Page 1 of 1: OSCE-Buster: Antenatal care Counseling First Appointment

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First appointment

The first appointment needs to be earlier in pregnancy (prior to 12 weeks) than may have
traditionally occurred and, because of the large volume of information needs in early pregnancy,
two appointments may be required. At the first (and second) antenatal appointment:
• give information, with an opportunity to discuss issues and ask questions; offer verbal
information supported by written information (on topics such as diet and lifestyle
considerations, pregnancy care services available, maternity benefits and sufficient
information to enable informed decision making about screening tests)
• identify women who may need additional care (see Algorithm and Section 1.2) and plan
pattern of care for the pregnancy
• check blood group and rhesus D (RhD) status
• offer screening for anaemia, red-cell alloantibodies, Hepatitis B virus, HIV, rubella
susceptibility and syphilis
• offer screening for asymptomatic bacteriuria (ASB)
• offering screening for Down’s syndrome
• offer early ultrasound scan for gestational age assessment
• offer ultrasound screening for structural anomalies (20 weeks)
• measure BMI and blood pressure (BP) and test urine for proteinuria.
After the first (and possibly second) appointment, for women who choose to have screening, the
following test should be arranged before 16 weeks of gestation (except serum screening for
Down’s syndrome, which may occur up to 20 weeks of gestation):
• blood tests (for checking blood group and RhD status and screening for anaemia, red-cell
alloantibodies, hepatitis B virus, HIV, rubella susceptibility and syphilis)
• urine tests (to check for proteinuria and screen for ASB)
• ultrasound scan to determine gestational age using:
• crown–rump measurement if performed at 10 to 13 weeks
• biparietal diameter or head circumference at or beyond 14 weeks
• Down’s syndrome screening using:
• nuchal translucency at 11 to 14 weeks
• serum screening at 14 to 20 weeks.

16 weeks

The next appointment should be scheduled at 16 weeks to:
• review, discuss and record the results of all screening tests undertaken; reassess planned
pattern of care for the pregnancy and identify women who need additional care

• investigate a haemoglobin level of less than 11g/dl and consider iron supplementation if indicated
• measure BP and test urine for proteinuria
• give information, with an opportunity to discuss issues and ask questions; offer verbal
information supported by antenatal classes and written information.

18–20 weeks

At 18–20 weeks, if the woman chooses, an ultrasound scan should be performed for the
detection of structural anomalies. For a woman whose placenta is found to extend across the
internal cervical os at this time, another scan at 36 weeks should be offered and the results of
this scan reviewed at the 36-week appointment.

25 weeks

At 25 weeks of gestation, another appointment should be scheduled for nulliparous women. At
this appointment:
• measure and plot symphysis–fundal height
• measure BP and test urine for proteinuria
• give information, with an opportunity to discuss issues and ask questions; offer verbal
information supported by antenatal classes and written information.
Antenatal care: routine care for the healthy pregnant woman

28 weeks

The next appointment for all pregnant women should occur at 28 weeks. At this appointment:
• offer a second screening for anaemia and atypical red-cell alloantibodies
• investigate a haemoglobin level of less than 10.5 g/dl and consider iron supplementation, if
indicated
• offer anti-D to rhesus-negative women
• measure BP and test urine for proteinuria
• measure and plot symphysis–fundal height
• give information, with an opportunity to discuss issues and ask questions; offer verbal
information supported by antenatal classes and written information.

31 weeks

Nulliparous women should have an appointment scheduled at 31 weeks to:
• measure BP and test urine for proteinuria
• measure and plot symphysis–fundal height
• give information, with an opportunity to discuss issues and ask questions; offer verbal
information supported by antenatal classes and written information
• review, discuss and record the results of screening tests undertaken at 28 weeks; reassess
planned pattern of care for the pregnancy and identify women who need additional care

34 weeks

At 34 weeks, all pregnant women should be seen in order to:
• offer a second dose of anti-D to rhesus-negative women
• measure BP and test urine for proteinuria
• measure and plot symphysis–fundal height
• give information, with an opportunity to discuss issues and ask questions; offer verbal
information supported by antenatal classes and written information
• review, discuss and record the results of screening tests undertaken at 28 weeks; reassess
planned pattern of care for the pregnancy and identify women who need additional care

36 weeks
At 36 weeks, all pregnant women should be seen again to:
• measure BP and test urine for proteinuria
• measure and plot symphysis–fundal height
• check position of baby
• for women whose babies are in the breech presentation, offer external cephalic version (ECV)
• review ultrasound scan report if placenta extended over the internal cervical os at previous scan
• give information, with an opportunity to discuss issues and ask questions; offer verbal
information supported by antenatal classes and written information.
38 weeks
Another appointment at 38 weeks will allow for:
• measurement BP and urine testing for proteinuria
• measurement and plotting of symphysis–fundal height
• information giving, with an opportunity to discuss issues and ask questions; verbal
information supported by antenatal classes and written information.
40 weeks
For nulliparous women, an appointment at 40 weeks should be scheduled to:
• measure BP and test urine for proteinuria
• measure and plot symphysis–fundal height
• give information, with an opportunity to discuss issues and ask questions;

41 weeks
For women who have not given birth by 41 weeks:
• a membrane sweep should be offered
• induction of labour should be offered
• BP should be measured and urine tested for proteinuria
• symphysis–fundal height should be measured and plotted
• information should be given, with an opportunity to discuss issues and ask questions; verbal
information supported by written information.
General
Throughout the entire antenatal period, healthcare providers should remain alert to signs or
symptoms of conditions which affect the health of the mother and fetus, such as domestic violence,
pre-eclampsia and diabetes.

sepplabber · Credits: 9520 My Scrapbook

thanks

bindasnikhilg · Credits: 44921 My Scrapbook

tht was exhaustv

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

The number of appointments is generally recommended in uncomplicated pregnancies:

-Nulliparous women - 10
-Parous women - 7

All appointments should include measuring BP and testing urine for proteinuria.

akanksha · Credits: 41247 My Scrapbook My Reading List 14 Books

Provide enough information to help her make an informed decision about undergoing available screening tests:

Offer:

1). Screening of mother for-

anaemia,
red cell allo-antibodies,
HBV,
HIV,
rubella susceptibility,
syphilis,
asymptomatic bacteriuria.

Arrange tests as agreed.

There is no evidence to support routine screening for gestational diabetes.

2) Early scan - for assessment of gestational age ;
performed at 10-13 weeks - measuring the crown-rump length.

Alternatively, at or after 14 weeks, measure bi-parietal diameter or circumference of head.

3) Screening of fetus for Down's syndrome

(ensure patient is aware of right to refuse tests and that they carry 60% detection rate and 5% false positive rate) and arrange as agreed.

-Nuchal translucency on ultrasound before 14 weeks.
-Serum tests at 14-20 weeks

4. Screening of fetus for other structural anomalies (ultrasound scan at 20 weeks) if available.

dr999 · Credits: 2065 My Scrapbook

Throughout all the visits mother's BP, urine test, fundal hight, fetal heart monitoring is being done accordingly.
In normal pregnancy, usuallu in UK 2 USG scan are done, first one 10-13 weeks for gestational age and second one at 20-21 weeks for any fetal abnormality.

pancakes · Credits: 589 My Scrapbook

Note that 'every pregnancy is a potential high risk ', and so should be handled wit care.
Is HIV screening a routine test at antenatal visit?

sploop · Credits: 253 My Scrapbook

sploop · Credits: 253 My Scrapbook

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