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Summary

Explore the comprehensive coverage of antenatal care for medical professionals with this on-demand teaching session. From understanding the access pathways for women seeking help to discussing care for at-risk groups, this workshop expands your knowledge. Increase your awareness of routine antenatal appointments, principles of care, and the importance of effective screening for both maternal and fetal health. Learn how to tackle the challenges faced by those with language barriers, young mothers, or women exposed to domestic abuse. Delve deep into the complexities of maternal mental health and explore the use of the Edinburgh Postnatal Depression Scale. Enhance your understanding of antenatal clinical care and foster strategies to fill your knowledge gaps. Recognize high-risk factors and how to provide proactive care for them. The session emphasizes hands-on approaches like case studies, making it an engaging and informative learning experience.

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Description

About the MedAll Primary Care CPD Programme

We are passionate about making great medical education easily accessible and we power thousands of medical courses and events every year. In light of the increasing commitments faced by healthcare professionals, including the rising cost of living and strained practice finances, we felt compelled to do something. It's why we have introduced a flexible, easy access CPD programme for doctors, nurses and other healthcare professionals working in primary care. We recognise that the high expense of traditional CPD update courses is a significant barrier, and by collaborating as an entire primary care community we hope we can offer a practical, accessible alternative that delivers exceptional value.

About our speaker: Prof David Cahill

David Cahill, now retired, previously worked at Bristol Medical School, University of Bristol. David's research was in Educational Assessment, Higher Education and Gynaecology. His energies are presently focussed on teaching undergraduate medicine and postgraduate gynaecology in developing countries, as well as facilitating access to PLAB in his own country. His research focus is presently directed towards the understanding of differential assessment attainment in different ethnic undergraduate groups.

Who Should Join?

✅ GPs

✅ GP Trainees

✅ Primary care and practice nurses

✅ Practice pharmacists

✅ Other allied healthcare professionals in Primary Care

Accreditation Note

This event is not formally accredited by an external organisation for CPD points. The current guidance for GP CPD is that it is appropriate that the credits you self-allocate should equal however many hours you spent on learning activities, as long as they are demonstrated by a reflective note on lessons learned and any changes made or planned (if applicable).

Learning objectives

  1. By the end of the session, participants should be familiar with the different ways a woman can engage with antenatal care system, including self-referral and referral through a health professional or public establishment.
  2. Participants should be able to identify risk groups, including women who misuse substances, migrants, refugees, non-English speakers, young women, and women who are victims of domestic abuse.
  3. The session should enhance participants' understanding of the antenatal care process, including the different number of routine appointments necessary for first-time mothers and those who have given birth before.
  4. The objective is to understand the significance of collecting various general and social history details during the booking for antenatal care and monitoring maternal and fetal health throughout the pregnancy.
  5. Participants should grasp the principles of screening for mental health disorders in pregnant women, learn how to apply the Edinburgh Postnatal Depression Scale, and understand the factors contributing to mental health disorders during pregnancy.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

