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GEM - antenatal care part one including reference to NICE guidance

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Scenario A.

A 35 year old lady who is planning to try and conceive visits you at your GP surgery. This is her third pregnancy. She has had a previous miscarriage at 10/52 four years previously and a three year old daughter who was born at 41/40 via normal vaginal delivery. Her blood pressure is 120/80 mmHg. She is a smoker and drinks 10 units of alcohol per week.

With respect to smoking and pregnancy:

Alcohol in pregnancy:

  • what are the concerns regarding alcohol consumption and pregnancy? Is there a "safe" daily alcohol consumption?

Risk of Down's syndrome with maternal age:

This lady has been diagnosd with epilepsy for the last two years and is currently on sodium valproate 400mg bd.

Scenario B

The same lady came to see you at the GP surgery 4/12 lady later with the news that she had a pregnancy test which was positive. Her last menstrual period commenced 6 weeks ago.

With respect to diet in pregnancy:

  • what dietary advice should be given?
  • what infection in pregnancy is associated with eating mould-ripened cheeses such as Camembert ?
  • this lady asked for particular advice regarding iron supplementation. What advice should you give her?

With respect to routine ultrasound scans:

  • should she get one or two ultrasound scans and when should the scan(s) occur?
  • with respect to Down's screening, what is the nuchal translusency?
  • is the double test a recommended test for Down's screening
  • what level of risk from screening tests indicates the need for an amniocentesis?

Some Common conditions during pregnancy:

  • hyperemesis gravidarum
    • when is the characteristic onset of this condition?
    • what other conditions may be associated, other than a normal pregnancy, may be associated with hyperemesis during early pregnancy?
    • with respect to the standard management of hyperemesis gravidarum
      • what non-pharmacological interventions may be recommended?
      • what does NICE recommend as the first-line pharmacological intervention?
  • asymptomatic bacteriuria in pregnancy
    • what risks to the mother and unborn baby are associated with this condition?
    • what should the management be?

Reference:

  1. Royal College of General Practitioners. Curriculum Statement 10.1 Womens health.

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