Sunday, September 30, 2012

Sickle cell and thalassaemia in pregnancy - cystic fibrosis and cervical cancer screening


Sickle cell and thalassaemia in pregnancy: Sickle cell and thalassaemia disorders are inherited blood conditions that mainly affect the way oxygen is carried around the body. You will be offered a blood test early in pregnancy for thalassaemia and asked for facts about your and your baby’s father’s family origin to decide if any other tests are required. These facts will help your midwife or doctor to offer the correct tests and will also help to give you the correct results of the test. It is very important that you tell the midwife, doctor or person doing the test if you think you or your baby’s father have an ancestor who came from outside northern Europe (for example, someone who is Italian, Maltese, Portuguese, Spanish, Indian, Chinese, African or African-Caribbean).
Healthy people can be carriers of sickle cell or thalassaemia without knowing it and can pass it on to their children. It’s possible for you or your baby’s father to be carriers of these disorders without it affecting your baby at all. Carriers cannot develop the disorders, but if both of you are carriers there is a risk that your baby could have a sickle cell or thalassaemia disorder. Your midwife or doctor will discuss the implications for your baby. For further facts contact the Sickle Cell Society or the UK Thalassaemia Society for more details.
Cystic fibrosis and pregnancy  
Cystic fibrosis is an inherited disease that affects vital organs in the body, especially the lungs and digestive system, by clogging them with thick sticky mucus. The sweat glands are usually also affected. The disease is inherited and both parents must be carriers of the gene variation for their baby to be born with cystic fibrosis. Testing is offered if there is a family history of cystic fibrosis.
Cervical cancer screening   
Cervical smears detect early changes in the cervix (the neck of the uterus), which could later lead to cancer if left untreated. Routine smears are only offered to women over 25.
If you are due to have a cervical smear (if you have not had one in the last three years), you will probably be told to wait until three months after your baby is born unless you have a history of abnormal smears. This is based on guidance by the NHS cervical screening program.

Anemia in pregnancy - rubella, syphilis, hepatitis b and c during pregnancy


Anemia in pregnancy: Anemia makes you tired and less able to cope with any loss of blood when you give birth. If tests show you are anemic, you will probably be given iron and folic acid.
Hemoglobin test in pregnancy
This stands for ‘hemoglobin’. It is tested in your blood sample to check if you are anemic.
Rubella immunization after pregnancy (German measles)
If you get rubella in early pregnancy, it can seriously damage your unborn baby. Your midwife or doctor will talk to you about what happens if your test results show low or no immunity. You will be offered a rubella immunization after your baby is born.
Syphilis and pregnancy  
You will be tested for this infection because if left untreated, it can lead to miscarriage and stillbirth.
Hepatitis B in pregnancy    
This is a virus that can cause serious liver disease. If you have the virus or are infected during pregnancy, it may infect your baby. Your baby will not usually be ill but has a high chance of developing long-term infection and serious liver disease later in life. Your baby can start a course of immunization at birth to help prevent infection. If you have hepatitis B, you will be referred to a specialist.
Hepatitis C during pregnancy     
This virus can cause serious liver disease and there is a small risk that it may be passed to your baby if you are infected. This cannot be prevented at present. Tests for hepatitis C are not usually offered routinely as part of antenatal care. If you think you may be at risk, talk to your midwife or GP. They can arrange a test. If you are infected, your baby can be tested within a few days of birth. If you have hepatitis C, you will be referred to a specialist.
Herpes and pregnancy  
If you, or your partner, have ever had herpes, or you get your first attack of blisters or ulcers during your pregnancy, let your midwife or doctor know. Herpes can be dangerous for your newborn baby and it may need treatment.

