Antenatal care
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Antenatal Care. Dr Clare Tower Clinical Lecturer St Mary’s Hospital. Antenatal Care. Aim Guide to antenatal clinics Hand held notes Antenatal examination Assess risk Down’s screening. Antenatal clinics. Large amount of antenatal care now provided by midwives

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Antenatal Care

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Antenatal care

Antenatal Care

Dr Clare Tower

Clinical Lecturer

St Mary’s Hospital


Antenatal care1

Antenatal Care

  • Aim

  • Guide to antenatal clinics

  • Hand held notes

  • Antenatal examination

  • Assess risk

  • Down’s screening


Antenatal clinics

Antenatal clinics

  • Large amount of antenatal care now provided by midwives

  • Mixture of midwifery & medical clinics

    • Medical history – identify high risk women

    • Drug history

    • Screening

    • Ultrasound examinations

    • Health promotion

    • Clinical examination


Nice antenatal care

NICE – antenatal care

  • http://guidance.nice.org.uk/CG62/QuickRefGuide/pdf/English

  • ..\images\CG062QuickRefGuide.pdf


Summary of schedule

Summary of schedule

  • Primips: 10 visits + anomaly scan (20 weeks)

  • Multips: 7 visits + anomaly scan

10 16 2025 28 31 34 36 38 40 41

USS

Booking

Red = extra visits for primips


Antenatal care

Handheld notes

  • Page 1

  • Medical and Social History

  • Previous pregnancies

  • Antenatal screening

  • Ultrasound

  • Record of Antenatal visits

http://www.preg.info/pages/index.htm


Antenatal examination

Antenatal examination

  • Ask permission

  • Blood pressure

    • Korotkoff V

    • Falls mid pregnancy

    • Increases to term

  • Urinalysis

    • Protein

    • Glucose


Antenatal care

Antenatal examination

  • Inspect

    • Distension

    • Linea nigra

  • Palpate

    • Symphysio-fundal height

    • Fundus to top to symphysis

    • 20 weeks = umbilicus

    • 1cm per week


Antenatal care

Antenatal examination

  • Palpate

    • Fetal lie =Longitudinal axis of baby to that of the mother

    • Presenting part = what is coming 1st

    • Position- laterality of occiput or sacrum

    • Engagement – amount of head you can feel in fifths

  • Auscultate fetal heart

    • Ask about fetal movements


Fetal lie

Fetal lie

Longitudinal

transverse


Presenting part

Presenting part

Cephalic

Footling Breech

Extended breech


Position

Position

Occipito-posterior

OP

Occipito-anterior

OA


Head engagement

Head engagement

  • Amount of head in ‘fifths’ you can feel in the abdomen

Fully engaged = more head in pelvis than in abdomen

= 2 fifths palpable


Antenatal care

Screening – Down’s

  • Increased risks of trisomy 21, 13 and 18 with maternal age


Screening downs

Screening - Downs

  • Problem: only way of providing a diagnosis is amniocentesis or chorionic villus biopsy/ sampling (CVB/CVS)

  • Risk of miscarriage:

    • Amnio 1%

    • CVS higher ? 2%


Screening tests

Screening tests

  • Many options

  • Measurements of hormone levels

  • USS assessment of nuchal translucency

    • 11-13+6


Antenatal care

Screening – which test?


Antenatal care

Screening

  • By April 2007 – 75% detection rate for 3% false positives – no where near!!

  • Still only generates a ‘risk’ eg 1:1000

  • Generated risks heavily weighted to maternal age

  • Arbitarily defined ‘high risk’ of 1:200-1:250

    • Based on miscarriage risk from invasive testing


Summary

Summary

  • Antenatal care important- improves outcomes

  • Most Drs meet pregnant women

  • Clinical signs to find!!


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