Pre Conception Care Flashcards
What should Srh consultation cover?
Advice on how to become pregnant and factors affecting pregnancy
Time frames
If pregnancy fails to occur what to do
When should couples TTC have sex?
2-3 times a week
No reference to fertile period
How many couples no known underlying cause infertility will achieve pregnancy in 12 mths regular vaginal sex?
80%
Ix after a year…..
What factors will decrease fertility?
Age
Over or underweight
Smoking
ETOH
High BMI what pre conception advice?
Weight loss to improve wellbeing and fertility
5mg folic acid
10ug vit D on conception
Ref dietitian if bmi >40
Cons care
Do not diet in pregnancy but eat healthy
No extra calories needed trim 1+2
200cal/day trim 3
What to say re alcohol?
Do not drink to minimise risks
M/c iugr SB PTL
FAS
Smoking?
Ref to cessation
M/c
IUGR
SB
SGA
SIDS
Caffeine?
Increase risk miscarriage
Age?
Fertility declines
-age 30 conception 75% in year
-age 40 conception 44% in year
T21
-age 30 1:800
-age 40 1:100
Existing medical conditions?
Relevant previous surgery?
MDT
Optimisation condition
Risks pregnancy Fetal/maternal
Alteration current mgt if needed
DM
Pre preg r/v ideally
Optimise control aim hba1c <6.5%
Eye screening
Poorly controlled conception onward: increased risk malformation, miscarriage SB and NND
Epilepsy
Specialist r/v
Sodium valproate (Preg Prevent programme ) and carbamazepine and multidrug regimes increased malformations and neuro developmental problems
Do not stop or alter meds until has specialist r/v and ensure adequate contraception until then
VTE RF
May need mdT counselling
May need switch off warfarin
May need early lmwh
Preconception screening check:
Smears (as avoid In prey and for 3/12 pn)
Chlamydia
Rubella
Consider BBV/haemaglobinopathy
Who needs high dose folic acid?
DM
Anti-epileptic
BMI 30
History of NTD in parent/family/prev child
Sickle Cell
Thalasemia
Take till 12 weeks except SCD and thal take throughout
High dose is 5mg (400mcg standard)
