PRENATAL CARE : INITIAL VISIT

PRECONCEPTION COUNSELLING folic acid to prevent NTD ís (0.4 to 1 mg daily in all women, 4 mg if past NTD) genetic history and risk fa...

PRECONCEPTION COUNSELLING

1. folic acid to prevent NTD ís (0.4 to 1 mg daily in all women, 4 mg if past NTD)
2. genetic history and risk factors
3. modify medications, alcohol, smoking
4. rubella immunity
5. proper nutrition
6. use of prenatal vitamin and iron supplementation
7. impact on family and occupation (maternity/paternity leave)
8. domestic violence  (50% of domestic violence begins in pregnancy) depression / mental health

INITIAL VISIT

generally after 12 weeks

    History

1. determine GA by dates from the first day of the LMP (if regular periods and sure dates)
2. if LMP unsure, get a dating ultrasound
3. determine EDC using the Naegele Rule

first day of LMP + 7 days - 3 months
e.g. LMP = 1 Apr. 1999, EDC = 8 Jan. 2000

modify appropriately for longer or shorter cycles

  4.  obtain obstetric history of all previous pregnancies (GTPAL)

  5.  obtain relevant medical, social, and family history
  6.  counselling

• drug use, alcohol consumption, smoking
• breastfeeding

      Physical

1. complete physical exam
2. baseline BP (very important for relating subsequent changes)
3. baseline weight
4. pelvic exam

Investigations

  1.  blood work

• CBC, blood group and type, Rh antibodies
• rubella titre, VDRL, HBsAg routine; HIV serology should be
  offered to all

  2.  urine

• R&M (Routine and Microscopy), C&S (Urine culture and sensitivity)
  asymptomatic bacteriuria in 5% of pregnant women
• if untreated 25-30% will get a UTI in pregnancy (increased risk of preterm labour)

   3.  pelvic exam

• Pap smear (if none within 6 months), culture for GC and Chlamydia

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