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523127e675b4ed3d | ## **Further review and information:**
This guideline will remain current until the next review on or before **August 2018**. Requests for further information, comments or suggestions are encouraged and can be forwarded to:
*Centre of Research Excellence in Stillbirth Mater Research Institute Level 3, Aubigny Place S... |
e9997342b871a6a2 | #### **2.1 Recommendations for fetal movement monitoring**
| Recommendations | Evidence level and references* | Recommendation grade* |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
cffae7402648b47e | #### **2.1 Recommendations for fetal movement monitoring**
| Recommendations | Evidence level and references* | Recommendation grade* |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
fc1502732ad241a3 | #### **2.1 Recommendations for fetal movement monitoring**
| Recommendations | Evidence level and references* | Recommendation grade* |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
3972a5882c091602 | #### **2.1 Recommendations for fetal movement monitoring**
| Recommendations | Evidence level and references* | Recommendation grade* |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
e7aeb9f03841d57b | #### **2.2 Recommendations for the investigation of decreased fetal movements**
| Recommendations | Evidence level and references* | Recommendation grade* | |
|------------------------------------------------------------------------------------------------------------------------------------------|--------------------... |
1cbbcc7e95b4872d | #### **2.2 Recommendations for the investigation of decreased fetal movements**
| Recommendations | Evidence level and references* | Recommendation grade* | |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------... |
d21d478495017689 | #### **Examination**
- Abdominal palpation to assess uterine tone & tenderness, fetal lie/presentation
- Symphyseal fundal height (SFH) to be measured in centimetres & plotted on growth chart
- Handheld ultrasound Doppler is recommended, not auscultation with a stethoscope or Pinards.
- Record maternal pulse rate & co... |
88f4dd6e3751d1af | #### **CTG**
- Perform within 2 hours of presentation
- Perform for at least 20 mins or until satisfactory.
- Use maternal fetal movement recorder during CTG |
7666fc594abe1f47 | ## 3.1 Maternal perception of fetal movement and adverse events
Other considerations that complicate the interpretation of fetal health based on the number of fetal movements are the limited understanding of patterns of fetal activity during "sleep" and active cycles, and the changes in the type of movements as pregna... |
59061d93662b8fee | ## 3.2 Perinatal mortality in Australia and New Zealand
Other factors which are associated with an increased risk of stillbirth in a high-income country setting include: maternal age older than 35 years; maternal overweight and obesity; maternal smoking; primiparity; previous stillbirth; and pre-existing maternal diab... |
f6f956f239c1aed0 | #### 3.3 Clinical assessment of fetal movement concerns
Despite the apparent increased risk associated with maternal perception of DFM, a Norwegian study reported that one in four women could not recall having received any information about fetal movements during routine antenatal care. Furthermore, existing guideline... |
feecbba31961a2ca | #### 3.3 Clinical assessment of fetal movement concerns
Wide variation in clinical practice regarding the management of DFM was shown in a recent survey of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), as well as in a similar survey for midwives in Australia and New Zealan... |
2c1343e15bb307cc | ## **The role of formal fetal movement counting**
The large trial by Grant et al contributing largely to the Cochrane Review findings, however, deserves closer review. This multicentre cluster randomised controlled trial was conducted to investigate the role of fetal movement counting in 68,654 women of at least 28 we... |
64b87c10aa434cbf | ## **The role of formal fetal movement counting**
d towards more antenatal admissions in the fetal movement counting group than in the control group. Further, there was an increased use of other fetal testing methods, with more women having cardiotocography in the fetal movement counting group than in the group where ... |
5c0916e0ad2a3a66 | ## **The role of formal fetal movement counting**
However, a more recent study in Norway demonstrated that a modified count-to-10 method of fetal movement counting may have contributed to a significant increase in antenatal detection of fetal growth restriction . A multi-centre, randomized controlled trial of 1,076 pr... |
90986e60d16ce6ae | #### **6.1 Fetal heart rate monitoring**
| Recommendations | Evidence level and references | Recommendation grade | |
|------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------|-------------------------|... |
65aaf47a5e8894e8 | #### **6.1 Fetal heart rate monitoring**
The first step in the management of DFM is to ensure the fetus is alive and not in imminent danger of death. Once death is excluded, any coincidental associated pathology should also be excluded as a possible cause for DFM. |
