Consideration Should Be Given To Maternal Preferences And Priorities Planning care: Assessment

Are any of the following present ? Identify women who may need additional care Women with other conditions:
(e.g. hypertension, cardiac or renal disease, endocrine, psychiatric, epilepsy, diabetes, haematological disorders, auto immune diseases, cancer, HIV )

Antenatal care

1st pregnancy
No

2nd or subsequent pregnancy

At first contact women should be given information on the pregnancy care services, lifestyle considerations, maternity benefits, dietary advice and screening tests. week Verbal information should be supported by classes and written information that is evidence based as this increases satisfaction with care and reduces anxiety. The purpose of all tests should be understood before they are undertaken.

812

Women who have any of the following Up to 12 weeks women are recommended to take folic acid supplements (400 micrograms per day). age > 40 or <18 years old a BMI more than 27 or less than 18 vulnerable services available and the options available, lifestyle considerations including maternity previous caesarean section Women should usually carry their own case notes. Women should be informed of the results of all severe pre-eclampsia, HELLP or eclampsia tests and systems need to be in place to feedback results to women. 3 or more miscarriages previous preterm birth or mid trimester loss The following tests should be offered and recommended in early pregnancy to all women: psychiatric illness or puerperal psychosis neonatal death or stillbirth Haemoglobin (to screen for anaemia) Rubella immunity baby with congenital abnormality Blood group, rhesus status and red cell antibodies Hepatitis B SGA or LGA infant A urine test to screen for asymptomatic bacteriuria HIV USS to assess gestational age and identify twin pregnancies Syphilis serology

Yes

Women who smoke or who have recently quit should be supported by anti-smoking interventions. Assessment at the first appointment should include: measure BMI and Blood pressure (BP). Women do not need routine breast or pelvic examinations. Women should be offered screening for Downs syndrome. Effective screening tests include: 1st trimester nuchal translucency (NT), the combined test (NT with HCG and PAPP-A), 2nd trimester serum testing with the triple test or integrated test. week

These women are likely to need additional care which is outside the scope of this guideline. The care outlined here is the baseline care

Healthcare professionals should be alert to the symptoms or signs of domestic violence and women should be given the opportunity to disclose domestic violence.

20

Women should be offered USS screening for structural anomalies between 18 and 20 weeks. 1st pregnancy check BP at 20 weeks

Antenatal care Maternity services should strive to achieve continuity of care by as small a group of carers as possible. Gestational age

First pregnancy

Second pregnancy

The following interventions are NOT recommended components of routine antenatal care: Repeated maternal weighing Breast examination Pelvic examination Screening for post natal depression using EPDS Routine iron supplementation Screening for the following infections o chlamydia o cytomegalovirus o hepatitis C o group B streptococcus o toxoplasmosis Screening for gestational diabetes mellitus (including dipstick testing for glycosuria) Screening for preterm birth by assessment of cervical length (either by USS or VE) Formal fetal movement counting Routine antenatal electronic cardiotocography in low risk pregnancies Ultrasound scanning after 24 weeks Routine umbilical artery Doppler in low risk women Routine uterine artery Doppler to predict pre-eclampsia in low risk women

25

Measure symphysis fundal height (SFH) + BP Urinalysis for proteinuria Measure SFH + BP, Urinalysis for proteinuria Repeat Haemoglobin, antibodies and give Anti D if rhesus negative SFH + BP + urinalysis SFH + BP + urinalysis If rhesus negative check antibodies and give 2nd dose Anti D Measure SFH + BP, urinalysis for proteinuria check position if breech offer ECV

28

31 34

3637

39 41

SFH + BP++ urinalysis Measure SFH + BP+ urinalysis for proteinuria Offer membrane sweep Offer induction after 41 weeks

Total appointments in 1st pregnancy: 9

Total appointments in 2nd pregnancy: 6

This algorithm should, where necessary be interpreted with reference to the full guideline (Antenatal care )