HOMERTON ANTENATAL CARE GUIDELINES Author(s) Dr Rishu Goel - Consultant Obstetrician Dr Maryam Parisaei - Consultant Obstetrician Dr Charlotte Austen - Obstetric Registrar Sarah Latham – Deputy Head of Midwifery Jane Bekoe - Antenatal Clinic Manager Ella Hill Behari – Lead CMS in Fetal Medicine Version 5.0 Version Date June 2020 Implementation June 2020 /Approval Date Review Date June 2023 Review Body Maternity Risk Management Review Group Policy Reference Number 276/swsh/mat/Antenatal Care Guideline/RG/MP/CA/SL/JB/ EHB Version Control Version Date Author(s) Reason Ratification 2.1 4.4.2012 Dr Maryam Parisaei To strength 2.0 actions to be No Consultant Obstetrician taken if consultant obstetrician is away Dr Kirsten Brown GP 2.2 10.4.2012 Annette Anderson To include information about Yes Maternity Clinical Risk MCADD actions from Manager implementing the NPSA alert 2.3 20.8.2014 Dr Maryam Parisaei Reviewed Yes Consultant Obstetrician Dr Kirsten Brown GP Dr John Anderson Endocrinology General Medicine Diabetic Consultant Dr Adam Steingold Dr Debra Penny Catherine Meyers- Antenatal Clinic Midwifery Sister Venetia Johnson Midwife Lana Jones-Sandy Audit midwife 3 1.4.2014 Lindsey Morgan Updated following Clinical Project lead actions from RCA and in line with national guidance 4 20.01.2017 Dr Maryam Parisaei - Consultant Obstetrician Dr Kirsten Brown – GP Dr D Tsitsikas – Consultant Haematologist Dr Anna McDougall – Specialty Registrar Dr Elena Mantovani- Specialty Registrar Sarah Latham - Maternity Outpatients Matron Catherine Meyers - Antenatal Clinic Midwifery Sister Lana Jones-Sandy Audit midwife Ella Hill Behari – Lead CMS in Fetal Medicine 4.1 20.09.2017 Annette Anderson – Maternity Clinical Updated following a No Risk Manager & Mr Ade Kojeku – maternal death SI Consultant Obstetrician investigation to include referring to the obstetric medicine clinic for mothers with a history of cardiac conditions 4.2 August 2018 Ms Cathy Roberts - Consultant Updated following a Obstetrician SI Investigation 5.0 May 2019 Ms Rishu Goel (Consultant Obstetrician) Jane Bekoe (Antenatal Clinic Manager) Dr.Charlotte Austen (Registrar) Antenatal Care Guideline Page 2 of 60 Contents 1.0 Philosophy .......................................................................................................... 5 2.0 Summary ............................................................................................................ 5 3.0 Introduction and Aim of the Guideline ................................................................. 5 4.0 Scope ................................................................................................................. 6 5.0 Roles & Responsibility ........................................................................................ 6 6.0 Children’s Centre ................................................................................................ 6 7.0 Preconception .................................................................................................... 6 8.0 Referral for Booking ............................................................................................ 6 9.0 Specialist Clinics ................................................................................................. 7 10.0 Woman Orientated Antenatal Care ................................................................. 7 11.0 Booking Visit by the midwife ............................................................................ 8 12.0 Investigations: if not already done by the GP .................................................. 9 13.0 Follow-up Antenatal Visits (See schedule of AN visits below) at each visit ..... 10 14.0 The Maternity Notes ....................................................................................... 14 At the booking appointment ....................................................................................................... 14 For follow up appointments ........................................................................................................ 14 Transfer of care in antenatal period ........................................................................................... 15 15.0 Schedule of Antenatal Visits for Low Risk Women .......................................... 15 16.0 Risk factors and suggestive management protocols...................................... 16 17.0 Maternal Factors ........................................................................................... 17 18.0 Relevant medical conditions .......................................................................... 20 19.0 Previous Obstetric History ............................................................................. 23 20.0 Booking Examination..................................................................................... 24 21.0 Responses to Investigations ......................................................................... 24 Anaemia ..................................................................................................................................... 24 Haemoglobin .............................................................................................................................. 24 Haemoglobinopathies: ............................................................................................................... 25 Management of Anaemia .......................................................................................................... 25 Advice regarding oral iron: ......................................................................................................... 25 Iron Studies: ............................................................................................................................... 26 Algorithm for the management of anaemia ................................................................................ 27 22.0 Thrombocytopenia in Pregnancy ................................................................... 28 1. Gestational thrombocytopenia ............................................................................................... 28 2. Immune Thrombocytopenic Purpura (ITP) ............................................................................ 29 3. Hypertensive disorders of pregnancy; ................................................................................... 30 4. Microangiopathies ................................................................................................................. 31 5. Other causes of maternal thrombocytopenia ........................................................................ 32 23.0 Blood Group & Antibody screen .................................................................... 35 24.0 Syphilis Serology ........................................................................................... 35 25.0 Hepatitis B Serology ...................................................................................... 35 26.0 Haemoglobinopathy screen ........................................................................... 35 27.0 Raised Random Blood Glucose ..................................................................... 36 28.0 MSU .............................................................................................................. 36 29.0 Cervical Smear ............................................................................................. 36 30.0 Group B Streptococcus ................................................................................. 36 27.0 Problems arising in pregnancy ...................................................................... 36 Mental Illness in Pregnancy ....................................................................................................... 36 Chicken Pox in Pregnancy ......................................................................................................... 36 Itching In Pregnancy .................................................................................................................. 37 Breech Presentation .................................................................................................................. 37 28.0 Ultrasound, Combined Test, Amniocentesis and CVS .................................... 37 29.0 Booking or dating scan .................................................................................. 38 30.0 The Combined Test ....................................................................................... 38 31.0 Low PAPP-A ................................................................................................. 38 First trimester management ....................................................................................................... 38 Second trimester management .................................................................................................. 39 Anomaly Scan ...................................................................................................................... 39 Antenatal Care Guideline Page 3 of 60 Growth or Late Scan ............................................................................................................ 39 Amniocentesis & Chorionic Villous Sampling (CVS) ............................................................ 39 32.0 The “BARTS” or “QUADRUPLE” Test ............................................................ 39 33.0 HIV ................................................................................................................ 39 34.0 Sickle