Presentation on theme: "Care of the pregnant woman Year 2 Lent term. The Case 38 year old booked at 12 weeks gestation in the antenatal clinic Expecting her third baby 1 st baby."— Presentation transcript:
Care of the pregnant woman Year 2 Lent term
The Case 38 year old booked at 12 weeks gestation in the antenatal clinic Expecting her third baby 1 st baby 2.8kg (6lb 3oz) at term 2 nd baby 2.4 kg (5lb 6oz) at term Smokes 20/day BMI 25
What investigations are routinely offered in antenatal care?
Investigations: blood Standard at booking: Hb, Blood group, antibodies, rubella antibodies, serum test for syphilis. Optional at booking: triple test, tests for hepatitis B, HIV Varies with units: random blood sugar
Investigations: ultrasound Dating scan ?nuchal scan (under development nationally) Anomaly scan
What are the risk factors in this particular case?
Risk factors Maternal age Past obstetric history of small babies smoking
Risks of smoking in pregnancy Reduced fertility, ectopic pregnancy, miscarriage Preterm labour Placental abruption Stillbirth Intrauterine restriction: dose related Cot death, infant respiratory infection, lower IQ
Smoking: the single most preventable cause of adverse events in pregnancy
How would you manage this case?
Management of case Delivery in hospital unit with fetal monitoring and paediatric facilities Consider induction of labour with close fetal monitoring – timing may be decided from other parameters
How would you advise her if this was her baby’s growth chart?
Treatment plan Refer (if willing) to smoking-cessation programme Monitor fetal growth in third trimester using ultrasound- measure head circumference and abdominal circumference Biometric tests for fetal well-being: liqour volume, Doppler, cardiotocography
Despite your advise the patient requests to have her baby at home
She sees the midwife, who goes through the checklist with her:
Is the midwife obliged to deliver this patient at home?
Yes, if she insists. Second midwife recommended as back- up
Is the GP obliged to attend?
No unless in an emergency
Pain relief available at home?
Midwife can bring “Entonox” and give pethidine
Why is Syntometrine given?
Syntometrine 5U syntocinon 0.5mg ergometrine Given at delivery of anterior shoulder to constrict the uterus Helps prevent post-partum bleeding
Why is vitamin K given?
Vitamin K Given to the baby (usually IM) Helps prevent haemorrhagic disease of newborn from deficiency of clotting factors (immature liver)