1st visit/ Booking visit Target weight gains during pregnancy: Pre-pregnancy BMI (kg/m2) Rate of weight gain 2nd and 3rs trimester (kg/week) Recommended total weight gain range (kg) <18.5 underweight 0.51 12.5 to 18 18.5 to 24.9 normal weight 0.42 11.5 to 16 25.0 to 29.9 overweight 0.28 7 to 11.5 ≥…

Recommendation 1 Second and Third Trimester (Basic Dose 625 IU) Recommendation 2 Recommendation 3 Good Practice Point Recommendation 5 Recommendation 6 Recommendation 7 Recommendation 8 Recommendation 9 Timing Recommendation Grade First Trimester All Rh(D) negative women (without preformed Anti-D) should be offered 250 IU Anti-D in cases of: – Abortion…

First trimester vaginal bleeding Bleeding in second half of pregnancy (antepartum bleeding) Third term EPL irrespective of pregnancy location or management option.  Determining viability and location of pregnancy 

Signs of low breast mild supply Increase milk supply Cease breastfeeding Nipple pain

BMJs Best Practice – search Cholestasis of pregnancy  Diagnosis of cholestasis in pregnancy is confirmed by: Clinical features Investigations Fetal surveillance Treatment of maternal pruritis

 AFP: Decreased fetal movements- A practical approach in primary care setting  http://www.racgp.org.au/afp/2014/november/decreased-fetal-movements-a-practical-approach-in-a-primary-care-setting/  Pregnancy factors and outcomes associated with decreased fetal movements Pregnancy factors associated with DFM Outcomes associated with DFM Fetal growth restrictionSmall for gestational agePlacental insufficiencyOligohydramniosThreatened preterm labourFetomaternal transfusionIntrauterine infections Congenital malformationPreterm birthPerinatal brain injuryDisturbed neurodevelopmentLow birth weightLow Apgar…

Risk Factors Clinical presentation If medical or expectant: 

Epidemiology Risk Factors and Prevention Microbiology Clinical Assessment History and Physical Examination Breast Abscess Examination of the Infant and Breastfeeding Investigation Differential Diagnosis Management Ibuprofen or paracetamol for pain early antibiotic therapy is important to prevent abscess formation. Abx = dicloxacillin 500 mg orally, 6-hourly. For 10 days    OR…

Drug M/PAUC % maternal dose   Comments Acid-suppressants: Cimetidine 1.7-5.8 5.4-6.7 Avoid in favour of safer alternatives with lower potential for side effects. May accumulate in milk due to active transport. Famotidine 1.5 1.6 Probably safe. Ranitidine 2.8 5.0-7.8 Probably safe when restricted to sporadic doses or a single dose…

Definitions of Miscarriage: Risk Factors for Early Pregnancy Loss Epidemiology History and Physical Examination: Management of Miscarriage MIST Trial Findings: Recurrent pregnancy loss (RPL) Pregnancy loss by maternal age Maternal age (years) Rate of pregnancy loss (%) 20–24 11 25–29 12 30–34 15 35–39 25 40–44 51 >45 93 Common causes:…

Pelvic instability is possibly related to an increase in the hormone relaxin which acts to create laxity in pelvic ligaments as the pelvic girdle adapts to an anticipated pregnancy. There may be a relationship between the levels circulating levels of relaxin and pelvic instability, however conclusive evidence remains forthcoming Most…

Placenta abruption Placenta acccreta Vasa previa

6 weeks BABY CHECK MOTHER Contraceptive options Contraceptive type Notes Contraindications Options for all women, including those breastfeeding Levonorgestrel intrauterine device Lasts up to five yearsFrequent spotting or bleeding in the first 3–5 months is common; thereafter, the device significantly reduces menstrual bleedingHigh level of effectivenessCan be inserted <48 hours postpartum/immediately…

Diagnosis criteria the organ/system features Hypertension Proteinuria baseline blood long-term health risks    Future risks if gestational hypertension Future risks if preeclampsia Future risks if severe preeclampsia, HELLP syndrome or eclampsia Gestational hypertension in future pregnancy  Risk ranges from about 1 in 6 (16%) to about 1 in 2 (53%).…

Avoiding TORCH Genetic Testing genetic carrier screening What is screened Currently offering carrier screening for: fragile X syndrome – X-linked dominant pattern Symptoms/Signs Cystic Fibrosis  Spinal muscular atrophy

Medical and Pregnancy History Supplements Nutrition and BMI Optimization Immunizations and Screenings Physical Examinations Lifestyle Modifications Pre-conception Testing Optimizing Health Before Conception Medication Review Counseling and Education Interpregnancy Intervals

Risk factors: – Previous preterm abnormality – Bacterial vaginosis – UTI/ STI – Gestational diabetes – Hypertensive disorders of pregnancy – Cervical incompetence (previous cone biopsy) – Intrauterine infection – Multiple pregnancy – Use of ART – Uterine abnormalities – Polyhydramnios/ oligohydramnios – Placental abruption/ previa – Interpregnancy duration of…

Rx

First line agents (mild symptoms ) Second line agents (moderate symptoms) Third line agents (severe symptoms – PUQE-24 score ≥13)