First Antenatal Visit
This is usually the longest consultation that takes place during the pregnancy. Many women will come along with their partner, making this a nice introduction to the start if a 9 month relationship.
Your history is initially taken. Details such as the date of the last period, whether the periods are regular, the number of pregnancies previously etc. are obtained. Any previous obstetric history is discussed and a note is taken of risk factors i.e. previous presence of hypertension or caesarian section. A full medical and family history is also taken, along with smoking, drinking and allergy history.
Obviously this is the time to discuss any present issues with the pregnancy eg. Nausea ore recent bleeding. The first pregnancy especially is a very worrying time and often some fears can be allayed at this stage.
You would then be examined. This usually involved a blood pressure check and cardio vascular examination. A vaginal examination and pap smear will be done if this is necessary and the pregnancy is still early. I then perform an ultrasound either transabdominally or transvaginally to assess the pregnancy, but at this early stage I am only expecting to see a “jelly bean” with a heart beat.
This first consultation takes place between 8-10 weeks, although I will see women earlier if there have been previous medical or fertility issues, or bleeding during this pregnancy.
There are then routine investigations that are organised. Sometimes these have already been organised by the referring GP. The investigations that I like to have performed are:
1 Blood Group and Antibodies. There are a number of different blood groups. Once of these is Rhesus Negative. If you are Rhesus Negative and your baby has Rhesus Positive blood, you may be at a small risk of developing antibodies in your blood, either during the pregnancy or the birth of this baby. This can have potentially damaging outcomes for future pregnancies.
There is an injection that can be given in the event of any bleeding or after birth to help prevent the development of these antibodies. These injections are provided also at 28 and 34 weeks to women who are Rhesus Negative.
2.Full Blood Examination. This is a test to see if you are anemic. Anemia can make you feel very tired. It is often seen in women who are vegetarians, have a poor diet, or have had heavy periods in the past. It does not effect the baby. It is treatable by taking iron supplements.
3.Mid-Stream Urine (MSU). A Urinary Tract Infection does not always need to have symptoms. Infections can produce bladder infections and cause kidney infections and are associated with Anemia and preterm labour. Obviously any symptoms of UTI need to be mentioned during the pregnancy.
4.Serum Folate and B12. Folic acid deficiency is associated with an increased risk of Spina Bifida abnormalities but is very uncommon as most women will take vitamin supplements before conception.
Vitamin B12 deficiency is seen in women with pernicious anemia or malabsorption problems, or in Vegan’s. Vitamin B 12 deficiency can produce neurological problems in the baby and it is also important that it be corrected during the pregnancy.
Vitamin B12 can be provided in tablet form or by injection and is very rarely a problem.
5.Syphilis. Risk of Syphilis a Syphilis infection is very rare but it can have side effects for you and the baby and is treatable by antibiotics.
6.Hepatitis B. Hepatitis B is a virus that can cause liver disease and can be passed onto the baby. The baby is not infected during the pregnancy but can be infected during birth. If it is known that you are a Hepatitis B carrier, the baby can be protected by immunisation soon after birth.
Your Hepatitis B status is also important because it is a blood born infection and can be spread during examinations or delivery.
7.HIV. This is now a routine test for all pregnant women to enable appropriate treatment to the mother and baby during pregnancy and delivery.
8.Varicella (Chicken Pox) Serology. If you do not have immunity to Chicken Pox and are exposed to active disease it is possible to treat you safely by immunoglobulin or acyclovir. This disease is more harmful to the mother and rarely effects the baby.
9.Parvovirus. This is a virus infection that can cause miscarriages and fetal loss in the middle part of the pregnancy. There is no vaccination available but if you do not have immunity, blood tests are repeated monthly until 30 weeks, and appropriate treatment to the baby can be applied if necessary. The overall risk is small.
10.Thyroid Function Test. Thyroid deficiency can produce neurological problems in the baby and need to be treated. An overactive Thyroid may be treated during the pregnancy but uncommonly will affect the fetal development.
11.Serum Screening for Down Syndrome. This is preferably performed at 10 weeks gestation. A simple blood test is taken and checks for 2 pregnancy related hormones.
12.Combined Screening for Down Syndrome. It is usual today to have a blood test taken at 10 weeks gestation checking 2 pregnancy hormones and an ultrasound performed at 12 weeks to assess the nuchal thickness which is the skin fold at the back of the neck. The combination of these results in conjunction with the maternal age, will help predict the risk of having a baby with Down Syndrome and several other chromosome abnormalities. A risk of 1/300 is regarded as high and women who have a higher risk will be offered further testing, after a prolonged discussion.