286a1da82d70543b | #### **6.1 Fetal heart rate monitoring**
A handheld Doppler can immediately confirm the presence of a fetal heartbeat. In doubtful cases, cardiotocography (CTG) may be required to detect a fetal heart beat and to establish the fetal heart rate (FHR) pattern. In both situations, a fetal heartbeat needs to be differenti... |
84509d7cbb72ef91 | #### **6.1 Fetal heart rate monitoring**
ls were conducted in the early 1980s when these tests were first introduced into clinical practice. However, a 2011 retrospective, population-based cohort study of women presenting with maternal perception of DFM during the third trimester found that the CTG was a reliable scre... |
3f6b0600a840c5a2 | # **Discussion: Implementation and future research**
The recommendations of this guideline cover two key areas: 1) information for pregnant women about what constitutes normal fetal movements and advice about reporting concerns of a reduction in fetal movements to a health care provider; and 2) information for clinici... |
299fe2a621a189ae | # **Discussion: Implementation and future research**
Two large stepped-wedge, cluster-randomized trials currently underway will likely impact guidelines to support women experiencing a decrease in fetal movement. These trials in Scotland (AFFIRM study) and Australia/New Zealand (My Baby's Movements) hypothesise to red... |
1cf3fcd70b513ea5 | **Appendix A. Risk factors for stillbirth in high-income country settings**
| Factor | aOR (95% CI) | PAR* (%) |
|-------------------------------------------------------------|-----------------|----------|
| Demographic and fertility | | |
| Maternal age¥ | | |
| 35-39 years | 1.5 (1.2-1.7) | - |
| 40-44 years | 1.8 (... |
4a0d57a41a34ad5a | **Appendix A. Risk factors for stillbirth in high-income country settings**
tillbirths: rates, risk factors and potential for progress towards 2030. Lancet 2016; 387: 587–603. Lamont K, Scott NW, Jones GT, Bhattacharya S. Risk of recurrent stillbirth: systematic review and metaanalysis. *BMJ* 2015; 350: h3080. |
2df1588e372854ae | # **Appendix B. Methods for guideline development**
- Disseminate and implement the guideline;
- Monitor, evaluate and maintain the guideline
- Identify gaps in current information for the ongoing refinement of the guideline.
In 2015-16, an update was undertaken to review the literature, evidence and recommendations.... |
6eccd70351834bb6 | ### **1 ABOUT THESE GUIDELINES**
Over the past 17 years, the Guidelines have provided midwives with the guidance they need to make sound clinical decisions and to consult and refer to qualified health professionals where the need arises. Previous editions of the Guidelines have been endorsed in most States and Territo... |
65c0109b36ebf0b6 | #### **1.2 Background**
The guidance provided throughout the five sections of this edition will not only assist midwives and other health care providers involved in the provision of maternity care, but it will also inform policies, clinical practice standards and guidelines both across each of the Australian jurisdict... |
24be082e810f9947 | #### **Commencement of care**
Commencement of care refers to the first contact between a maternity care or other health provider and the woman, in the antenatal period. Antenatal care may commence as part of the initial health care interaction for the purposes of confirming pregnancy or following a referral to a mater... |
0711bc89174c4481 | ### **3 INTRODUCTION**
The aim of these Guidelines is to provide an evidence-based, structured, decision-making framework for midwives caring for women at the commencement of care, during the antenatal period; throughout labour and birth; and in the postnatal period. The fourth edition also includes guidance surroundi... |
8c8b22bcd6d3a1b8 | #### **3.2.1 Use of the Guidelines**
- 3. If problems occur during pregnancy, birth or the postnatal period, the midwife may decide to discuss with peers in the first instance; or consult directly with a medical practitioner or other health care provider. A referral should occur where indicated.
- 4. At all times, the... |
d3697d85a4f6b4d4 | #### **3.2.2 Informed choice**
- 1. Before the commencement of care, the midwife should outline the scope and boundaries of midwifery care to the woman and where relevant, her partner and family. This will include an explanation of how these Guidelines influence the provision of care and any associated decisions.
- 2.... |
e8beea56d6adcdc4 | #### **3.2.2 Informed choice**
informed decision-making. The midwife, medical practitioner and any other health care provider must provide the woman with sufficient information for the woman to offer informed consent to any procedure or intervention. The woman should be afforded sufficient time to (1) consider the adv... |
a9993a707d86000d | #### **3.3 Structure of the Guidelines**
To assist midwives in providing the best quality and most effective care possible, the Guidelines provide indications for consultation and/or referral. This guidance supports midwives to quickly identify situations that require the input of other health care professionals.
