and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
The Obstetric History and Examination and Antenatal Assessment are discussed in Chap. 5.
The aim of antenatal care is to ensure that the baby is delivered in the best condition, and that any problems are diagnosed as early as possible.
At the First Visit
Confirm pregnancy and establish the expected date of delivery. This is 9 months and 7 days after the Last Normal Menstrual Period (LNMP) – assuming day 14 ovulation. This is easily calculated: from January to March add 9 months; from April to December take away 3 months; then add 7 days.
This should be confirmed using ultrasound
Clinical assessment to identify any conditions that may be relevant during the pregnancy
Routine Investigations at First Visit
Haematology
Full blood count (FBC) including Mean Corpuscular Volume (MCV) and Mean Corpuscular Haemoglobin Concentration (MCHC). If abnormal, haemoglobin electrophoresis should be undertaken to detect thalassaemia.
Blood group and antibody screen (this includes Rhesus and other minor red blood cell antigens).
Infection Screens
Rubella immunity- check at the start of each pregnancy
Varicella immunity –checking is recommended if there is not a definite history of previous infection
Syphilis serology and HIV
Hepatitis B and Hepatitis C serology is recommended
CMV- not performed routinely
Toxoplasma screening – if indicated
Chlamydia screening – can be offered
Midstream urine, microscopy and culture
Hormone Tests
TSH – uniform screening for subclinical thyroid disease is still controversial
Vitamin D
Women at risk of deficiency should be screened (low exposure to sunlight)
General Advice
Advice about a healthy diet and sensible weight gain (ideally no more than a pound a week)
Work plan
Avoiding smoking and recreational drugs
Avoiding any non-prescription medications
Avoid exposure to X-rays and other radiation unless absolutely necessary
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