basic obstetrics

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role and responsibilities of the lmc basic obstetrics for medical students * who can offer lead maternity care? specialist obstetrician midwife gp – diploma obstetrics shared care options * comparison of philosophy midwife holistic approach “social justice approach” work towards self-health and self determination partnership model the woman ‘births’ her baby medical the mother reaches the end of pregnancy as healthy or healthier than the outset that any physical or psychological defects are detected and treated that the mother is delivered of a healthy baby * first antenatal visit confirmation of pregnancy planned or unplanned ?top assessment of pregnancy ‘risk’ take full obstetric, medical & social history (including assessment for domestic violence) * * termination of pregnancy reasons explain legal position discuss other options full hx / exam including hvs, chlamydia swabs, antenatal bloods psych state info sheet, discuss procedure contraception follow up * obstetric history gravida, para previous top/miscarriage …

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maternal triple test 15wks mssu chlamydia screening amniocentesis or cvs in high risk cases 1% miscarriage risk * msu asymptomatic bacteriuria 2%-10% (nice 2003) can cause pyleonephritis and preterm labour urine dipstick unreliable only detects 50% of cases (nice guidelines 2003) * chlamydia urine screening should be offered to high risk women under 25yrs unmarried women history of std new/multiple partners no history of barrier contraception women in communities with high rates 1st trimester and 3rd trimester (kirkham et al 2005) * medications and advice folic acid 0.8mg till 12wks morning sickness contact if pain or bleeding discuss lead maternity care options lmc referral obstetric referral if risk identified * further tests 18-20wks anomaly scan 28wks- cbc, ?ferritin if hb < 10.5g/dl, antibodies, anti d rh neg (nice 2003) 34 wks ?kick chart (debateable point), 2nd dose anti d rh neg (nice 2003) 36wks- cbc for those on iron, antibodies …

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nic effects * monitor urine for ketones u&e for dehydration if severe vomiting refer and admit if signs of hyperemesis gravidarum early scan to exclude molar pregnancy * thank you for attention

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role and responsibilities of the lmc basic obstetrics for medical students * who can offer lead maternity care? specialist obstetrician midwife gp – diploma obstetrics shared care options * comparison of philosophy midwife holistic approach “social justice approach” work towards self-health and self determination partnership model the woman ‘births’ her baby medical the mother reaches the end of pregnancy as healthy or healthier than the outset that any physical or psychological defects are detected and treated that the mother is delivered of a healthy baby * first antenatal visit confirmation of pregnancy planned or unplanned ?top assessment of pregnancy ‘risk’ take full obstetric, medical & social history (including assessment for domestic violence) * * termination of pregnancy reasons e...

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