed between 18 (0 days)-20 weeks(6 days) to detect structural anomalies
-for a woman whose placenta extends across the internal cervical os offer another scan at 32 weeks
Women needing additional care
Cardiac disease incl hypertension
Renal disease
Endocrine disorders or diabetes requiring insulin
Psychiatric disorders
Haematological disorders
Autoimmune disorders
Epilepsy requiring anticonvulsant durgs
Malignant Disease
Severe asthma
Use of recreational drugs
HIV or HBV infection
Obesity
Higher risk complications women over 40, smoke
Women who are particularly vulnerable- teenagers or who lack social support
Additional care women who experienced this in previous pregnancies
Recurrent miscarriage 3 or more
Preterm birth
Severe preeclampsia, HELLP syndrome or eclampsia
Rhesus
Uterine surgery inclu c section
Antenatal or postpartum haemorrhage on 2 occasions
Puerperal psychosis
Grand multiparity 4 or more
Stillbirth or neonatal death
SGA infant
LGA infant
Baby weighing below 2.5kg or above 4.5kg
Baby with congenital abnormality
16 weeks examination
Screening tests
BP and test urine proteinuria
Hb below 11g/100ml consider iron supplements
Routine anomaly scan specific info
25 weeks for nulliparous women
Measure bp and proteinuria
Symphysis-fundal height
28 weeks
BP and proteinuria
Second screening for anaemia and atypical red cell alloantibodies
Hb level below 10.5g/100ml consider iron
Anti-D prophylaxis RhD-
Symphysis fundal height
31 weeks for nulliparous women
Screening tests at 28 weeks discuss
Bp and urine test
Symphysis- fundal height
34 weeks
Screening test discuss
BP and urine test
Second dose of anti-D prophylaxis RhD-
Symphysis- fundal height
Specific info on prep labour and birth, birth plan, recognising active labour and coping with pain
36 weeks
Bp and urine test
Symphysis-fundal height
Position of baby, if breach offer external cephalic version
Info: breastfeeding, care new baby, VitK prophylaxis , newborn screening tests, postnatal self care, awareness of baby blues and postnatal depression
38 weeks
BP and urine
Symphysis fundal height
Info: options of management for prolonged pregnancy
40 weeks nulliparous women
BP and urine test
Symphysis fundal height
Discussion management prolonged pregnancy
41weeks
Who haven’t given birth yet:
-offer membrane sweep
-offer induction of labour
-BP and test urine
-measure symphysis fundal height
From 42 weeks offer women who decline induction of labour increased monitoring (at least twice weekly cardiotocography and US exam of max amniotic pool depth
Lifestyle advice
Work: occupational risk, safe to keep work, maternity rights and benefits
Nutritional supplements: folic acid before conception and first 12 weeks, vit D pregnancy and breastfeeding, don’t recommend routine iron supplements, risk for brith defects associated with vit A and to avoid vit A and liver products
Avoiding infection: reduce risk listeriosis and salmonella and how to avoids toxoplasmosis infection
Medicines: prescribe as few medicines as possible
Complementary therapies: use few
Exercise: no risk but avoid sports with abdominal trauma, falls or excessive joint strain, scuba diving
Sexual intercourse:L safe
Alcohol: avoid
Smoking: avoid
Cannabis: avoid
Air travel: increase risk venous thrombosis
Car travel: seatbelt above and below bump
Travel abroad: discuss flying, vaccinations and travel insurance with midwife or doctor
How ANC works: example preeclampsia
Unique to pregnancy
Associated with:
-raised blood pressure >140/90,mmHg
-proteinuria (at least 1+ urine dipstick)
Presents after 20 weeks gestation but mainly 3rd trimester