Max Brinsmead MB BS PhDMay 2015

To date the pregnancy But ultrasound is more accurate

To identify problems requiring pro active care Antenatal care is an exercise in screening

To establish rapport In order to prepare patients for childbirth

and parenthood Is difficult unless there is continuity of care

Pregnancy dating

Past obstetric history

Past medical history

Social and Psychological Profile

Drug history

Family History

Is important because…▪ Both pre term and post term pregnancies are at

risk▪ As is being small or large for dates▪ Many tests require dates for accurate

interpretationBegin with LNMP and cycle length

▪ Inaccurate indicator of conception in 1:3 womenDate when fetal movements are first felt

▪ 16 – 22w in Primigravida & 14 – 20w for MultiparaThe EDD is calculated by Naegele’s rule

▪ Add 9 months and 7 – 10 days to LMP▪ Or use an obstetric wheel

A few women keep a menstrual calendar

Go back over important eventsCoital history sometimes helps“When did you first think you might

be pregnant”▪ Assisted conceptions▪ Date of the 1st missed period▪ Date of the 1st positive pregnancy test▪ Fetal movements

Date of the first scan – and its EDDDate of EDD from the 1st examination

Let the woman tell her own story▪ This tells you about “where she’s coming from”

But the essential information is…▪ Date and outcome of all pregnancies▪ Gestation and birthweight▪ Complications of pregnancy▪ Onset and length of labour▪ Mode of delivery▪ Complications of the labour, birth or

puerperium▪ The baby

Facilitated by a form or aide memoire

“Serious illnesses or operations”▪ But especially those that may impact

pregnancy Trigger phrases that I use…

▪ Heart problems or rheumatic fever▪ Asthma, bronchitis or other lung problems▪ Kidney disease or bladder infections▪ High blood pressure▪ Blood clots or thromboses▪ Nerves or depression▪ Back or spine problems▪ Serious accidents or blood transfusions▪ Sexually transmitted infections▪ Pap smears and gynaecological operations

“Is this a planned pregnancy” Age, education, occupation & religion All about the partner (or father of the

baby)▪ The relationship – how long and how good▪ His age, health, occupation and family▪ Domestic violence

The in-laws and outlaws▪ Especially relationship with the patient’s mother

Do you have all your previous children with you?

Pregnancy and birth plans “Do you wish to meet with a

counselor”

Smoking, Alcohol, Prescribed and Other Drugs

Trigger phrases that I use…▪ Do you smoke, how many, do you have

to, have you ever stopped▪ What is your favourite alcoholic drink,

how often, how many▪ Are you taking any other vitamins,

minerals or supplements▪ Have you ever injected yourself with

drugs▪ Do you use pot, marijuana or any other

recreational drugs▪ How about your partner

Usually Hypertension, Diabetes & Twins

▪ But routine screening makes the latter 2 superfluous

Trigger phrases that I use…▪ Do you know of any inherited conditions that

run in the family like anaemia, birth defects, stillborn babies or babies that did not survive

▪ Have there been any early deaths from heart disease or strokes, blood clots or thromboses

▪ Anyone in the family who suffers from depression or nerves

▪ Epilepsy or any other handicaps▪ Anyone in your family require Caesarean section

Single out pregnancies that are abnormal, disordered or high risk…

In order to provide interventions that will optimise an outcome

So this is an exercise in screening

That starts with the history

x = N orm al0 = D isease

x x x 0 x x x 0 x x x 0x x x 0 x x x 0 x x x 0x x x 0 x x x 0 x x x 0x x x 0 x x x 0 x x x 0

x = N orm al0 = D isease

x x x x x x x x xx x x x x x x x xx x x x x x x x xx x x x x x x x x

0 0 00 0 00 0 00 0 0

x x x 0 x x x 0 x x x 0x x x 0 x x x 0 x x x 0x x x 0 x x x 0 x x x 0x x x 0 x x x 0 x x x 0

x = N orm al0 = D isease

0 0 x x x xx x x x x xx x x x x xx x x x x x

x x x x x x x 0x x x x x x x xx x x x x x x xx x x x x x x x

x x x x x x x x x x x xx x x 0 x x x x x x x xx x x x x x 0 x x x x xx x x x 0 x x x x x x x

Sensitivity = the chance that the disease will be detected

Positive predictive value = the chance that a screen positive individual will have the disease

Is there a good screening test available

Is there an intervention available Is the disease worth detectingWill screen positive patients complyWill the test reach those applicableHas the program been tested by RCTCan the health system cope with the

program

Unless the answer that you get will help you in the care of your patient

And never do an examination or a test

Unless the result is going to influence what you do next

This is especially true for the physiological event that is Pregnancy and Childbirth

Read the companion text to this Powerpoint :

www.brinsmead.net.au/mdoc/ModelANRecord.pdf