The... |
a434f120715f3dc5 | #### **4.1 The Levels of Consultation and Referral Explained**
When a variance from normal is identified during a woman's care, it is recommended that the midwife use their clinical judgement and the following guidance to determine the appropriate level of consultation and/or referral. |
ca164cc90a637976 | **Table 4.1 Levels of consultation and referral**
- Where there are variations in the severity of a condition, more than one level may be recommended e.g., B/C; A/B/C.
- Clinical judgement should be used to determine the level of referral and/ or consultation based on the woman and/or baby's presentation.
- If a woman... |
040188ec18cc3d0a | **Table 4.1 Levels of consultation and referral**
the midwife should follow the guidance for a Level B and in collaboration with the medical practitioner (or other health care provider) to determine whether referral is required. |
994f44fe712ee406 | **Table 4.2: Level A/A\* - Discuss**
| LEVEL | DESCRIPTION | GUIDANCE |
|-------|-------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| A/A* | Discuss |... |
34ffcea49d7f3a8a | **Table 4.3: Level B - Consult**
- 4.3.1 Following a discussion with the woman about the need for consultation and the woman offering informed consent, it is the midwife's responsibility to initiate consultation with a medical practitioner (or other health care provider), as indicated. The midwife must clearly communi... |
fe2f403d74027ff4 | **Table 4.3: Level B - Consult**
- a) Via a 'face to face' assessment with the woman specific to the indication for consultation, OR
- b) Between the midwife and the medical practitioner (or other health care provider) where the woman is unable or chooses not to attend. In this situation, the consultation is undertak... |
4bec37811e1118d5 | #### **6.3 Antenatal**
| | Severe eclampsia | C |
|--------|------------------------------------------------------------------------|-----|
| | Manual removal | B/C |
| 6.3.13 | Preterm labour/birth | |
| | History of threatened preterm labour | B |
| | History of preterm prelabour rupture of membranes +/- preterm bir... |
6d06b52e06a6a2d7 | #### **6.4 Intrapartum 6.5 Postpartum**
| 6.4.1 | Caesarean section | |
|-------|---------------------------------------------------------------------------------------|-------|
| | Classical/midline incision | B/C |
| | T incision | B/C |
| | Lower segment caesarean section | B |
| | Two or more previous caesarean se... |
e6700ce37ac83400 | #### **6.6 Neonatal**
| 6.6.1 | Congenital and/or hereditary disorder of a previous child | B |
|-------|-----------------------------------------------------------|-----|
| 6.6.2 | Infection | |
| | GBS infection in neonate | B |
| | Neonate with other infection requiring admission | B/C |
| 6.6.3 | Neonatal asphyxia... |
8017cfb73abae645 | ### **7 CLINICAL INDICATIONS DEVELOPED OR IDENTIFIED DURING THE ANTEPARTUM PERIOD**
| | Small for gestational age (SGA) with normal liquor and dopplers | A/B |
|--------|-------------------------------------------------------------------------------------------------|---------|
| | Fetal growth restriction (FGR) | B/C... |
bcbf11b53143b70e | ### **7 CLINICAL INDICATIONS DEVELOPED OR IDENTIFIED DURING THE ANTEPARTUM PERIOD**
| | Small for gestational age (SGA) with normal liquor and dopplers | A/B |
|--------|-------------------------------------------------------------------------------------------------|---------|
| | Gestational diabetes – uncontrolled ... |
9ce51f6e232e5a8d | #### **7. Clinical Indications...** *continuation*
| 7.1.14 | Hypertension | |
|--------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------|
| | Pre-eclampsia BP of > 140/90 a... |
9589ca185cddb712 | #### **7. Clinical Indications...** *continuation*
| | Gonorrhoea | B |
|--------|-------------------------------------------------------------------|-----|
| | Acquired in third trimester | C |
| | Parvovirus | B |
| | Rubella | |
| | Primary infection | C |
| | Recurrent infection | B |
| | Syphilis | B/C |
| | Toxo... |
0cc8d7e636f665d0 | #### **7. Clinical Indications...** *continuation*
| | Brow, face or shoulder presentation | B/C |
|--------|---------------------------------------------------------------|-----|
| | Placenta praevia | C |
| | Vasa praevia | C |
| | Single umbilical artery | B |
| 7.1.23 | Post-term or post-dates pregnancy | |
