ante natal care sharon wallis senior matron. importance of an care appropriate care pathway from...
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Ante natal Ante natal carecare
Sharon WallisSenior Matron
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Importance of AN careImportance of AN care
Appropriate care pathway from startAssessment of maternal & fetal well beingEarly detection of pregnancy induced
conditions or exacerbation of pre exisiting ones
Appropriate & timely referralSupport women & their families
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Choice, continuity & Choice, continuity & control!control!
Place of birth – hospital or home
Choice of pain relief in labour
Continuity of care / carer
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Booking Booking
Ideally between 8 – 10 weeks gestationThorough social / obstetric /medical
/family historyIncludes mental health historyRoutine enquiry into domestic abuseHealth advice – smoking / substance &
alcohol misuse / diet / exerciseMaternity benefitsScreening / blood tests
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Social historySocial history
Support - benefitsTeenage Safe guardingLearning disabilitiesNon English speaking / readingInterpreters
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Obstetric historyObstetric history
Previous C/SPPH3rd degree tearIUFD / stillbirthBaby >4.5 kgIUGRPreterm labourGrand multipRetained placenta x 2Shoulder dystocia3 x consecutive 1st trimester miscarriage2nd trimester miscarriage
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Relevant medical historyRelevant medical history
Cardiac diseaseEndocrine diseaseGenital tract surgeryHaemaglobinopathiesBBVBMI >35 /<18Skeletal / spinal problemsDeclines blood productsMalignanciesSevere asthma
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Family historyFamily history
1st degree relative with IDDMFH Pre eclampsiaThromboembolic disordersCongenital abnormalities / deafnessFH – poor obstetric outcome
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Mental health Mental health
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
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Domestic abuseDomestic abuse
Routine enquiry at least 3 times during pregnancy episode
All women askedRE + /-Contact numbers highlightedSafeguarding issues with disclosure
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Health adviceHealth advice
Smoking AlcoholSubstance misuse
Don’t do it! Referal to Fresh start / drug and alcohol
specialist midwife if necessary
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ScreeningScreening
All women offered NT+ (combined screening) between 11+ - 13+ weeks
FBCSickle + thalasaemia screeningBlood group & anti bodiesMicrobiology screeningMSU
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AN visit scheduleAN visit schedule
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