Initial visit

• Confirm pregnancy – planned/unplanned/wanted
• LMP/EDD – check cycle length
• PMHx 
  • including CST
  • alcohol/smoking/drug intake
  • Depression – use EDPS
  • FDV/intimate partner violence
  • Congenital abnormalities
  • thyroid/autoimmune disease/GDM/ diabetes
  • kidney disease
  • Thrombophilia – prev DVT/PE
  • previous anaesthetic concerns
  • JW
• FamHX – congenital /hereditary anomalies
• Medications
• ObsHx
  • gravida:  parity:
  • previous Caesar
  • previous preterm birth – (<34 weeks commence cervical length surveillance on USS from 13 weeks, contact GH)
  • previous stillbirth/foetal loss/infant death
  • previous low birth weight baby
  • previous eclampsia/pre-eclampsia
  • previous birth defects inc neural tube defects
• Exam
  • BP, pulse
  • BMI with consent
  • general exam including cardiac
• Vaccinations incl flu

Management

• Dating scan – preferably around 7 weeks
• Any concerns re viability (spotting/cramping) – consider Bhcg 48 hours apart if <2500.  If > 2500 then for USS
• Folic acid – 400mcg daily (ideally 1 month prior and 3 months during)
  • If increased NTD risk eg anticonvulsant, prepregnancy DM, BMI > 30, famHX of NTD – 5mg folic acid
• Prenatal vitamins (incl iodine, vit D and folic acid)
• CMV education – CMV – cerebral palsy alliance patient brochures
• Listeria /safe foods – provide list and those foods to avoid
• Aspirin (at least 100mg)  if mod-high risk of pre-eclampsia
  • 1 of
  Previous
  • 2 of            –     nulliparity
    • ART
    • BMI > 35
    • Age > 40
    • FamHx of PET
    • Long interpregnancy interval > 10 years  

Preeclampsia risks

• One of
  • Previous PET <37/40 or hypertension
  • Essential Hypertension
  • Diabetes (1 or 2)
  • APS/SLE
  • Multiple gestation
• Two of
  • Nulliparous
  • ART
  • BMI > 35
  • Family history of PET
  • Interpregnancy interval more than ten years

TESTS

• FBC
• Bld grp and Ab
• HbA1c (if risk factor for DM and nil in 12 months prior) OR OGTT (if prev GDM of prev HbA1c 6-6.4%)]
• HIV, syphilis, Hep B, hep C
• Rubella titre
• Urine M/C/S
• Urine PCR (first void) – chlamydia/gonorrhoea
• Offer genetic carrier screening – cystic fibrosis, fragile X and spinal muscular atrophy (SME).   Bulk billed once per lifetime.  Ideally preconception – the earlier the better
• CONSIDER – vit D (usual MBS criteria), B12, varicella (unclear Hx). TSH, CMV serology (high risk eg child care worker)

Fetal chromosomal abnormality testing

• Combined first trimester screening (CFTS)
  • Bloods – (10-13+6) – make sure copied to radiology
  • USS (12-13+6) – GH and SJOG only. Form must state “risk of fetal abnormality” to be covered by medicare

OR

• Non invasive prenatal testing (NIPT)
  • >10 weeks blood test
  • “Early anatomy scan” at 13-13+6 weeks

List of current GPOs available

Geraldton.maternityadmin@health.wa.gov.au

08 9956 8622

Recommend booking with their choice of GPO ASAP as limited availability

Please send /cc all AN investigations to SJOG/GH with the name of the planned GPO

Please call the obs team if ANY concerns/questions.  09 9956 2222 and ask for the “second on-call”