Pre/post natal check-up*

Prenatal Checkup

Taking a thorough antenatal history is an essential part of prenatal care. It helps in identifying any potential risks to the mother and the baby and in planning 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.
    • Gravidity (total number of pregnancies) and parity (number of deliveries after 24 weeks).
  2. Obstetric History:
    • 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).
  3. 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.
  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. Obstetrica 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 heart tones.
    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
        • 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 bloods for trisomy 13/18/21 risk
      • 20 week scan for fetal development and anomaly screening.
  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 (live vaccine – before or after 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:
    • 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 in a sensitive and nonjudgmental manner, ensuring the comfort and confidentiality of the patient. Regular follow-ups and updating the antenatal history as the pregnancy progresses are also crucial for ongoing care and monitoring.

Post Natal Checkup

A postnatal checkup is a critical step in ensuring the health and well-being of both the mother and the newborn after delivery. This checkup usually occurs around 6 weeks after birth, but can vary depending on individual circumstances. Here’s what should typically be done during a postnatal checkup:

Mother’s Health Assessment

  • Physical Examination:
    • Check blood pressure, weight, and overall physical recovery.
    • Examine the abdomen, particularly the uterus, to ensure it is returning to its pre-pregnancy size.
    • Inspect any episiotomy or C-section scar for proper healing.
    • Perform a pelvic exam to check the health of the uterus, ovaries, and cervix.
  • Breast Examination:
    • Check for issues like mastitis, breast engorgement, or nipple problems, especially in breastfeeding mothers.
  • Mental Health Screening:
    • Assess for postpartum depression or anxiety through discussion or a questionnaire such as the Edinburgh Postnatal Depression Scale
    • Discuss emotional well-being and coping mechanisms.
  • Bleeding and Discharge:
    • Inquire about the amount, frequency, and nature of vaginal bleeding or discharge.
  • Contraception and Sexual Health:
    • Discuss contraception options.
    • Address any concerns related to resuming sexual activity.
  • Bladder and Bowel Function:
    • Assess for urinary or fecal incontinence, constipation, or any discomfort during urination.

Baby’s Health Assessment

  • Growth and Development Check:
    • Measure the baby’s weight, length, and head circumference.
    • Discuss developmental milestones and observe the baby’s alertness, tone, and activity.
  • Feeding:
    • Discuss breastfeeding or formula feeding, ensuring the baby is feeding well and frequently.
    • Address any feeding problems like latching difficulties, sore nipples, or formula intolerance.
  • Physical Examination:
    • Complete physical examination including eyes, ears, heart, lungs, abdomen, hips, and genitalia.
    • Check the umbilical cord site for proper healing.
  • Vaccinations:
    • Review and update the baby’s vaccination schedule.
  • Screening Tests:
    • Ensure all newborn screening tests have been completed and discuss the results.

Additional Assessments

  • Lifestyle and Support:
    • Discuss lifestyle factors like diet, exercise, and alcohol or tobacco use.
    • Enquire about the level of support at home and the mother’s ability to rest and recover.
  • Education and Anticipatory Guidance:
    • Provide educational materials and resources for new parents.
    • Discuss the importance of attending future pediatric appointments for the baby and regular check-ups for the mother.
    • Provide information on infant care, including safe sleeping, signs of illness, and when to seek medical help.
    • Discuss the importance of self-care for the mother.
  • Referrals and Follow-Up
    • Refer to specialists if any issues or concerns arise during the checkup for either the mother or the baby.
    • Schedule follow-up appointments as needed, based on the health status of the mother and the baby.
  • Documentation
    • Document all findings and the plan of care.

The postnatal checkup is a comprehensive assessment that should address both physical and mental health aspects. It’s a vital opportunity for healthcare providers to support and educate new mothers, ensuring a safe and healthy recovery post-delivery.