This document outlines the key aspects of antenatal care including preconception counseling, routine visits and tests for low-risk pregnancies, common discomforts and complications, screening and management of issues like preeclampsia, gestational diabetes, and intrauterine growth restriction. It also discusses postnatal care for both the mother and baby. The overall aim is to provide guidance on monitoring and promoting a healthy pregnancy.

1. Antenatal care

2. Pre conception counselling
 Smoking
 Alcohol
 Drugs
 Diet
 Exercise
 Folic acid

3. Pre conception counseling
 Family history
 Personal history
 Past obstetric history
 Folic acid
 Rubella status

4. First visit
 LMP EDD
 POH
 MH
 PMH
 Drugs
 Allergies

5. First visit
 Smoking
 Alcohol
 FH
 Advise
 Exemption card
 Referral

6. 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

7. Low risk pregnancies
 Hosp visit 12-14/52
 History
 Nuchal transluceny scan

8. Low risk pregnancy
 15 weeks
 Serum AFP and downs screening
 If booking scan not done before 14 weeks

9. 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

10. 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

11. 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

12. Common discomforts
 Pelvic pains – ligamental stretch
 Urinary frequency - ? Uti
 Ankle swelling – ivc compression
 Varicosities – support stockings
 Heartburn – posture antacids
 Constipation – fluids, fibre, fybogel

13. Common discomforts
 Low back pain – posture and relaxin
 Dental decay – see dentist
 Skin changes – chloasma
 Itch – iron def, cholestasis antihistamines
 Stretach marks - moisturisers

14. First trimester
 Ectopic preg
 Sharp pain
 Irregular vaginal bleeding
 Abdo tenderness
 Dizziness or fainting

15. Ectopic pregnancy
 Diagnosis
 Pos preg test
 Serial hcg levels they increase more slowly
 Progesterone level lower than normal
 Ultra sound scan vaginally/abdominally

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

17. Ectopic pregnancy treatment
 Tube not ruptured
 Methotrexate
 Salpinostomy flushng the tube out
 Laparoscopic removal

18. Ectopic pregnancy treatment
 Tube ruptured
 Laparoscopic removal of embryo and tube

19. Miscarriage
 Symptoms
 Pv bleeding
 Colicky pain
 Refer to EPAU

20. hyperemesis
 1 in 300 preg
 Weeks 8-20
 Cause unknown – high oestrogen & hcg
 More commom multiple preg obesity first babies

21. 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 -

22. Anaemia
 Symptoms
 Fatigue weakness
 Pallor
 Dizziness or fainting
 SOB
 palpitations

23. Anaemia
 Treatment
 Diet
 Pregaday
 Does not alter outcome in most cases

24. 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

25. 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

26. Pre eclampsia
 Raised BP
 Proteinura
 XS swelling

27. Pre eclampsia
 3-4% pregnancies
 !% very severe
 50,000 deaths world wide

28. Pre eclampsia
 Risk factors
 Young mothers teenagers
 Older mothers > 35 yrs
 Family history
 First pregnancy
 New father
 Diabetes
 hypertension

29. Pre eclampsia
 Serious adverse effects
 Fits
 Stroke
 Pulmonary oedema
 Kidney failure
 Liver damage
 D I C

30. Pre eclampsia
 Warning signs
 Raised bp
 Proteinuria
 Xs swelling
 Headcahe
 Flashing lights
 Vomiting
 Upper abdo pain

31. Pre eclampsia
 Treatment
 Lower bp
 Magnesium sulphate
 Deliver baby
 Aspirin
 Metabolic syndrome

32. 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

33. 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

34. Treatment
 Control blood sugar
 Exercise
 Diet
 Blood glucose monitoring
 A few will need insulin

35. Intra uterine growth retardation
 Birth weigth < 2500g
 Causes
 Smoking
 Poor nutrition
 Placental factors
 Maternal ill health

36. Risk factors
 Smoking
 Drug and alcohol use
 Severe malnutrition
 Maternal high bp, or pre eclampsia
 Infections – cmv, rubella, toxoplasma
 Chronic maternal disease – diabetes,
rheumatological

37. Diagnosis
 Fundal height – 18-34/52 height = distance in cm
 Ultra sound – ratio of head circumference to abdo

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

39. Hydatidiform mole
 Incidence 1 in 2000 preg
 Increased risk with age
 Abnormalities in sperm chromosome
 Abnormalities of egg

40. Hydatidiform mole
 Signs
 Uterus larger than date
 Vaginal bleeding
 Diagnosis
 Ultrasound
 Hcg higher than normal

41. Hydatidiform mole
 Treatment
 Suction curettage
 Monitor hcg for several months due to risk of choriocarcinoma
 Postpone preg for a year

42. APH
 Placenta abruptio
 1% of all deliveries
 Vaginal bleeding in 3rd trimestre
 Constant back or abdo pain
 Contractions tenderness or rigidity of uterus

43. Risk factors
 Smoking
 Pergnancy induced hypertension
 Alcohol or drug use
 Increased maternal age >40 yrs
 Premature rupture of membranes
 Injury to mother

44. Diagnosis
 No clear test
 May or may not show on ultrasound
 Exclusion of other causes of bleeding – placenta
praevia

45. Treatment
 Evaluate maternal well being
 Monitor
 Evaluate fetal well being
 If severe bleeding or fetal distress cesarean

46. 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

47. Placenta previa
 Signs
 Painless bright red vaginal bleeding
 Risk factors
 Smoking
 First preg after lscs
 Previous placenta previa
 Advanced maternal age

48. Placenta previa
 Diagnosis
 Ultrasound
 Treatment
 lscs

49. 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

50. Management
 Monitor baby
 Too large baby
 Decreased amniotic fluid
 Deliver if cervix ripe try oxytocinon
 If cervix not ripe try prostaglandin gel
 Otherwise lscs

51. Pre term labour
 Labour before end of 36th week preg
 Low birth weight < 2500g
 8-12% of all pregnancies

52. 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

53. 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

54. 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

55. Postnatal care
 Blood pressure
 Fundal height
 Perineum
 Symptoms of depression
 Contraceptive advice

56. Postnatal care
 Fetal
 Method of delivery
 Length of gestation
 Weight
 Feeding
 concerns

57. Postnatal care
 Fetal examination
 Fontanelles
 Eyes- cataract
 Sclera – jaundice
 Hs
 Lungs
 Abdo - masses

58. Postnatal care
 Fetal exam
 Genitalia
 Hips
 Femoral pulses
 Spine
 Birth marks

59. 6 week exam
 Maternal
 Feeding
 Depression
 Lochia
 Contracption
 Bp
 Abdo exam
 Smear if due

60. 6 week exam
 Fetal
 According to chs schedule