Antenatal care

Pre conception counselling

 Smoking

 Alcohol

 Drugs

 Diet

 Exercise

 Folic acid
 Pre conception counseling
 Family history
 Personal history
 Past obstetric history
 Folic acid
 Rubella status
 First visit
 LMP EDD
 POH

 MH

 PMH

 Drugs

 Allergies
 First visit
 Smoking

 Alcohol

 FH

 Advise

 Exemption card
 Referral
 Low risk pregnancies
 12-14/52 hosp visit
 Routine blood tests
 Blood group + rhesus factor
 Fbc + haemoglobinopathies if indicated
 Randon blood sugar
 Treponemal antibody
 Hep b
 Hiv
 pappa
 Low risk pregnancies

 Hosp visit 12-14/52

 History

 Nuchal transluceny scan

 Low risk pregnancy
 15 weeks

 Serum AFP and downs screening

 If booking scan not done before 14 weeks

 Low risk pregnancy
 23 weeks – anomally scan
 26 weeks – midwife/gp
 28 weeks – fbc + antibodies
 30 weeks – midwife/gp
 34/36/38/40 weeks – midwife/gp
 41 weeks - hosp
 Exercise
 Non – contact sport only after 16/52
 Intensity decreased by 25%
 HR under 140/min
 Core temp < 38
 Strenuous exercise limited to 15-20 mins
 Antenatal visits
 Weight gain 12-15kg in total
 BP dias. >90 or increase > 20 from first visit is
significant
 Urinalysis watch for protein glucose uti
 Fetal movements
 Uterine size
 Fetal lie presentation
 Common discomforts
 Pelvic pains – ligamental stretch
 Urinary frequency - ? Uti
 Ankle swelling – ivc compression
 Varicosities – support stockings
 Heartburn – posture antacids
 Constipation – fluids, fibre, fybogel
 Common discomforts

 Low back pain – posture and relaxin

 Dental decay – see dentist
 Skin changes – chloasma
 Itch – iron def, cholestasis antihistamines
 Stretach marks - moisturisers
 First trimester
 Ectopic preg
 Sharp pain
 Irregular vaginal bleeding
 Abdo tenderness
 Dizziness or fainting
 Ectopic pregnancy
 Diagnosis

 Pos preg test

 Serial hcg levels they increase more slowly

 Progesterone level lower than normal

 Ultra sound scan vaginally/abdominally

 Ectopic pregnancy risk factors
 PID
 Previous tubal preg or tubal surgery
 Endometriosis
 IUD
 Multiple induced abortions
 Drugs that stimulate ovulation
 Ectopic pregnancy treatment

 Tube not ruptured

 Methotrexate

 Salpinostomy flushng the tube out

 Laparoscopic removal
 Ectopic pregnancy treatment

 Tube ruptured

 Laparoscopic removal of embryo and tube

 Miscarriage

 Symptoms

 Pv bleeding

 Colicky pain

 Refer to EPAU
 hyperemesis
1 in 300 preg
 Weeks 8-20
 Cause unknown – high oestrogen & hcg
 More commom multiple preg obesity first babies
 Treatment
 Exclude other causes
 Drink small amounts frequently
 Diet high in cho and proteins
 Admit for iv fluids if severe, dehydrated or
electrolyte imbalance
 Drugs -
 Anaemia
 Symptoms

 Fatigue weakness
 Pallor

 Dizziness or fainting
 SOB

 palpitations
 Anaemia

 Treatment

 Diet

 Pregaday

 Does not alter outcome in most cases

 Infection in pregnancy

 Chicken pox – only 2% of infections age > 20yrs

 3% risk of fetal damage in first 20/52
 If mum’s rash develops 1/52 before delivery or to 4/52 after
baby can get sever infection needs protection
 No risk between 20/52 and term
 If no history of cp check varicella antibodies
 If non immune needs VZ Ig no later than 10 days from exposure
 Infections in pregmnancy
 Rubella – 2-10/52 90% chance of featal damage
 Toxoplasma gondii 89% adults not immune
 If fetus infected 10% chance of fetal damage
 Avoid kittens particularly litter trays
 Eat well cooked meat
 Wash vegetables
 Listeria – soft cheeses, pate. Cookchill foods
 Pre eclampsia

 Raised BP

 Proteinura

 XS swelling
 Pre eclampsia

 3-4% pregnancies

 !% very severe

 50,000 deaths world wide

 Pre eclampsia
 Risk factors
 Young mothers teenagers
 Older mothers > 35 yrs
 Family history
 First pregnancy
 New father
 Diabetes
 hypertension
 Pre eclampsia
 Serious adverse effects
 Fits
 Stroke
 Pulmonary oedema
 Kidney failure
 Liver damage
D I C
 Pre eclampsia
 Warning signs
 Raised bp
 Proteinuria
 Xs swelling
 Headcahe
 Flashing lights
 Vomiting
 Upper abdo pain
 Pre eclampsia
 Treatment
 Lower bp
 Magnesium sulphate
 Deliver baby
 Aspirin
 Metabolic syndrome
 Gestational diabetes
 Plenty of insulin, but insulin malfunctioning
 Macrosomia > 4500g
 Problems with labour and delivery
 Newborn has low blood sugar
 Increased risk stillbirth
 Proper management prevents increased risk
ofcomplications
 Risk factors
 Incidence 1%-3% pregnancies
 Family history
 Obesity
 Maternal age > 30 yrs
 Previous large baby
 Prior icidence of gestational diabetes
 Ethnic group – south asians, mexican american
 Treatment
 Control blood sugar
 Exercise

