POOR OBSTETRIC OUTCOME/ BAD OBSTETRIC HISTORY

UNIT 2 PROTOCOL

Should probably be Poor Foetal Outcome (Obstetric outcome also includes the mother)

ONLY THE FOLLOWING PATIENTS TO BE MANAGED BY UNIT 2:

1. PREVIOUS UNEXPLAINED OR UNEXPLORED STILLBIRTH

2. PREVIOUS RECURRENT 1ST TRIMESTER MISCARRIGES
PREVIOUS FSB, ENND & 2ND TRIMESTER MISCARRIGES TO BE MANAGED BY THE ALL UNITS

AT FIRST CONTACT:

11-14/40: NUCHAL TRANSLUCENCY/ NASAL BONE & PROPER DATING (CRL)

IF NT >2.5mm: REFER FOR A DETAILD ULTRASOUND

18-24/40: ANOMALY SCAN & PROPER DATING

MAKE SURE ALL BOOKING BLOODS ARE DONE

FURTHER INVESTIGATIONS:

- HBA1c
- TSH
- ANTI B2 GLYCOPROTEIN ANTIBODIES/ ACLA/ LA/ANA
- BOOK OGTT IF >24/40

ASK ABOUT SUBSTANCE ABUSE (IF YOU DON’T ASK , PATIENTS DON’T TELL)

- ADVISE AGAINST CAFFEIN(<3 CUPS OF COFFEE/DAY)/SMOKING/ALCOHOL/DAGGA & NYAOPE

- IF OBESE (MUAC >33cm): COUNSEL ON PROPER DIET/ EXERCISE DURING PREGNANCY & CONSULT DIETICIAN.

REVIEW AT 28/40:

- ULTRASOUND: DOPPLER & EXCLUDE IUGR

- NST
- FOETAL KICK COUNT (> 4 KICKS IN 1hr) AT HOME
- IF ALL IS WELL: REV 2 WEEKLY

IF APS +VE (AT LEAST 1 CLINICAL CRITERIA & 1 LABORATORY CRITERIA)

- START CLEXANE 40mg BD & ASPIRIN 75mg DAILY UNTILL TERM

AT 36/40: INDUCTION OF LABOUR-IOL (COUNCEL PATIENT ON SIDE-EFFECTS/ POSSIBLE COMPLICATIONS & SIGN CONSENT FORM)

- ADMIT ON DAY OF INDUCTION

- ULTRASOUND TO CONFIRM EFW >2kg
- START STERIODS IN WD 29 (PATIENTS USSUALLY DELIVER > 24hrs/ WD 25 USSUALLY FULL)
- BISHOP SCORE<6: INSERT BULB & START CYTOTEC SOLUTION

PREVIOUS FSB / ENND (SHOULD BE SEEN BY ALL UNITS)

REVIEW 2 WEEKLY FROM 28/40/ REVIEW WEEKLY FROM 36/40/ SEND HOME ON FOETAL KICK COUNT/ IOL AT 38-39/40

PREVIOUS IUFD d/t ABRUPTIO OR PREECLAMPSIA TO BE SEEN BY ALL UNITS

IF PREVIOUS ENND d/t SPONTANEOUS PRETERM DELIVERY

- PRESCRIBE VAGINAL OR ORAL PROGESTERONE (NOT AVAILABLE IN THE PUBLIC SECTOR)

- 2 WEEKLY TRANSVAGINAL CERVICAL LENGTH AT 16-24/40
IF < 25mm: INSERT CERLAGE (RESCUE CERCLAGE CAN BE DONE AT 25-26/40)

DR DH NDLOVU 2018