Pregnancy blood tests - the Rhesus factor and disease prevention


Pregnancy blood tests: As part of your antenatal care, you will be offered a number of blood tests. Some are offered to all women and some are only offered if it is thought that you are at risk of a particular infection or inherited condition. All of the tests are done to help make your pregnancy safer or to check that your baby is healthy. Talk to your midwife or doctor so that you understand why the blood tests are being offered and so that you can make an informed choice about whether or not you want them. Your midwife or doctor should also inform you about the tests. Below is an outline of all the tests that can be offered.
Blood group and Rhesus factor test    
Your blood will be tested to check your blood group and to see whether you are rhesus negative or positive. Some women are rhesus negative. This is usually not a worry for a first pregnancy but it may affect the next child.
People who are rhesus positive have a substance known as D antigen on the surface of their red blood cells. Rhesus negative people do not.
A woman who is rhesus negative can carry a baby who is rhesus positive if the baby’s father is rhesus positive. During pregnancy or birth, small amounts of the baby’s blood can enter the mother’s bloodstream. This can cause the mother to produce antibodies. This usually doesn’t affect the existing pregnancy, but the woman becomes ‘sensitized’. This means that if she gets pregnant with another rhesus positive baby, the immune response will be quicker and much greater. The antibodies produced by the mother can cross the placenta and attach to the D antigen on her baby’s red blood cells. This can be harmful to the baby as it may result in a condition called haemolytic disease of the newborn, which can lead to anemia and jaundice.
Prevention of rhesus disease
Anti-D injections prevent rhesus negative women producing antibodies against the baby and reduce the risk of a rhesus negative woman becoming sensitized.
Rhesus negative mothers who are not sensitized are offered anti-D injections at 28 and 34 weeks as well as after the birth of their baby.
This is quite safe for both the mother and her baby.

Late pregnancy midwife appointments and checking fetal movement


Late pregnancy midwife appointments: From 20–24 weeks, your antenatal appointments will become more frequent. If your pregnancy is uncomplicated and you are well, you may not be seen as often.
Your later appointments are usually quite short. Your midwife or doctor will:
check your urine, blood pressure, and sometimes your weight
feel your uterus to check your baby’s position
measure your uterus to check your baby’s growth
listen to your baby’s heartbeat if you want them to.
You can also ask questions or talk about anything that is worrying you. You should be informed about:
Your plan of birth
How to prepare for labor and birth
How to tell if you are in active labor
Induction of labor if your baby is late
The ‘baby blues’ and postnatal depression
feeding your baby
screening tests for newborn babies
looking after yourself and your new baby.
Checking fetal growth and movement
At each antenatal appointment from 24 weeks, your midwife or doctor should check your baby’s growth. To do this, they will measure the distance from the top of your uterus to your pubic bone. The measurement will be recorded in your notes.
In the last weeks of pregnancy, you may also be asked to keep track of your baby’s movements.
If your baby’s movements become less frequent, slow down or stop, contact your midwife or doctor immediately.
You will be offered an ultrasound scan if your midwife or doctor has any concerns about your baby’s growth. 

Baby delivery at home and deliver baby at hospital - routine checks during antenatal appointments


Baby delivery at home: If you are going to have your baby with midwifery care in a midwifery unit, in hospital or at home you will probably see your own midwife for most of your antenatal care. You may be offered a visit at the hospital for an initial assessment and perhaps for an ultrasound scan or for special tests. Sometimes your midwife may visit you at home.    
Baby delivery at hospital
If you are going to have your baby in hospital, you’ve to know that antenatal care varies around the country. In some areas, the booking appointment is at the hospital, then all or most of the remaining appointments are with a midwife or GP. However, if there are complications, all appointments will be at the hospital. In other areas, all care is given by a midwife or GP unless there are complications, which mean a referral to the hospital antenatal clinic.
Routine checks at every antenatal appointment  
Your urine and blood pressure will be checked at every antenatal appointment.
Pregnancy urine test   
Your urine is checked for a number of things, including protein or ‘albumin’. If this is in your urine, it may mean that you have an infection that needs to be treated.
It may also be a sign of pre-eclampsia or ‘High blood pressure and pre-eclampsia’.
Pregnancy blood pressure   
A rise in blood pressure later in pregnancy could be a sign of pre-eclampsia. It is very common for your blood pressure to be lower in the middle of your pregnancy than at other times.
This is not a problem, but may make you feel light-headed if you get up quickly. Talk to your midwife if you are concerned.

