"I:"äirir:f "nrenararvisit by doctor or rldylrg shourd ideary occur arter the rirst

missed period at about 10 weeks geslailon , ded fort lf a woman pr"""nt'iät", pertotrnätt

"nl9l:i1l care activities recommen

first antenatal visit pluã tÉåse which cou"rpond to ãutt"nt gestation especially if

äiãàót t un 32 weêks gestation.8. Á minimum ot rou|.

"Ài""nä;ñì;¡t, should be offered/provided to women with low

Related toPics:rã Health ineck - V.Vomen, Page 384

ffi Sexually transmitted infections' p.age +o+

H äffilí öüä;il ProPhYräxié' Pase 413:fl

Rn tnimunoglobulin, Page 431

2.

3.

Women and antenatal health

Antenatal care

May Present with:. Missed period. UTI

lmmediate management: - not applicable

Glinical assessment:. Obtain comPlete Patient historY. perform standard

"l¡"äi ;;rations + confirmation of pregnancy by urine /

blood test (hCG test). Compfete Obstetric Bisk Score

: ï:n',""1äïüiËln;ì"iit'Jrn;'"" is important. urtrasound examination mav beperformed uv ,rt'"'onågiäËñãüi"" "¡sietrician

/ Mo with skills

y"Triällarar care schedure wir depend on rhe individuarwoman's needs.

Review with:- MO - 4 weekly until 30 weeks gestation' 2 weekly from 30 - 36 weeks

- flrïFit:i weeklv until 30 weeks sestation' 2 weeklv from 30 - 36 weeks

. ,n "3i"Jjlilnl"r"

tt "r"

is no midwife refer women for antenatar care ro visiting Mo

following the same schedule. Transfer to referring ;;tdri" facility at 36 weeks gestation or earlier according to

woman's needs. From first visit provide antenatal education on smoking' alcohol and other drug

use in pregnancy, nealthy nutrition' physical activity

High risk Pregnancy managementH¡gh nsK presnarrçv "l':';;;;;;ih high risk pregnancy as determined by. Frequency of visits lor

obsietric Risk Score I or moreObstetric- obstetrician before 20 weeks gestation- MO'¡"

";;sultation with obstetrician every 2 we^eks

- rn¡O*¡t" in consultation with obstetriciln.gu"ry 2 weeks

Þr¡rrãtõtinicat care Manual 2009Page 389- *å"f.fy uitits at receiving facility until delivery

2009

Wi¡ürrtri and antènatal health

0ralsupplements ifindicated [].

All women should be on a Folic Acid supplement for the first lZ weet<s anO iOeallypreconception. Women with pre-pregnancy diabetes mellitus require a 5 mg dailydose, in place of the usual 0.5m9 Folic Acid [7]lron supplementation is recommended for women at particular risk or iron deficieney,Routine iron supplementation is not recommended in every pregnancy. lt is muchmore important to give good diqtary advice where the diet is likely to be deficient

Investigationand treatmentof anaemia

lf haemoglobin is less than 1.|0 g/L take ¡rooos toi@studies, red cell folate, serum 812, Hb electrophoresisstart iron and folic acid supplements - if supplementation is effective in increasing Hb,the reticulocyte count, when repeated in three weeks, should be greater than 2%0. lf ltis not greater than 2% Consult MO.lf haemoglobin less than 105 g/L:Consult MOcommence Vitamin Cconsider parenteral iron if there is little time available to raise the Hb to safe levels,and /or a pregnant woman with Hb <1 00 g/L and not respondingto treatment count greater than 2%) or is 34 or more weeks

Page 392 Primary Clinical Care Manual 2009

. Blood pressureo Urinalysis¡ Assessment of fetal age, cunent growth,

rate of change, position, heart soundand rate

lf in high risk grouptake BGL (venous)lf result > 5.5 mmol/L perform OralGlucose Tolerance Test (OGTT)with 75

OGTT (in allAboriginal and ToresStrait lslander women and other hiohrisk women)FBCRandom venous BGL (if not performing0GTT)Repeat antibody screen if Rh negative.(Document on pathology request if AntiD given and date)Repeat RPR and EIMPPARepeat HIV Antibody if high risk(intravenous drug use, positive partne0

o Blood pressure. Urinalysis¡ Assessment of fetal age, current growth,

rate of change, position, heart soundand rate

r Ultrasound- date check- placental site- detection of abnormalities

¡ Influenza vaccination if >14 weeks

o Blood pressuré¡ Urinalysis¡ Assessment of fetal age, current growth,

rate of change, position, heart soundand rate

. Rh negative women to receive Anti Dimmunoglobulin [8]