08/04/2024 Principles of care How does a woman get into the system? • listen to women self-referral referral by a GP, midwife, or another healthcare professional • be responsive to their needs through a school nurse, community centre refugee hostel 1 2 Antenatal care At risk groups What killsmothers? women who misuse substances Diseases, Povertyty, recent migrants, asylum seekers or refugees, or women who have difficulty reading or speaking English young women aged under 20 women who experience domestic abuse MBRRACE-UK - 2023 3 4 10 routine antenatal appointments - nulliparous 7 routine antenatal appointments - parous Summary: 5 6 1 08/04/2024 Booking Routine antenatal clinical care General details Social History - Smoking/Alcohol/Substancemisuse Past medical history Diet Booking Medication and Allergies Domestic violence Gynaecology History Measure and record the woman’s: LMP – EDD Height, weight, and body mass index. Screening https://www.youtube.com/watch?v=_afr5olIpTM Contraception Blood pressure and proteinuria. 2 mins 40 sec Smear – any treatment Offer Screening Past ObstetricHistory Maternal Reviewing Family History - DM/HT/Cardiac/Inheriteddisease Fetal Risk Factors Information on Pre-Eclampsia Support Planning delivery Gestational Diabetes Breastfeeding VTE Benefits Gaps in knowledge … so many SGA Classes Mental health Give Maternal Notes 7 8 Small for gestational age Maternal Screening Screening Fetal Maternal Anaemia Reassessduring Red cell alloantibodies (anti-D and rarer) third trimester Anaemia Haemoglobinopathies (such as sickle cell disease and Why? Mostly to exclude a fetal Red cell alloantibodies (anti-D and rarer) thalassaemia). abnormality (most obvious being Hepatitis B virus and HIV infection. Down’s, Edwards’, Patau’s Haemoglobinopathies (such as sickle cell disease and thalassaemia). Asymptomatic bacteriuria Hepatitis B virus and HIV infection. Syphilis Other things: Diabetes Renal agenesis - fatal Asymptomatic bacteriuria Hypertension / preeclampsia Syphilis Hydrocephaly – repairable Diabetes Venous Thromboembolism Duodenal atresia – repairable but … Small for gestational age Twin-twin transfusion – repairable Hypertension / preeclampsia Heart defects 9 10 Small for gestational age Pregnancy associated plasma protein-A if < 0.4 MoM A lower birth weight baby Maternal Maternal Preterm birth High risk Screening Preeclampsia – hypertension and proteinuria Screening Anaemia Anaemia Red cell alloantibodies (anti-D and rarer) Maternal medicine referral Red cell alloantibodies (anti-D and rarer) Any VTE episode unless single and related to major surgery Prophylaxis with LMWH Haemoglobinopathies (such as sickle cell disease and Haemoglobinopathies (such as sickle cell disease and thalassaemia). thalassaemia). Hepatitis B virus and HIV infection. Previous VTE with major surgery Hepatitis B virus and HIV infection. Intermediate risk Asymptomatic bacteriuria Thrombophilia Asymptomatic bacteriuria Maternal medicine referral Syphilis Medical comorbidities Syphilis Consider prophylaxis Diabetes Diabetes with LMWH Any surgery – even appendicectomy 4 risk factors: prophylaxis Hypertension / preeclampsia Hypertension / preeclampsia with LMWH from booking Venous Thromboembolism Venous Thromboembolism Small for gestational age Obesity low risk thrombophilia 3 risk factors: prophylaxis Small for gestational age with LMWH from 28 weeks Age >35 Immobility Parity >3 Multiple pregnancy 2 risk factors – Smoker mobilisation and avoid dehydration 11 12 2 08/04/2024 A randomized trial using ultrasound to identify the high-risk fetus in a low-risk population 1998 women at low risk Gaps in knowledge What is the most effective method for women to initially access antenatal care? Women receiving traditional care reported higher levels of satisfaction for the care provided by community midwives. Women receiving flexible care were more likely to report having a Howchoice over the number and timing of their antenatal visits, but were also more likely to report that theywould like to have been seen more often Does sleeping on your back increase the chance of stillbirth or SGA? Introduction of an ultrasound scan at 30–32 weeks’ and 36–37 weeks’ gestationmay reduce the risk of a growth-restricted infant and increases antenatal interventions. Ratesof admission to a neonatal unit are not significantly affected. PAW placental maturity (P), amniotic fluid volume (A), estimated fetalweight (W) Obstetricsand Gynecology,101, 626–32, 2003 13 14 Screening for mental health disorders Why are women likely to experience a mental health disorder? BMJ Glob Health 2023; 8: e012852. 15 16 Edinburgh Postnatal Depression Scale 1. I have been able to laugh and see the funny side of things 2. I have looked forward with enjoyment to things 3. I have blamed myself unnecessarily when things went wrong 4. I have been anxious or worried for no good reason 5. I have felt scared or panicky for no very good reason 6. Things have been getting on top of me 7. I have been so unhappy that I have had difficulty sleeping 8. I have felt sad or miserable 9. I have been so unhappy that I have been crying 10. The thought of harming myself has occurred to me 17 18 3