ANTENATAL CARE fysiologie van zwangerschap

FYSIOLOGIE VAN ZWANGERSCHAP
LES 9 : ANTENATAL CARE


1. NICE (=NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE)

1.1 NICE CLINICAL GUIDELINE

1. Lifestyle considerations
 Recommendation vitamin D: 10ug/day
- Pregnancy
- Breastfeeding
Woman at great risk :
 South Asian
 African
 Carribean
 Woman with limited exposure of sunlight
 Pre-pregnancy BMI above 30kg/m2
2. Screening for gestational diabetes
Risk factors:
 BMI >30
 Previous macrosomic baby 4,5kg or above
 Previous gestational diabetes
 Family history of diabetes

1.2 WOMAN-CENTERED CARE AND INFORMED DECISION-MAKING
1.2.1 ANTENANTAL INFORMATION

First contact  Folic acid supplementation
 Food hygiene
- Risk of foodacquired infections
 Lifestyle advice
 Antenatal screening
- Hb
- Screening Down
10 weeks  How baby develops
 Nutrition and diet
- Vit or antenatal screening D
 Pelvic floor exercises
 Place of birth
 Breastfeeding
- Including workshops
 Discussion of all antenatal screening
 Discussion of mental health issues
16 weeks  Discuss and record the results of all screening test
 Investigate a heamoglobine level
- Below 11g/100ml = iron supplementation
 Measure blood pressure
 Test urine for proteinuria
 Information
20 weeks  Ultstrasound scan
- Detection of structural anomalies
! Placenta found to extend across the internal cervical?
 Other scan at 32 weeks
25 weeks  Measure

, (for nulliparous - symphysis-fundal height
women) - blood pressure
- urine for proteinuria
 Information
28 weeks  Second screening
- Anaemia
- Atypical red-cell alloantibodies
 Investigate for heamoglobin level
- Below 10,5/100ml = iron supplementation
 Offer anti-D prophylaxis (rhesus-negative women)
 Measure
- Blood pressure
- Urine for proteinuria
- Symphysis-fundal height
 information
31 weeks  measure
- blood pressure
(for nulliparous
- urine for proteinuria
women)
- symphysis-fundal height
 information
 discuss and record results of screening at 28 weeks
34 weeks  information and antenatal classes
- preparation for labour and birth, recognition of active
labour
 second dose of anti-D (rhesus-negative women)
 measure
- blood pressure
- test urine
- symphysis-fundal height
 information
36 weeks  breastfeeding information
 preparation of labour and birth
- including information about coping with pain in labour
- birth plan
 recognition of active labour
 care of the new baby
 newborn screening test and vitamin K prophylaxis
 awareness of ‘baby blues and postnatal depression’
 measure
- blood pressure
- symphysis-fundal height
- position of baby
40 weeks  measure
- blood pressure
(for nulliparous
- test urine for proteinuria
women)
- symphysis-fundal height
 information
- including discussion about options for prolonged pregnancy
41 weeks  should be offered
- membrane sweep
- induction of labour

1.3 PROVISION AND ORGANISATION OF CARE

1. Frequency of antenatal appointments
 10 appointments = nulliparous women
 7“ = parous women
 written information about number, timing and content of antenatal appointments


2. Gestational age management