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Women and antenatal health

Antenatalcare
idearyoccurartertherirst
orrldylrgshourd
bydoctor
geslailon
"nrenararvisit
"I:"irir:f
at about10weeks
,
missedperiod
dedfor
recommen

careactivities
lf a womanpr"""nt'it", pertotrntt
if
especially
"nl9l:i1l
to utt"ntgestation
cou"rpond
which
visitplutse
firstantenatal
it t un32weksgestation
to womenwithlow
shouldbe offered/provided
.8. minimum
ot rou|.
"i""n;;t,

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infections'p.age+o+
transmitted
Sexually
ffi
413
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H
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431
Page
Rn tnimunoglobulin,
May Presentwith:
. Missedperiod
. UTI
2.
3.

lmmediatemanagement: not applicable


Glinicalassessment:
. ObtaincomPletePatienthistorY
;;rations
. performstandard
"l"i
bloodtest (hCGtest)
. CompfeteObstetricBiskScore

of pregnancyby urine/
+ confirmation

be
mav
examination
urtrasound
: :n',""1iln;"iit'Jrn;'""isimportant.
/ Mowithskills
uv,rt'"'ongii""
performed
"sietrician

needs.
y"Trillarar careschedure
onrheindividuarwoman's
wirdepend
Reviewwith:
from 30 - 36 weeks
- MO - 4 weeklyuntil 30 weeksgestation'2 weekly

from30- 36weeks
2 weeklv
sestation'
until30weeks
- flrFit:i weeklv
Mo
carerovisiting
forantenatar
referwomen
tt isnomidwife
. ,n
"r"
"3i"Jjlilnl"r"
the sameschedule
following
earlieraccordingto
.

36 weeks gestationor
Transferto referring;;tdri" facilityat
woman'sneeds
on smoking'alcoholandotherdrug
Fromfirstvisitprovideantenataleducation activity
physical
use in pregnancy,nealthynutrition'

risk presnarrv
High
HghnsK
Pregnancymanagement
by
"l':';;;;;;ih
highriskpregnancyas determined
. Frequencyof visitslor
obsietricRiskScoreI or more
Obstetric
- obstetricianbefore20 weeksgestation
with obstetricianevery 2 we^eks
- MO'"
2 weeks
";;sultation
withobstetriciln.gu"ry
- rnO*t"
in consultation
delivery
- *"f.fy uitits at receivingfacilityuntil
2009

rrrttinicat care Manual2009

Page 389

Wirrtriand antnatalhealth

0ral
Allwomen
shouldbeona FolicAcidsupplement
forthefirstlZ weet<s
anOiOeally
supplements
if preconception.
Women
withpre-pregnancy
diabetes
mellitus
require
a 5 mgdaily
indicated
[].

dose,inplaceoftheusual0.5m9FolicAcid[7]
lronsupplementation
is recommended
forwomen
atparticular
riskor irondeficieney,

Routine
ironsupplementation
isnotrecommended
ineverypregnancy.
lt ismuch

moreimportant
to givegooddiqtaryadvice
wherethedietis likelyto bedeficient

Investigation lf haemoglobin
islessthan1.|0g/Ltakerooos
toi@
andtreatment studies,
redcellfolate,
serum
812,Hbelectrophoresis
- if supplementation
ofanaemia startironandfolicacidsupplements
iseffective
in increasing
Hb,
thereticulocyte
count,whenrepeated
inthreeweeks,
shouldbegreater
than2%0.lf lt
is notgreater
than2%Consult
MO.
lf haemoglobin
lessthan105g/L:
ConsultMO
commence
Vitamin
C
parenteral
consider
ironif thereis littletimeavailable
to raisetheHbtosafelevels,
and/ora pregnant
womanwithHb<100g/L andnotresponding
to treatment
countgreater
than2%)or is 34ormoreweeks

. Bloodpressure
o Urinalysis
Assessment
of fetalage,cunentgrowth,
position,
rateof change,
heartsound
andrate
o Bloodpressure
. Urinalysis
Assessment
offetalage,currentgrowth,
rateof change,
position,
heartsound
andrate
r Ultrasound
- datecheck
- placental
site
- detection
of abnormalities
Influenza
vaccination
if >14weeks
o Bloodpressur
Urinalysis
Assessment
offetalage,currentgrowth,
position,
rateof change,
heartsound
andrate
. Rhnegative
womento receive
AntiD
immunoglobulin
[8]

Page 392

lf inhighriskgroup
takeBGL(venous)
perform
lf result> 5.5mmol/L
Oral
Glucose
Tolerance
Test(OGTT)with
75

OGTT(inallAboriginal
andTores
Straitlslander
womenandotherhioh
riskwomen)
FBC
Random
venous
BGL(ifnotperforming
0GTT)
Repeat
antibody
screenif Rhnegative.
(Document
onpathology
request
if Anti
Dgivenanddate)
Repeat
RPRandEIMPPA
Repeat
HIVAntibody
if highrisk
(intravenous
partne0
druguse,positive
Primary Clinical Care Manual 2009