| | Po... |
d4f7e66950b53a10 | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| 8.1.1 | Amniotic fluid embolism | | | | | |
|--------|-------------------------------------------------------------------------------------|-----|--|--|--|--|
| 8.1.3 | Breech presentation | | | | | |
| | Diagnosed prior to labour – maternal choice for vag... |
eff6b0b14b21831b | ### **8 CLINICAL INDICATIONS DURING THE INTRAPARTUM PERIOD**
| | EBL >500ml and symptomatic | | | |
|--------|-----------------------------------------------------------------------------------------------------------------------------------|-----|--|--|
| 8.1.18 | Induction of labour | B/C | | |
| 8.1.19 | Instrument... |
1c88d22ace54007e | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.20 | Maternal vital signs Persistent deviation from normal including: Bradycardia Tachycardia Hypertension Hypotension Tachypnoea Pyrexia >38 (2 consecutive readings at least an hour apart) | B/C |
|--------|---------------------------... |
49194689634c4a40 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
94cf66e37e386d96 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
c3caff70c4e26b5d | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
a92a423299269c9c | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
6cf5e404dc448863 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| 8.1.24 | Prolonged labour Consider ease of access and/or transfer to referral services | B/C | | |
|--------|----------------------------------------------------------------------------------------------------------------------------------... |
8839191075ade888 | #### **8. Clinical Indications During the Intrapartum Period** *continuation*
| | Rupture of membranes >24 hours associated with abnormal fetal heart rate, meconium stained liquor, signs of infection as examples | | |
|--------|-------------------------------------------------------------------------------------------... |
4d005ff5d99e0876 | ### **9 CLINICAL INDICATIONS DURING THE POSTPARTUM PERIOD**
Postpartum/Postnatal from 1st hour post birth until 6 weeks post birth |
baa1cc6e88a4fee9 | #### **9.1 Maternal**
| 9.1.1 | Lactation | | | |
|-------|----------------------------------------------------------------------------------|---------|--|--|
| | Primary postpartum haemorrhage – dependent on symptoms and clinical condition | A/B/C | | |
| | Secondary postpartum haemorrhage - asymptomatic | B/C | | |
... |
b6f6ffb917aa20a1 | #### **9. Clinical Indications During the Postpartum Period** *continuation*
| 9.1.7 | Prolapse | |
|--------|---------------------------------------------------------------------|--------------|
| | Uterine | C |
| | Cystocele | C |
| | Rectocele | C |
| 9.1.8 | Pulmonary embolism | C |
| 9.1.9 | Stroke | C |
| 9.1.1... |
aa5b2c32c5946137 | #### **9. Clinical Indications During the Postpartum Period** *continuation*
| 9.1.7 | Prolapse | |
|--------|---------------------------------------------------------------------|--------------|
| 9.1.11 | Suspected or actual maternal infection | |
| | Pyrexia >38°C | A*/B |
| | Mastitis | A*/B |
| | Urinary tract in... |
3034eaf472ce69a9 | #### **9.2 Newborn**
| 9.2.4 | Congenital abnormalities | C |
|--------|----------------------------------------------------------------------------------------------|--------------|
| 9.2.11 | Preterm birth <37 weeks | B/C |
| 9.2.12 | Seizure activity, observed or suspected | C |
| 9.2.13 | Temperature instability |... |
ed97d4d63c17c538 | #### **9.2 Newborn**
| 9.2.4 | Congenital abnormalities | C |
|--------|----------------------------------------------------------------------------------------------|--------------|
| 9.2.15 | Neonatal abstinence syndrome/substance withdrawal | B/C |
| 9.2.16 | Vomiting Green, bile stained Projectile Excessive | A*, ... |
dd21bf1104994874 | #### **Background**
- clearly describing the scope of their practice and any limitations
- providing advice and care that is consistent with the Guidelines
- providing information about the risks and benefits of any aspect of care being provided and any alternative approaches
- providing information that is sourced fr... |
b8bf1ce3654eeb13 | #### **When an emergency or issues arise in labour**
If issues arise during labour or in urgent or emergency circumstances, the midwife is obliged to attend to the woman.