Thursday, September 27, 2012

Weight and height for pregnant women - midwife booking appointment questions


Weight and height for pregnant women: You will be weighed at the booking appointment, but you probably will not be weighed regularly during your pregnancy. Your height will be measured along with your weight so that your midwife can calculate your BMI (body mass index). Most women put on between 10 and 12.5kg (22–28lbs) in pregnancy, most of it after the 20th week. Much of the extra weight is due to the baby growing, but your body will also be storing fat ready to make breast milk after the birth. Eating sensibly and taking regular exercise can help. It’s useful to know advices about what you should eat and about exercise.
In some areas, height, weight and BMI are used to produce a personalized growth chart for your baby’s development. However, other areas will use an average growth chart instead.
Pregnancy booking appointment questions    
You will be asked a lot of questions to build up a picture of you and your pregnancy.
This is so that you are given the support you need and any risks are spotted early. You will probably want to ask a lot of questions yourself.
You may be asked about:
The date of the first day of your last period, to help work out when your baby is due
Your health
Any previous illnesses and operations
Any previous pregnancies or miscarriages
your and your baby’s father’s origins. This is to find out if your baby is at risk of certain inherited conditions, or if there are other factors, such as a history of twins
Your work or your partner’s work and what kind of accommodation you live in, to see if there is anything about your circumstances that might affect your pregnancy
How you are feeling and if you have been feeling depressed.
At the end of your booking appointment, you should understand the plan of care for your pregnancy and have your hand-held notes to carry with you at all times.
Your booking appointment is an opportunity to tell your midwife or doctor if you are in a vulnerable situation or if you need extra support.
This could be because of domestic violence.

Antenatal care in early pregnancy - first appointment with doctor when pregnant


Antenatal care in early pregnancy: In early pregnancy (up until 20–24 weeks), your antenatal appointments will take longer than those in mid- pregnancy. This is because your midwife or doctor will need time to assess you and your baby, discuss your care and give you advices. At each appointment you should have the chance to ask questions and discuss any concerns or issues.
First appointment with midwife or GP    
As soon as you think you are pregnant, you should make an appointment to see your midwife or GP. The earlier you do this, the better. At this appointment you will be given advices about:
Folic acid and vitamin D supplements
Nutrition and diet
Food hygiene
Lifestyle factors that may affect your health or the health of your baby.
Antenatal screening tests.
Your pregnancy booking appointment  
Most women have their ‘booking appointment’ between the 8th and 12th week of pregnancy. This can take a couple of hours. You will see a midwife and sometimes a doctor. You should also be offered an ultrasound scan.
You should be given facts about:
How the baby develops during pregnancy
Nutrition and diet
Exercise and pelvic floor exercises
Antenatal screening tests
Your antenatal care
Breastfeeding, including workshops
Antenatal education
Maternity benefits
planning your labor
Your options for where to have your baby.

34- 41 weeks pregnant doctor appointments


34 weeks doctor’s appointment: Your midwife or doctor should give you facts about preparing for labor and birth, including how to recognize active labor, ways of coping with pain in labor and your birth plan. Your midwife or doctor should:
review, discuss and record the results of any screening tests from the last appointment
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein
offer your second anti-D treatment if you are rhesus negative.
36 weeks doctor appointment     
Your midwife or doctor should inform you about:
feeding your baby
caring for your newborn baby
Vitamin K and screening tests for your newborn baby
Your own health after your baby is born
The ‘baby blues’ and postnatal depression.
Your midwife or doctor should:
use a tape to measure the size of your uterus
check the position of your baby
measure your blood pressure and test your urine for protein.
38 weeks doctor’s appointment   
Your midwife or doctor will discuss the options and choices about what happens if your pregnancy lasts longer than 41 weeks. Your midwife or doctor should:
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein.
40 weeks pregnant doctor appointment 
Your midwife or doctor should give you more facts about what happens if your pregnancy lasts longer than 41 weeks. Your midwife or doctor should:
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein.
41 weeks pregnant doctor appointment      
Your midwife or doctor should:
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein
offer a membrane sweep
discuss the options and choices for induction of labor.

