An examiner, no lover of females, thrust a femur into her hand.
‘How many of these have you got?’ he demanded.
‘How do you come to that conclusion?’ he asked contemptuously.
‘I have two of my own, the one in my hand, and the two of my unborn child.’ ANONYMOUS ANECDOTE
Pregnancy and childbirth are highly important and emotional events in the lives of women and their families. Their care during and after pregnancy is one of the most satisfying aspects of the work of the family doctor, who generally chooses breadth of knowledge rather than depth of knowledge. The changing trend towards specialisation has meant a change of role for the city practitioner and now shared obstetric care is a commonly practised routine. The quality of care that can be given in family practice is often superior to that offered in the hospital antenatal clinic, partly because of the continuing personal care offered by the family doctor.1
Antenatal care presents preventive medicine opportunities par excellence and is the ideal time to develop an optimal therapeutic relationship with the expectant mother and her family.
The information presented here is a basis for the shared care model where family doctors share antenatal care with consultants and have a ready referral strategy for high-risk pregnancies.
The aim of antenatal care is to monitor the pregnancy, assess risk to the mother and fetus, address any risks that arise and ultimately improve outcomes for mothers and babies.
Preconception care is to be commended to the woman contemplating pregnancy and her family doctor is well placed to provide general health care and screening as well as genetic counselling.
General advice should include optimal nutrition and diet, weight control, regular exercise and discouragement of smoking, alcohol and drugs.
Ask if there are chronic conditions such as diabetes, thyroid disease, hypertension, epilepsy and thrombophilia, ensuring current management is optimal. Take a menstrual history and identify women who may be at risk of fertility problems, such as those with endometriosis or oligomenorrhoea.
Folic acid (0.5 mg tablets daily) is recommended to commence at least 1 month prior to conception, continuing for the first trimester. The dose is 5 mg/day for women at increased risk, such as those on anticonvulsant medication, those with a past or family history of neural tube defects, a BMI >30, pre-pregnancy diabetes, 5-methyltetrahydrofolate deficiency or a risk of malabsorption.2 This often comes combined with an iodine supplement (150 mcg daily), which is also recommended for women who are pregnant, breastfeeding or considering pregnancy. Examination should include blood pressure, cardiac status, breast examination and cervical screening test (if due).
Rubella and varicella serology should be estimated and, if required, immunisation 4 weeks prior to conception should be initiated. ...