Where a woman has refused emergency transport or transfer of care during active labour, the midwife must remain in attendance as the primary care p... |
9001d38107266d51 | #### **PART 1: Record of advice/discussions**
| Did you discuss your maternity care option(s) with your midwife and/ or other care providers? Why/why not? | Summarise those discussions, including: the safest and most ethical course under these circumstances discussion of appropriate next steps if the woman continues t... |
f8a9a7e71b920ca3 | ## **13 APPENDIX B: MAKING A REFERRAL**
It is strongly recommended that midwives provide a referral letter either in the clinical record or separately by letter when making a referral. It is expected that healthcare providers will communicate with the midwife in writing about their findings including the provision of ... |
1eb1f3be940b8c05 | #### **SAMPLE referral letter**
Date:
Obstetric Clinic/Hospital Address:
Dear Consultant
Re: Woman's name ("Jennifer Jones") DOB: \_\_/\_\_ /\_\_ ID #
Address:
Phone number:
Thank you for seeing "Jennifer Jones" who is now ## weeks pregnant. She requires review because of her previous caesarean section. Her hist... |
c1314bdc6f5c6ab7 | # Prepregnancy Counseling
riate whether the reproductive-aged patient is currently using contraception or planning pregnancy. Because health status and risk factors can change over time, prepregnancy counseling should occur several times during a woman's reproductive lifespan, increasing her opportunity for education ... |
b24cfb686f228092 | #### Recommendations and Conclusions
- The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address modifiable risk factors, and provide education about healthy pregnancy.
- Women should be counseled to seek medica... |
06cac7e647db628f | #### Recommendations and Conclusions
- All patients should receive an annual influenza vaccination; those women who are or will be pregnant during influenza season will have additional benefits.
- Assessment of the need for sexually transmitted infection (STI) screening should be performed at the time of prepregnancy ... |
138a7b5bd8ea0c5f | #### Recommendations and Conclusions
- Screening for intimate partner violence should occur during prepregnancy counseling.
- Female prepregnancy folic acid supplementation should be encouraged to reduce the risk of neural tube defects (NTDs).
- Patients should be screened regarding their diet and vitamin supplements ... |
29003ebdf517daa8 | #### Introduction
Obstetrician–gynecologists have a prime opportunity to improve maternal and fetal outcomes through prepregnancy counseling. Like a well-woman visit, the prepregnancy visit (when the patient presents to discuss a potential future pregnancy) provides an excellent opportunity to counsel patients about m... |
a60e2986d460c064 | # Review of Medical, Surgical, and Psychiatric Histories
Many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and should
be optimally managed before pregnancy (Table 1). Consideration may be given to referral to a maternal–fe... |
5d76fae5021039dd | #### Review of Current Medications
All prescription and nonprescription medications should be reviewed during prepregnancy counseling. This review also should include nutritional supplements and herbal products that patients may not consider to be medication use but could affect reproduction and pregnancy. The pregnan... |
14ae1ec377538058 | #### Review of Family and Genetic History
-----------------------------------------------------------------------------------------------|--|
| Chronic hypertension | Preeclampsia and intrauterine growth restriction | Assessment of the teratogenic risk of hypertensive medications should be performed. Angiotensin conve... |
401442b4ea647b1c | #### Review of Family and Genetic History
(Continued)
Table 1. Major Medical Conditions That Affect Pregnancy (continued) |
1f9fe1f6d2448365 | #### Review of Family and Genetic History
| Condition | Associated Risks | Treatment | Goals | |
|------------------------------------------|--------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------... |
e7121ad3e4909443 | #### Review of Family and Genetic History
y Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. American Association of Clinical E... |
37a6b41b46105f3a | # Immunizations
ld be given at least 28 days before pregnancy, or in the postpartum period if not previously given. Because two doses of the varicella vaccine are recommended, and the CDC recommends that women not become pregnant for 1 month after being vaccinated, a woman who desires pregnancy should begin vaccinatio... |
e2da4a65b43aec64 | # Infectious Disease Screening
Assessment of the need for STI screening should be performed at the time of prepregnancy counseling. Guidance on recommended STI screening is available from the CDC (28) and ASRM (29). Gonorrhea, chlamydial infection, syphilis, and human immunodeficiency virus (HIV) should be screened fo... |
41b10fa72ff6dafd | # Infectious Disease Screening
tional programs to reduce maternal Toxoplasma gondii infection and, thus, congenital toxoplasmosis. However, despite the successes demonstrated in some observational studies, several reviews (including a Cochrane review) suggest that weaknesses in study design prevent the conclusion that... |
876c17bd406c5692 | # Individuals with Human Immunodeficiency Virus
