Ante natal care Sharon Wallis Senior Matron

Importance of AN care Appropriate care pathway from start Assessment of maternal & fetal well being Early detection of pregnancy induced conditions or exacerbation of pre exisiting ones Appropriate & timely referral Support women & their families

Choice, continuity & control! Place of birth – hospital or home Choice of pain relief in labour Continuity of care / carer

Booking Ideally between 8 – 10 weeks gestation Thorough social / obstetric /medical /family history Includes mental health history Routine enquiry into domestic abuse Health advice – smoking / substance & alcohol misuse / diet / exercise Maternity benefits Screening / blood tests

Social history Support - benefits Teenage Safe guarding Learning disabilities Non English speaking / reading Interpreters

Obstetric history Previous C/S PPH 3 rd degree tear IUFD / stillbirth Baby >4.5 kg IUGR Preterm labour Grand multip Retained placenta x 2 Shoulder dystocia 3 x consecutive 1 st trimester miscarriage 2 nd trimester miscarriage

Relevant medical history Cardiac disease Endocrine disease Genital tract surgery Haemaglobinopathies BBV BMI >35 /<18 Skeletal / spinal problems Declines blood products Malignancies Severe asthma

Family history 1 st degree relative with IDDM FH Pre eclampsia Thromboembolic disorders Congenital abnormalities / deafness FH – poor obstetric outcome

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 abuse Routine enquiry at least 3 times during pregnancy episode All women asked RE + /- Contact numbers highlighted Safeguarding issues with disclosure

Health advice Smoking Alcohol Substance misuse Don’t do it! Referal to Fresh start / drug and alcohol specialist midwife if necessary

Screening All women offered NT+ (combined screening) between weeks FBC Sickle + thalasaemia screening Blood group & anti bodies Microbiology screening MSU

AN 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