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Normal pregnancy and antenatal care

Specialties > Obstetrics

Overview of Normal Pregnancy 🧠

Pregnancy Trimesters

  • First Trimester (0-12 weeks): Critical period for organogenesis. Common symptoms include nausea, vomiting (morning sickness), fatigue, and breast tenderness. Important to confirm pregnancy, establish estimated due date (EDD), and perform initial blood tests.
  • Second Trimester (13-26 weeks): Period of fetal growth and maturation. Common symptoms include increased energy, fetal movements (quickening), and occasional heartburn. Screening for gestational diabetes and anomaly scans are typically performed.
  • Third Trimester (27-40 weeks): Final period of fetal growth and preparation for birth. Symptoms may include back pain, Braxton Hicks contractions, and increased urinary frequency. Monitoring for complications like preeclampsia and ensuring birth preparedness is key.

Antenatal Care 🥼

Booking Appointment (Around 8-10 Weeks)

  • Comprehensive History: Includes medical, obstetric, and family history, as well as lifestyle factors such as smoking and alcohol use.
  • Blood Tests: Full blood count, blood group, Rhesus factor, screening for infections (HIV, syphilis, hepatitis B), and rubella immunity.
  • Urine Tests: Dipstick for proteinuria, culture if necessary; initial screening for asymptomatic bacteriuria.
  • Information Provision: Discuss diet, supplements (folic acid, vitamin D), exercise, and what to expect during pregnancy.
  • Risk Assessment: Identify any high-risk factors that may require consultant-led care or additional monitoring.

Routine Antenatal Visits

  • Frequency: Typically every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly until delivery.
  • Monitoring: Blood pressure, urine dipstick, fetal growth (symphysis-fundal height), and fetal heart rate.
  • Screening: Anomaly scan (18-20 weeks), glucose tolerance test (if indicated), and routine blood tests at 28 weeks (including repeat hemoglobin, blood group antibodies, and glucose screening).
  • Patient Education: Discuss signs of complications (e.g., preeclampsia, gestational diabetes), birth plans, and options for pain relief during labor.
  • Vaccinations: Offer influenza vaccine (seasonal) and pertussis vaccine from 16 weeks onwards.

Key Points in History 🥼

Background

  • Obstetric History: Previous pregnancies, complications (e.g., preeclampsia, gestational diabetes), and outcomes (e.g., preterm delivery, cesarean section).
  • Medical History: Chronic conditions such as hypertension, diabetes, thyroid disorders, and any surgical history.
  • Drug History: Current medications, including over-the-counter and herbal supplements; assess for teratogenic risks.
  • Family History: Hereditary conditions, history of congenital anomalies, or recurrent pregnancy loss.
  • Social History: Smoking, alcohol, drug use, occupational risks, and support systems.

Possible Investigations 🌡️

Routine Investigations

  • Ultrasound Scans: Dating scan at 11-14 weeks, anomaly scan at 18-20 weeks, and growth scans if indicated (e.g., in cases of suspected growth restriction).
  • Blood Tests: Full blood count, blood group and Rhesus status, infection screening (HIV, syphilis, hepatitis B), and glucose screening for gestational diabetes.
  • Urine Tests: Routine dipstick testing for proteinuria and glucose; culture for asymptomatic bacteriuria.
  • Fetal Monitoring: Non-stress tests and biophysical profile may be used later in pregnancy if there are concerns about fetal well-being.
  • Additional Tests: Consider testing for thyroid function, hemoglobinopathies, or thrombophilia based on risk factors or clinical presentation.

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Obstetrics