All reproductive-aged patients living with HIV should receive prepregnancy counseling if considering pregnancy (36). Prepregnancy counseling should include a detailed discussion of interventions to reduce the risk of perinatal transmission, ways to optimize long-term hea... |
dfcdf41d10817d6d | #### Substance Use Assessment
All patients should be routinely asked about their use of alcohol, nicotine products, and drugs, including prescription opioids and other medications used for nonmedical reasons (39, 40). Adverse effects associated with smoking during pregnancy include intrauterine growth restriction, pla... |
23037e3028e4a632 | # Assess Nutritional Status
Fruits, vegetables, and daily multivitamins are good sources of antioxidants and vitamins that may assist in reproductive health for males and females. Female prepregnancy folic acid supplementation should be encouraged to reduce the risk of NTDs. All women of reproductive age (15–45 years)... |
a565bc6fe75254b6 | # Assess Nutritional Status
pregnancy with an NTD or women with seizure disorders, should be counseled to take 4 mg of folic acid daily (57). Because of the risk of vitamin A toxicity, women who need additional folic acid should not take additional prenatal vitamins; instead, women at higher risk of NTDs should be pre... |
7d659dd4546796f0 | # Assess Nutritional Status
, 65) and the U.S. Food and Drug Administration provides a patient resource for fish to avoid (66). Maternal listeria infection has been associated with preterm delivery and other obstetric and neonatal complications, and pregnant women should be advised to avoid eating foods with a high ri... |
7c1ada298b5006af | # Assess Exercise and Physical Activity
Regular physical exercise improves cardiovascular health, reduces obesity and associated medical comorbidities, and improves longevity. Patients should exercise moderately at least 30 minutes a day, 5 days a week, for a minimum of 150 minutes of moderate exercise per week (73). ... |
0e53e98d079cbda1 | # Assess for Teratogens and Environmental and Occupational Exposures
Mounting and robust evidence suggests there are reproductive and pregnancy risks associated with environmental pollutants, workplace teratogens, and endocrine disruptors. By the time a woman presents with pregnancy, disruptions of organogenesis may h... |
12824b1b06949968 | #### Pregnancy Dating
Women should be counseled to seek medical care before attempting to become pregnant or as soon as they believe they are pregnant to aid in correct dating and to be monitored for any medical conditions in which treatment should be modified during pregnancy. Correct first-trimester pregnancy dating... |
0232ab02023e3cbc | #### Physical activity
- 150 min exercise per week or 30 min/day
- Pelvic floor training |
7c2c41d137d56643 | #### Nutrient intake
- Supplementation
- Folate 400 mcg daily or 5 mg if increased riskA
- Iodine 150 mcg daily
- Adequate intake of iron, calcium, vitamin D
- Restricted intakeB
- Vitamin A (retinol) 800 mcg/day
- Restricted caffeine intake (200 mg/day from all sources)
- Mercury-containing fishC |
e1045d6fb3f82834 | # Infectious diseases and conditions
- Recommended screening investigations for all potential parents
- Blood-borne viruses: HIV, hepatitis B, hepatitis C
- STIs: syphilis
- Infectious diseases: rubella, varicella zoster
- Recommended screening investigations determined by individual situation
- STIsD: chlamydia, ... |
4cc50ab9e64094b7 | #### Parental exposure
- Alcohol
- Ask about alcohol use with AUDIT-C tool and advise there is no safe level in pregnancy
- Provide support for reducing alcohol intake
- Smoking and e-cigarettes
- Ask about smoking and e-cigarette use and advise on benefits of quitting
- Consider cessation support, including refer... |
c9ccbce485eebad2 | #### Medication
- Review prescription and over-the-counter medications for safety in pregnancy
- Cease and prescribe alternative medications as required |
c79092a427da56a4 | # Preventive health
- Cervical screening and breast self-examination
- Dental review |
3439aee04cea4199 | Smoking remains an important preventable risk factor for preterm birth, low birthweight and perinatal death. Up to 22% of women smoke in the preconception and early pregnancy period, with higher rates among First Nations people, younger people and people living in rural and remote areas.22 The use of e-cigarettes is in... |
1dcde1949521145b | | Pregnancy and postpartum (current or recent pregnancy) | |
|---------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|
| London measure ... |
17cb0068225a1708 | prior to pregnancy. Contraception should be offered
Preconception care **Focus** | **Clinical**
where appropriate while stabilising chronic conditions. All medications, both prescription and complementary, should be reviewed, considering the drug indication, dosing, route of administration and alternatives to ensure ... |
77b51ac730dcf30f | # **Preventive health and screening, including sexually transmissible infections and infectious diseases**
All potential parents should be educated about infectious diseases and have a review of their vaccination history for measles, mumps, rubella, varicella zoster, diphtheria, tetanus and pertussis and hepatitis B u... |
9b597c5d2770955d | # Pregnant (antenatal testing)
- No antenatal testing
- CVS from 11 weeks
- Amniocentesis from 15 weeks |
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