GEM - antenatal care part one including reference to NICE guidance

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:

• does smoking affect a woman's fertility?
  • GPN reference
• if this lady was given smoking cessation medication, is nicotine replacement therapy or bupropion advised in pregnancy ?
  • GPN reference 1
  • GPN reference 2

Alcohol in pregnancy:

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

Risk of Down's syndrome with maternal age:

• what is her background risk of Down's syndrome?
  • GPN reference

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

• how does this lady's epilepsy affect preconceptual advice?
  • use of folic acid
  • risk of congenital malformations with epilepsy treatment

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

With respect to routine ultrasound scans:

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

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?
    • GPN reference
  • 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?
      • GPN reference
• asymptomatic bacteriuria in pregnancy
  • what risks to the mother and unborn baby are associated with this condition?
  • what should the management be?
    • GPN reference

Reference:

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