 Diet

 Blood glucose monitoring

A few will need insulin
 Intra uterine growth retardation
 Birth weigth < 2500g
 Causes
 Smoking
 Poor nutrition
 Placental factors
 Maternal ill health
 Risk factors
 Smoking
 Drug and alcohol use
 Severe malnutrition
 Maternal high bp, or pre eclampsia
 Infections – cmv, rubella, toxoplasma
 Chronic maternal disease – diabetes,
rheumatological
 Diagnosis

 Fundal height – 18-34/52 height = distance in cm

 Ultra sound – ratio of head circumference to abdo

 Treatment
 Stop smoking
 Good nutrition
 Bed rest on left side
 Fetal movement chart
 Serial ultrasound scans
 Volume of amniotic fluid
 Hydatidiform mole

 Incidence 1 in 2000 preg

 Increased risk with age

 Abnormalities in sperm chromosome

 Abnormalities of egg
 Hydatidiform mole
 Signs
 Uterus larger than date
 Vaginal bleeding

 Diagnosis
 Ultrasound
 Hcg higher than normal
 Hydatidiform mole
 Treatment
 Suction curettage

 Monitor hcg for several months due to risk of choriocarcinoma

 Postpone preg for a year

 APH
 Placenta abruptio
 1% of all deliveries
 Vaginal bleeding in 3rd trimestre
 Constant back or abdo pain
 Contractions tenderness or rigidity of uterus
 Risk factors
 Smoking
 Pergnancy induced hypertension
 Alcohol or drug use
 Increased maternal age >40 yrs
 Premature rupture of membranes
 Injury to mother
 Diagnosis
 No clear test
 May or may not show on ultrasound
 Exclusion of other causes of bleeding – placenta
praevia
 Treatment
 Evaluate maternal well being

 Monitor

 Evaluate fetal well being

 If severe bleeding or fetal distress cesarean

 Placenta previa
 4-8% placentas low lying
 Only 10% remain low
 Marginal – placenta near edge of os
 Partial – placenta covers cervical opening
 Total – placent completely covers os
 All need cesarean
 Placenta previa
 Signs
 Painless bright red vaginal bleeding
 Risk factors
 Smoking
 Firstpreg after lscs
 Previous placenta previa
 Advanced maternal age
 Placenta previa
 Diagnosis

 Ultrasound

 Treatment

 lscs
 Post term pregnancy
> 42/52
 Risks
 Reduced amniotic fluid increased risk of cord
compression
 Meconium in liquor inhlaed by baby causing
pneumonia
 Too large baby > 4500g
 Management
 Monitor baby
 Too large baby
 Decreased amniotic fluid
 Deliver if cervix ripe try oxytocinon
 If cervix not ripe try prostaglandin gel
 Otherwise lscs
 Pre term labour

 Labour before end of 36th week preg

 Low birth weight < 2500g

 8-12% of all pregnancies

 Signs and symptoms
 Regular uterine contractions for more than 1 hr
 Backache

 Intestinal cramping with or without diarrhoea

 Spotting or blood tinged discharge
 Thin cervix, dilation beyond 1 cm, contractions
 Risk factors
 Smoking alcohol drugs
 Previous pre term delivery
 3 or more 1st trimestre miscarriages
 Cervical incompetence
 Placenta previa
 Serious maternal infection
 Low maternal weight < 45 kg
 Postnatal care
 Maternal
 Lochia xs bleeding = pph admit
 Breasts – engorgement lasts 2-3 days mild temp
fell fluey
 Nipple pain- camomile creams daktarin if
candidal
 Mastitis – empty breast flucloxacillin
 Postnatal care
 Blood pressure
 Fundal height
 Perineum

 Symptoms of depression
 Contraceptive advice
 Postnatal care
 Fetal

 Method of delivery
 Length of gestation
 Weight

 Feeding

 concerns
 Postnatal care
 Fetal examination
 Fontanelles
 Eyes- cataract
 Sclera – jaundice
 Hs
 Lungs
 Abdo - masses
 Postnatal care
 Fetal exam
 Genitalia

 Hips

 Femoral pulses
 Spine

 Birth marks
 6 week exam
 Maternal
 Feeding
 Depression
 Lochia
 Contracption
 Bp
 Abdo exam
 Smear if due
 6 week exam
 Fetal
 According to chs schedule