8- 31 weeks pregnant doctor’s appointments - dating and anomaly scans


8–14 weeks doctor appointment (dating scan): Ultrasound scan to estimate when your baby is due, check the physical development of your baby and screen for possible abnormalities.
16 weeks doctor appointment   
Your midwife or doctor should inform you about the ultrasound scan you will be offered at 18 to 20 weeks and help with any concerns or questions you have.
Your midwife or doctor should:
review, discuss and record the results of any screening tests
measure your blood pressure and test your urine for protein
consider an iron supplement if you are anemic.
18–20 weeks doctor appointment (anomaly scan during pregnancy)  
Ultrasound scan to check the physical development of your baby.
25 weeks pregnant doctor appointment   
Your midwife or doctor should:
check the size of your uterus
measure your blood pressure and test your urine for protein.
28 weeks doctors appointment  
Your midwife or doctor should:
use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein
offer more screening tests
offer your first anti-D treatment if you are rhesus negative.
31 weeks pregnant doctor appointment     
Your midwife or doctor should:
review, discuss and record the results of any screening tests from the last appointment
 use a tape to measure the size of your uterus
measure your blood pressure and test your urine for protein.

Antenatal appointments schedule - first and 12 weeks doctor appointments


First appointment for pregnancy: This is the appointment when you tell your midwife or doctor that you are pregnant.
They should give you information about:
Folic acid and vitamin D supplements
Nutrition, diet and food hygiene
Lifestyle factors.
Antenatal screening tests.
It is important to tell your midwife or doctor if:
There were any complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth.  
You are being treated for a chronic disease such as diabetes or high blood pressure
You or anyone in your family has previously had a baby with an abnormality, for example spina bifida.   
There is a family history of an inherited disease, for example sickle cell or cystic fibrosis.
Antenatal booking appointment (8–12 weeks)  
Your midwife or doctor should give you information about:
• How the baby develops during pregnancy
• Nutrition and diet
• Exercise and pelvic floor exercises
• Antenatal screening tests
• Your antenatal care
• Breastfeeding, including workshops
• Antenatal education
• Maternity benefits
• planning your labor
• Your options for where to have your baby.
Your midwife or doctor should:
• give you your hand-held notes and plan of care
• see if you may need additional care or support
• plan the care you will get throughout your pregnancy
• identify any potential risks associated with any work you may do
• measure your height and weight and calculate your body mass index
• measure your blood pressure and test your urine for protein
• find out whether you are at increased risk of gestational diabetes or pre-eclampsia
• offer you screening tests and make sure you understand what is involved before you decide to have any of them
• offer you an ultrasound scan at eight to 14 weeks to estimate when your baby is due
• offer you an ultrasound scan at 18 to 20 weeks to check the physical development of your baby and screen for possible abnormalities.

Wednesday, September 26, 2012

What is the importance of antenatal care appointments?


Antenatal appointments: If you are expecting your first child, you are likely to have up to 10 appointments. If you have had a baby before, you should have around seven appointments. In certain circumstances, for example if you have or develop a medical condition, you may have more appointments.
Your appointments may take place at your home, in a Children’s Centre, in your GP’s surgery or in hospital. You may be asked to go to hospital for your scans.
Your antenatal appointments should take place in a setting where you feel able to discuss sensitive problems that may affect you (such as domestic violence, mental illness).
Early in your pregnancy your midwife or doctor should give you information about how many appointments you are likely to have and when they will happen. You should have a chance to discuss the schedule with them. There is a table gives you a brief guide to what usually happens at each antenatal appointment.
If you cannot keep an antenatal appointment, please let the clinic or midwife know and make another appointment.
Importance of antenatal care appointments     
The aim is to check on you and your baby’s progress and to provide clear advices and explanations about your care. At each appointment you should have the chance to ask questions and discuss any concerns or issues with your midwife or doctor. Each appointment should have a specific purpose. You will need longer appointments early in pregnancy to allow plenty of time for your midwife or doctor to assess you, discuss your care and give you advices. Wherever possible, the appointments should include any routine tests.