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Ante natal care Sharon Wallis Senior Matron 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 Importance of AN care Place of birth – hospital or home Choice of pain relief in labour Continuity of care / carer Choice, continuity & control! 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 Booking Support - benefits Teenage Safe guarding Learning disabilities Non English speaking / reading Interpreters Social history Previous C/S PPH 3rd degree tear IUFD / stillbirth Baby >4.5 kg IUGR Preterm labour Grand multip Retained placenta x 2 Shoulder dystocia 3 x consecutive 1st trimester miscarriage 2nd trimester miscarriage Obstetric history Cardiac disease Endocrine disease Genital tract surgery Haemaglobinopathies BBV BMI >35 /<18 Skeletal / spinal problems Declines blood products Malignancies Severe asthma Relevant medical history 1st degree relative with IDDM FH Pre eclampsia Thromboembolic disorders Congenital abnormalities / deafness FH – poor obstetric outcome Family history 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 Mental health Routine enquiry at least 3 times during pregnancy episode All women asked RE + /Contact numbers highlighted Safeguarding issues with disclosure Domestic abuse Smoking Alcohol Substance misuse Don’t do it! Referal to Fresh start / drug and alcohol specialist midwife if necessary Health advice All women offered NT+ (combined screening) between 11+ - 13+ weeks FBC Sickle + thalasaemia screening Blood group & anti bodies Microbiology screening MSU Screening 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 AN visit schedule