The Booking Visit

Question 1

Past obstetric factors to ask during booking

Answer 1

Whether the woman has been pregnant before and if so has she delivered and how did she deliver?
- Get the story of the pregnancy and the delivery (any health complications during pregnancy, any complications during or after birth, any need for induction, augmentation or assisted delivery?)

Question 2

How do you work out parity and gravidity?

Answer 2

Parity = number of deliveries + number of other pregnancies 
Gravidity = number of pregnancies INCLUDING THIS ONE

Question 3

What is the parity and gravitidity for a woman who has had 2 children, one miscarriage and is pregnant again

Answer 3

Para 2+1 Grav 4

Question 4

What PMH and FH factors are important to ask?

Answer 4

HTN, Diabetes, Epilepsy, Heart conditions, Renal disease, Asthma, Thyroid conditions, Gynaecological conditions

Any previous operations (abdominal and gynaecological particularly) - think adhesions

FH: inherited conditions, chromosomal abnormalities, mother’s pregnancies okay - hx of diabetes

Question 5

What factors are important to ask about the current pregnancy?

Answer 5

Can give the mother an ESTIMATED DUE DATE (take the date of her LMP + 7/7 + 9/12)
- This will be updated and made more accurate at the dating scan (11+2-14+0)

Question 6

What factors of the social and drug history are important?

Answer 6

Note ALL Drugs and medications and allergies

Ask about alcohol, smoking and drugs and GIVE ADVICE about their cessation

Question 7

What advice should be given about smoking during the peri-natal period?

Answer 7

That it should be stopped for the entire pregnancy as it can lead to:
- FETAL GROWTH RESTRICTION (due to hypoxia and placental insufficiency)
- LOW BIRTH WEIGHT
- INTELLECTUAL AND EMOTIONAL IMPAIRMENT
Also associated with increased rates of:
- PREMATURE BIRTH, PLACENTAL ABRUPTION, IUD, SUDDEN INFANT DEATH

Question 8

What examinations should be done in the booking visit?

Answer 8

BP, HR, Baseline weight and height
Abdominal examination

URINE - look for proteins and glucose - infections MUST be treated

BOOKING BLOODS

Question 9

When will you first be able to palpate the funds of the uterus?

Answer 9

12 weeks

Question 10

What bloods are taken on routine booking bloods and what are you looking for?

Answer 10

FBC (exclude anaemia and thrombocytopenia)
Blood group / Group and Save (get blood group and also ascertain Rhesus status)
Rubella Status
Hb electrophoresis for haemoglobinopathies
Hep B status, HIV and Syphilis

Question 11

What final thing should be discussed with the woman at booking?

Answer 11

Her preferred mode of delivery
- Discuss the benefits and risks of vaginal and CS and use her previous history to discuss the risks to her

Encourage VBAC (70-75% chance of success)