Ante natal Ante natal carecare

Sharon WallisSenior Matron

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

Choice, continuity & Choice, continuity & control!control!

Place of birth – hospital or home

Choice of pain relief in labour

Continuity of care / carer

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

Social historySocial history

Support - benefitsTeenage Safe guardingLearning disabilitiesNon English speaking / readingInterpreters

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

Relevant medical historyRelevant medical history

Cardiac diseaseEndocrine diseaseGenital tract surgeryHaemaglobinopathiesBBVBMI >35 /<18Skeletal / spinal problemsDeclines blood productsMalignanciesSevere asthma

Family historyFamily history

1st degree relative with IDDMFH Pre eclampsiaThromboembolic disordersCongenital abnormalities / deafnessFH – poor obstetric outcome

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

Domestic abuseDomestic abuse

Routine enquiry at least 3 times during pregnancy episode

All women askedRE + /-Contact numbers highlightedSafeguarding issues with disclosure

Health adviceHealth advice

Smoking AlcoholSubstance misuse

Don’t do it! Referal to Fresh start / drug and alcohol

specialist midwife if necessary

ScreeningScreening

All women offered NT+ (combined screening) between 11+ - 13+ weeks

FBCSickle + thalasaemia screeningBlood group & anti bodiesMicrobiology screeningMSU

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