Obs-Gyn Pre-pregnancy counselling:

General history:
-

Relationship status, partner / IVF etc

General health
o BP, body weight, alcohol, smoking, nutrition, activity levels
o Ongoing medications
o Ongoing conditions / health
o Diabetes, risk factors
o Autoimmune disease
o Anaemia, transfusions
Partners health
Family health, hereditary diseases, family tree, FDIU / childhood deaths.

Gynaecological history:
-

Pregnancy and child-bearing history:

o Miscarriages, pregnancies, terminations, still-births, live-births, neonatal deaths
o Maternal health during prior pregnancies
Injuries, surgeries, infections, dyspareunia, post-coital bleeding, STIs, prior issues with
HSV
Vaccinations and immunity: Rubella, Varicella, CMV, syphilis, Hep B, HIV
Screening:
o Pap-smear
o FBE / Fe / Vit D levels
Menstrual cycling regularity, history, dysmenorrhoea, menorrhagia, etc.
Any prior problems with becoming pregnant, how long they have been trying for etc.

Arrange testing and treatment:

-

Blood grouping, testing for auto-antibodies

o Routine anti-D if appropriate, @ 28/40 and 34/40
o After delivery of Rh(D) +ive infant to ive mother, following quantitative Kleihauer
test.
o Therapeutic anti-D in first trimester for: CVS, TOP, miscarriage, ectopic pregnancy
o Therapeutic anti-D in 2nd and 3rd trimester for any of: suspected or confirmed
uterine bleeding, abdominal trauma, amniocentesis, cordocentesis, obstetric
haemorrhage, external cephalic version.
Vaccination if required, testing for serology as above
Treatment for any pre-existing infections
Optimise treatment for pre-existing conditions and transition from any teratogenic
prescribed medications
o Folate supplementation
o Avoid anticonvulsants: valproate, lithium,
Testing:
o First Trimester Combined Screening @ 10/40w
Maternal age, ultrasound (nuchal ligament thickness, foetal nasal bone),
PAPP-A
o NIPS if appropriate / financially feasible
o Morphology scan @ 20/40w
o OGTT @ 24/40w unless high risk patient, in which case test earlier as well, and
repeat tests as required
o GBS screening @ 34/40, depending on hospital