History – Antenatal

Taking a thorough antenatal history is an essential part of prenatal care. It helps identify any potential risks to the mother and the baby and plan appropriate care during the pregnancy. Here is an outline of the key components of a routine antenatal history:

  1. Identification Data:
    • Name, age, and contact details.
  2. Current Pregnancy:
    • Date of the last menstrual period (LMP) to estimate due date.
    • Presence of any pregnancy symptoms (morning sickness, breast tenderness, etc.).
    • Any bleeding or pain.
  3. Obstetric History:
    • Gravidity (total number of pregnancies).
    • Parity (number of deliveries after 24 weeks).
    • Details of previous pregnancies and their outcomes (including miscarriages, terminations, stillbirths, and neonatal deaths).
    • Complications in previous pregnancies (e.g., preeclampsia, gestational diabetes).
    • Details of previous births (mode of delivery, any complications, birth weights of the babies).
  4. Medical History:
    • Chronic illnesses (e.g., hypertension, diabetes, thyroid disorders, epilepsy).
    • Previous surgeries, especially on the reproductive organs.
    • Current medications and allergies.
    • Vaccinations
  5. Family History:
    • Genetic conditions or congenital anomalies in the family.
    • History of twins or multiple births.
    • History of inherited diseases or chronic conditions in the family.
  6. Social History:
    • Lifestyle factors (smoking, alcohol consumption, drug use).
    • Occupation and living conditions.
    • Support systems (partner, family, friends).
    • Domestic violence (4-9/100 women)
  7. Obstetric Physical Examination:
    1. General physical examination including weight, height, BMI.
    2. Blood pressure and heart rate.
    3. Urine dipstick +/- ACR if positive for protein
    4. Abdominal examination for uterine size, fetal position, and fetal heart rate.
    5. Pregnancy test to confirm pregnancy (if required).
  8. Screening Tests:
    • Blood tests
      • Blood group, Rh factor, anti-C, anti-D, anti-K
      • FBC +/- electrophoresis (if appropriate)
      • Iron
      • Immunity/Infection screening
        • HIV
        • HBV
        • HCV
        • Syphilis
        • Rubella
        • VZV
      • Note that TSH, UEC and LFTs are not routinely recommended
      • Consider OGTT
    • Urine
      • Beta hCG
      • Protein
      • Glucose
      • MSU MCS for assymtomatic bactiuria
      • Chlamydia PCR
    • CST (if due during pregnancy)
    • Ultrasound
      • Dating scan
      • 12 week scan to accompany SAMS blood to trisomy 21 risk
      • 20 week scan for fetal development and anomaly screening.
    • Genetic Carrier Screening
    • NIPT (Non Invasive Prenatal Testing)
  9. Immunisations:
    1. Boostrix (for pertussis 20-32 weeks)
    2. Influenza
    3. Pneumococcal (if a smoker)
    4. If not immune
      1. HBV (if high risk)
      2. VZV vaccine – before or after pregnancy
        1. Zostervax is live (so contraindicated)
        2. Shingrix is unknown data for pregnancy
      3. Rubella (live vaccine – before or after pregnancy)
  10. Psychosocial Assessment:
    • Assessment of mental health status.
    • Evaluation of risk factors for depression or anxiety.
    • Understanding of the support network and potential stressors.
  11. Review of Systems (RoS):
    • Systematic inquiry about other body systems that may not have been covered earlier.
  12. Counseling and Education:
    • Discussion about nutrition, exercise, and lifestyle modifications during pregnancy.
    • Smoking cessation (NRT is OK but Champix and Zyban are contraindicated)
    • Alcohol cessation
    • Information about common pregnancy symptoms and when to seek medical attention.
    • Prenatal vitamins and supplements
      • The only routine supplements are
        • folic acid 400mg (5mg if Hx NTD, DM, Obesity, Anticonvulsant)
        • iodine 150mg
      • May be required in certain circumstances
        • Iron
        • Vit D
        • Ca
    • Listeria (soft cheese), Toxoplasmosis (cats), Heavy metals – Hg (top level predator fish) and Pb
  13. Birth Plan and Preferences:
    • Discussion about plans for labor and delivery, including preferences for pain management and other interventions.

It’s important that this history is taken sensitively and nonjudgmentally, ensuring the patient’s comfort and confidentiality. Regular follow-ups and updating the antenatal history as the pregnancy progresses are also crucial for ongoing care and monitoring.