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Antenatal Care

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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  1. Antenatal Care Dr Clare Tower Clinical Lecturer St Mary’s Hospital

  2. Antenatal Care • Aim • Guide to antenatal clinics • Hand held notes • Antenatal examination • Assess risk • Down’s screening

  3. 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

  4. NICE – antenatal care • http://guidance.nice.org.uk/CG62/QuickRefGuide/pdf/English • ..\images\CG062QuickRefGuide.pdf

  5. 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

  6. Handheld notes • Page 1 • Medical and Social History • Previous pregnancies • Antenatal screening • Ultrasound • Record of Antenatal visits http://www.preg.info/pages/index.htm

  7. Antenatal examination • Ask permission • Blood pressure • Korotkoff V • Falls mid pregnancy • Increases to term • Urinalysis • Protein • Glucose

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

  9. 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

  10. Fetal lie Longitudinal transverse

  11. Presenting part Cephalic Footling Breech Extended breech

  12. Position Occipito-posterior OP Occipito-anterior OA

  13. 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

  14. Screening – Down’s • Increased risks of trisomy 21, 13 and 18 with maternal age

  15. 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%

  16. Screening tests • Many options • Measurements of hormone levels • USS assessment of nuchal translucency • 11-13+6

  17. Screening – which test?

  18. 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

  19. Summary • Antenatal care important- improves outcomes • Most Drs meet pregnant women • Clinical signs to find!!

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