Strictly Private and Confidential 1 Welcome to Maternity Care Update for General Practitioners April 2013 Amanda Mansfield Consultant Midwife

Strictly Private and Confidential 2 Seeing Women – 1 st Point of Call  Aims  Initial Consultation –Booked by 12 completed weeks – Midwife –Full Booking Bloods– 9 weeks –Bookings >12 wks – –Late booking >20 wks –Migrant women without previous full medical assessment – GP –Recognise and intervene with an obstetric emergency –Promoting Health and lifestyle –Discussion options in relation to pregnancy options

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Strictly Private and Confidential 6 Booking Assessment  Booking History:- –Low Risk –Intermediate Risk –High Risk  Shared Care – Midwife/GP  Consultant Led – Obstetrician (+other specialties)  Choice of Place of Birth – Which hospital  Choice of Mode of Birth – Which hospital does what?

Strictly Private and Confidential 7 Antenatal Care WhenWhere/WhoAssessment <9 weeksGP - Surgery Confirm Pregnancy/Booking Bloods/BP/BMI/Arrange USS/Refer to MW <12 weeksMW – Surgery/Home Book in with Local Maternity Provider Review blood results and Health & Social Needs Assessment weeksHospital/USSFirst Trimester Combined Screening or Dating Scan 16 weeksMW – Surgery/HomeBP, Urine, Bloods weeksHospital/USSAnomaly Ultrasound 25 weeks (1 st Timers)MW – Surgery/Home BP, Urine, Fetal Assessment – Palpation/Auscultation 28 weeks (All)MW –Surgery/HomeBP, Urine, Fetal Assessment, Offer Bloods 31 weeks (1 st timers)MW – Surgery/HomeBP, Urine, Fetal Assessment, FU Blood tests 34 weeks (All)MW/GP – Surgery/HomeBP Urine, Fetal Assessment, 36 weeks (All)MW/GP – Surgery/Home BP Urine Fetal Assessment, Risk assessment for Place of Birth 38 weeks (All)MW/GP – Surgery/HomeBP Urine Fetal Assessment, 40 weeks (1 st timers)MW – Surgery/HomeBP Urine Fetal Assessment, Discuss Birth Plan 41 weeks (All)MW – Surgery/HomeBP Urine Fetal Assessment, Cervical Assessment

Strictly Private and Confidential 8 Referrals  Antenatal Clinic  Fetal Assessment Unit ->20 weeks gestation 7-5pm Monday – Friday –Raised blood pressure – APEC guidelines ( 3 readings above 140/90 –+or – proteinuria) – Diagnosed cholestasis. - Pregnancy itching should only be referred if there are –abnormal Liver function tests. The GP’s will complete a full assessment of these –women and refer if appropriate. – Diagnosed IUGR – Postnatal checks for women with babies in SCBU – Pre- term premature rupture of membranes – Small pv bleeds ie. Spotting after 20 weeks gestation – Hyperemesis/dehydration after 20 weeks gestation – Anti D administration (see antenatal guideline No 24) – Glucose Tolerance Test – for suspected diabetes (see LW policy chapter 8) – Pre LSCS clerking (pre op assessment) – VBAC assessment at 41 weeks – Betamethasone injections

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