Antenatal 6 weeks

LMP -

Cycle length -

EDC -

Risk -

• High / Mod / Low - Cardiac, Psychosocial, Respiratory, GIT, Uro, Neuro, Endo, Haem, Imm, Psych, Other

Height, weight and BMI -

BP -

Pre-eclampsia risks -

• History PE =RR 8x

  • HTN = RR 5x

  • Diabetes = RR4x

  • Autoimmune disease = RR2.5x

  • Nulliparity = RR2x

  • BMI > 30 = RR3x

  • CKD = RR2x

• If high risk

  • Calcium supplement if dietary sources low

  • Low dose aspirin <75mg per day

  • Physical activity or leisure time is protective

Fetal growth restriction risks -

• Level 2 risk = 1 to 3 of

  • Age > 40

  • BMI > 35

  • Family history pre-eclampsia

  • IVF

  • Smoking

  • Alcohol

  • PAPPA-A 0.3-0.4 MoM

  • Indigenous, South Asian or African heritage

• Management

  • 1 risk factor = standard serial measures

  • 2 risk factors = low dose Aspirin until 36 weeks

  • 3 risk factors = low dose aspirin + Ultrasound at 24 t o 28 weeks and repeated 6 weekly

• Level 3 risk = any of

  • High risk of FTS pre-eclampsia screen

  • Previous FGR/SGA/PE

  • Previous FDIU

  • SLE, CKD, T2DM, HTN

• Management

  • Low dose aspirin + Ultrasound at 24 to 28 weeks and repeated 6 weekly

Preterm birth risks -

• Age > 40, BMI > 35, cervical cerclae, Hx LUSCS at full dilatation, mid trimester loss, PPROM < 37/40, IVF, Multiple, cone Bx / LLETZ, Primip, fibroid > 10cm, uterine variants

Substance use -

Medication safety -

VTE / Blood clot risk -

• Previous unprovoked VTE = 4

• Previous VTE provoked by major surgery = 3

• High risk thrombophillia = 3

• Medical (cancer, CHF, SLE, DM) = 3.

• Transient risks

  • OHSS = 4

  • Surgery = 3

  • Hyperemesis = 3

• Management

  • Antenatal >=4 = thrombo-prophylaxis from first trimester to 6 weeks post partum

  • Antenatal 3 = thrombo-prophylaxis from 28 weeks

  • Postnatal >=2 = thrombo-prophylaxis at least 10 days

  • Postnatal >3 = consider extending thrombo-prophylaxis with LMWH

Oral health -

• Do you have bleeding gums, swelling, sensitive teeth, loose teeth, holes in your teeth, broken teeth, toothache or any other problems in your mouth?

• Answer yes = dentist review

Vaccinations -

• COVID, Influenza, DTP

Mental health concerns -

• EPDS, DV

Investigations -

• Dating ultrasound (8 to 13 weeks) -

• First Trimester Screening (11+2 to 13+6 weeks)-

  • IMAP at JHH - blood test to be done 4 to 7 days before appointment ideally through Pathology North (Hospital

  • Privately (US through Hunter Imaging, PRP etc and blood test through Douglas Hanley Moir, Laverty etc)

• Non Invasive Prenatal Testing (blood test from 10 weeks = $500) -

• First presentation blood tests -

  • Blood group (BG) and blood group antibodies (BGA) tests, Full blood count (FBC) and ferritin, Hepatitis B, hepatitis C, syphilis serology, and HIV, Rubella, Varicella IgG, Mid stream urine (MSU) microscopy, culture and sensitivity (MCS)

• Offer chlamydia screening if aged under 30 years -

• Offer cervical cancer screening -

Diabetes risk -

• High risk if has 1 of - History of GDM, Impaired glucose tolerance, PCOS, unexplained stillbirth, macrosomia, ATSI, BMI > 35, medications (steroids, antipsychotics, immunosuppressant), metabolic surgery

• Or 2 of - Age > 35, BMI > 30, Non-caucasian background, poor obstetric history, intermediate family history of diabetes

• If high risk an <=12 weeks arrange fasting glucose + HbA1c, if > 12 weeks arrange OGTT

Thyroid Risk -

• Arrange TSH if high risk = Personal or family history thyroid disease or autoimmune disease, symptoms of thyroid dysfunction, known thyroid auto antibody positive, goitre, age > 30, thyroid irradiation, BMI > 40, medications (amiodarone, lithium), 2+ pregnancies

Management -

• Model of care

  • High risk = Private Obstetrician, Publicly through hospital with obstetricians

  • Low risk = Midwife care, GP shared care

• Folic acid supplement = at least 400 mcg per daily or 5mg per day if high risk

• Iodine supplement = 150 mcg per day

• Vitamin D supplement = 400 IU per day +/- sunshine

• Food safety

  • No soft cheeses, undercooked meats or fish, pre-prepared fruits and vegetables, soft-serve icecream, undercooked eggs, unpasteurised milk, alcohol

• Stop smoking

• Infections

  • Toxoplasmosis (cat litter), Other (syphillis, Hep B), Rubella, CMV, Chlamydia, Chickenpox, Herpes simplex (cold sores)

• Moderate Exercise of 30 minutes on most days e.g. brisk walk

• Morning sickness

• Medical conditions (asthma, thyroid, UTI, rash, iron deficiency, anaemia, diabetes)

• Booking in appointment at hospital