13.Vitamin D Deficiency. Vitamin D deficiency is very common. The Vitamin is important in the development of strong bones in the baby, and therefore if a mother is Vitamin D deficient she will be recommended to take supplementation. This supplementation is recommened during the breast feeding phase as well. An iron deficiency will cause Anemia. Many women have an inadequate intake of meat and are iron deficient and need supplementation during pregnancy. If this does not occur they can feel very tired and obviously an adequate haemoglobin or blood count is preferable to cope with the blood loss at delivery.
Other tests that will be offered during the pregnancy include:
1.An ultrasound at 19-20 weeks. This is a structural scan and the baby is assessed from head to toe for abnormalities. Sex of the baby may be detected at this ultrasound. I only recommend the use of obstetric ultrasongrapher’s who improve the reliability, but even so can not absolutely guarantee that all fetal problems are detected.
Other factors detected here include the position of the baby, and the position
of the placenta which is obviously crucial if a placenta is low lying.
2.Blood Testa at 26 weeks. At 26 weeks gestation, all women will have further blood tests. These consist of repeating the full blood count, iron studies and may require retesting of Vitamin D, Thyroid function and Parvovirus.
At this stage a Glucose Challenge test will be performed. This blood test measures the amount of sugar in your blood. You will be given a sweet drink and have the blood test taken 1 hour later. You do not need to fast for this blood test. If this blood test in abnormal a longer Glucose Tolerance Test, which takes 3 hours and involves fasting overnight will be necessary. In most cases women who are diagnosed with Diabetes of pregnancy, have minor dietary adjustments and there are no consequences to the mother or baby. Occasionally women will need oral medication of Insulin.
3.36 Week Vaginal Swab. At 36 weeks gestation you will have screening for GBS. This is a common organism found in the vagina which will not harm the mother but can cause health problems in the new born baby. The swab is taken from the lower vagina. If the swab is positive, that is you grow the germ, antibiotics will be provided during labour. Antibiotics are not required before labour starts.
There may be other investigations required during pregnancy, for example, more ultrasounds, more blood tests if you have Hypertension of Diabetes, or if other medical or obstetric problems arise.
Follow up during the pregnancy.
During a first pregnancy the consultations are usually monthly until 28 weeks gestation, fortnightly until 36 weeks gestation and then weekly until the baby is delivered.
A discussion about your expectations of labour will occur between 34 – 36 weeks gestation, although many of these aspects have been discussed prior to this stage. I have a midwife, Maryann, who will discuss labour and breast feeding from a Midwife’s perspective to the management.
Whoping Cough Vaccination
Why should parents have the vaccine?
The number of babies under six months old catching whooping cough has increased dramatically in Victoria over the last 5 years.
Around one in every 200 babies under six months of age who catch Whooping Cough will die. Some babies will suffer permanent disability from brain and lung damage.
Parents and family members are the main source of Whooping Cough infections in babies. Vaccination protects you from catching and passing on the infection to your baby.
Even if you were vaccinated as a child, you may no longer be protected; immunity provided by the vaccine fades after 6 to 10 years.
Partners of pregnant women should get the vaccine before the birth of the baby. Pregnant women should be the vaccination as soon as possible after the birth of the baby.
The vaccin is safe for adults and children including:
- Breastfeeding mothers
- People who have had a recent tetanus booster.
What is Whooping Cough?
Whooping Cough, also known as Pertussis, is a highly infectious disease causing a severe, persistent cough. In young babies the cough is often followed by breathing problems and vomiting. Whooping Cough is spread by coughs and sneezes from an infected person.
Severe complications such as Pneumonia, bleeding, convulsions, coma and permanent brain and lung damage can occur.
Why do babies need extra protection against whooping cough?
Babies under six months of age are particularly at risk, as they are not protected against Whooping Cough until their six months vaccination schedule is complete. Infected babies often require admission to hospital. A mother does not pass any protection against Whooping Cough onto her baby whilst pregnant or breastfeeding.
How do I obtain the free vaccine?
Ask your health care provider about getting the free Whooping Cough vaccine called Boostrix, which also contains protection against Diptheria and Tetanus. Some councils may also provide the vaccine. Contact your local council directly or ask you maternal and child health nurse.
Who can receive the vaccine for free?
The vaccine is available free until 30 June 2011 to parents, adoptive parents and foster parents of newborn babies. It is also available free to partners of pregnant women.
Other ways to protect your baby from Whooping Cough.
- Vaccinate your baby on time.
- Make sure all your children are up-to-date with Whooping Cough vaccines. Booster doses are required at 4 and 15 years of age.
- Anyone regularly in contact with your baby (grandparents, childcare and healthcare workers) should be vaccinated.
Where can I get further information about Whooping Cough?
More information is available from: