Antenatal care

Lt Col Abeera FCPS,MRCOG,FRCSEd,FRCOG

History
1901 first maternity antenatal bed in Edinburgh 1915 the 1st antenatal clinic Antenatal care perfect example of preventive medicine Midwife led.

Prepregnancy and booking

Medical history ; Advisable to become pregnant? Therapy needs adjustment eg epilepsy ,dietary advise necessary eg diabetes ,condition may deteriorate during pregnancy hypertension Timing of pregnancy; Medical problems may need postponement of pregnancy eg radioactive Iodine , thyroidectomy is an alternative

Obstetric history
Previous early pregnancy failure, there is recurrence risk for miscarriage , ectopic pregnancy ,trophoblastic disease Previous preterm labour : previos preterm pregnancy 15% , Two preterm 30% .workup can be done for prediction and prevention of preterm labour Previous PIH ; prophylaxis can be tried SGA and LGA may recur .

Obstetric complications
Previous third stage complications: Risk is trebled after one previous complicated 3rd stage. Previous perinatal death , care must be individualized ,surveillance offered Previous fetal malformation: Accurate diagnosis of prior problem is a prerequisite Periconceptual Folic acid Major reduction in CNS malformations Mode of delivery : repeat C- section in case of classical C-section, previous LSCS 40% , Myomectomy less hazardous

Maternal characters
Age:Adolescent and teenage mothers LBW, preterm labour due to biological and social factors Parity: grand multiparity Height and weight Short height risk factor for CPD esp kyphoscoliosis or rickets . Obese risk factor macrosomy, PIH ,diabetes, PPH, PE . Smoking;IUGR

Congenital Infections
Rubella: Knowledge of immune status ,vaccination before pregnancyor in puerperium Varicella Vaccine recently available Hepatitis B-Identify carriers , immunize newborn , staff precautions can be taken HIV screening selectively She has the option of not becoming pregnant ? TOP

HIV
Maternal therapy will reduce the rate of vertical transmission Abdominal delivery is preferable Breast feeding can be avoided Neonatal therapy can be avoided Toxoplasma can be screened

Risk assessment
Score of risk factors Booking (8-14 weeks) BP, weight, Booking blood_ Blood CP , Blood GP and RH factor ,Hb electrophoresis ,Hep B and C Urine R/E ,C/S if +ve Serum screening Downs, nuchal transluscency 11-14 weeks Dating scan

Visits
Every 4 weeks till 28 weeks then 2 weekly weekly from36 weeks Midtrimester visit ; Anomaly scan Blood tests-hb antibodies Urine dip test every visit Blood sugar Typical examination at each visit :BP, WT , Oedema , symphysio-fundal height , presentation , lie, engagement,FHR 36-38 week, pelvic assessment , CP , blood sugar ,ultrasound not routinely performed.