Antenatal Care In The Community

I'm currently feeling very depressed about the cricket. Matt Prior has just run himself out and I'm really regretting getting up at 4.30am (again!) to listen to a losing cause.

"I'm so glad to have you and it's getting worse/I'm so mad to love you and your evil curse..."

7.3.06

Community?
• "Shared care" - package of care carried out in community and secondary care - determined by clinical need.
• "Shared" notes - kept by patient.

Low-risk pregnancy: mainly midwife-/GP-led in the community.
High-risk pregnancy: mainly specialist-led in secondary care.

Why?
• Reduce maternal mortality and morbidity.
• Reduce neonatal mortality and morbidity.

What is it?
• Means of trying to ensure physical and emotional well-being of the pregnant woman.
• Ensure baby is in best physical health following delivery.
• Combination of screening and surveillance - designed to detect problems/abnormalities which might increase maternal and/or neonatal mortality and morbidity.
• Also seeks to address need to health promotion, information and choice for pregnant women.

Low-risk pregnancy
• Use specific criteria (16• Can move from low-risk to high-risk at any time in pregnancy.

History
• Confirm pregnancy - β hCG - early-morning urine sample.
• Age.
• Past menstrual history.
• Past gynaecological history.
• Past obstetric history.
• Medication.
• Social history.
• Family history.

Nice guidelines: www.nice.org.uk ~ 2003

Lifestyle advice
• Smoking - cigarettes/cannabis.
• Alcohol.
• Exercise.
• Travel - seatbelts/deep vein thromboses.
• Prescriptions.
• Complimentary therapies.
• Sexual activity.

Diet and food
• High fibre, low fat.
• Supplements: folic acid 400 mcg per day until 12 weeks.
• Avoid vitamin A supplements and liver.
• Avoid:
-Mould-ripened cheese eg. brie.
-Pate.
-Uncooked/undercooked ready-made meals.
-Raw/partially-cooked eggs and mayonnaise.

Toxoplasmosis
• Avoid contact with cat faeces and soil that may have traces of cat faeces in it.

Advice
• Screening and surveillance (main condition = Down's syndrome).
• Antenatal and parentcraft classes.
• Options wrt place of delivery, pain relief.
• National Childbirth Trust (NCT).