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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

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

slide6

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
slide8

Antenatal examination

  • Inspect
    • Distension
    • Linea nigra
  • Palpate
    • Symphysio-fundal height
    • Fundus to top to symphysis
    • 20 weeks = umbilicus
    • 1cm per week
slide9

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

slide14

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
slide18

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!!