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Ante natal care. Sharon Wallis Senior Matron. Appropriate care pathway from start Assessment of maternal & fetal well being Early detection of pregnancy induced conditions or exacerbation of pre exisiting ones Appropriate & timely referral Support women & their families.
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Ante natal care Sharon Wallis Senior Matron
Appropriate care pathway from start • Assessment of maternal & fetal well being • Early detection of pregnancy induced conditions or exacerbation of pre exisiting ones • Appropriate & timely referral • Support women & their families Importance of AN care
Place of birth – hospital or home • Choice of pain relief in labour • Continuity of care / carer Choice, continuity & control!
Ideally between 8 – 10 weeks gestation • Thorough social / obstetric /medical /family history • Includes mental health history • Routine enquiry into domestic abuse • Health advice – smoking / substance & alcohol misuse / diet / exercise • Maternity benefits • Screening / blood tests Booking
Support - benefits • Teenage • Safe guarding • Learning disabilities • Non English speaking / reading • Interpreters Social history
Previous C/S • PPH • 3rd degree tear • IUFD / stillbirth • Baby >4.5 kg • IUGR • Preterm labour • Grand multip • Retained placenta x 2 • Shoulder dystocia • 3 x consecutive 1st trimester miscarriage • 2nd trimester miscarriage Obstetric history
Cardiac disease • Endocrine disease • Genital tract surgery • Haemaglobinopathies • BBV • BMI >35 /<18 • Skeletal / spinal problems • Declines blood products • Malignancies • Severe asthma Relevant medical history
1st degree relative with IDDM • FH Pre eclampsia • Thromboembolic disorders • Congenital abnormalities / deafness • FH – poor obstetric outcome Family history
Past hx of severe MH disorders especially following childbirth • FH of severe MH disorders especially that required hospitalisation • Emphasis on early detection and referal to maternal MH team Mental health
Routine enquiry at least 3 times during pregnancy episode • All women asked • RE + /- • Contact numbers highlighted • Safeguarding issues with disclosure Domestic abuse
Smoking • Alcohol • Substance misuse Don’t do it! Referal to Fresh start / drug and alcohol specialist midwife if necessary Health advice
All women offered NT+ (combined screening) between 11+ - 13+ weeks • FBC • Sickle + thalasaemia screening • Blood group & anti bodies • Microbiology screening • MSU Screening
Based on individual clinical need • As a minimum, women are seen; • At booking (8-10 weeks) • Dating scan +/- NT+ (RDH) • 16 weeks • Anomaly scan (RDH) • 24 weeks • 28 weeks – repeat FBC / anti bodies / anti D if Rh neg • 31 weeks • 34 weeks – repeat FBC • 36 weeks • 38 weeks • Term • Manual BP / urinalysis / SF height measurement as minimum AN visit schedule