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What right do people have regarding decisions about their antenatal care?
People have the right to be involved in discussions and make informed decisions about their antenatal care.
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Which sources should healthcare professionals follow to ensure women can give informed consent in pregnancy?
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Name some ways antenatal care can be started to meet women's needs.
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What should be provided at the point of antenatal care referral to simplify the process?
Provide an easy-to-complete referral form.
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What early information should be offered before the antenatal booking appointment?
Early pregnancy health and wellbeing information, including modifiable factors that may affect pregnancy.
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Which modifiable factors should early pregnancy information include?
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What topics do the NICE guidelines mentioned in the text cover related to pregnancy?
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What accessibility requirement is specified for antenatal materials?
Ensure materials are available in different languages or formats such as digital, printed, braille or Easy Read.
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What should the referral form for starting antenatal care enable healthcare professionals to identify?
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What contact detail must be included on the antenatal referral form?
Include contact details about the woman's GP.
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By when should the first antenatal (booking) appointment with a midwife be offered?
Offer a first antenatal (booking) appointment with a midwife to take place by 10+0 weeks of pregnancy.
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If a woman contacts or is referred later than 9+0 weeks, when should the booking appointment be offered?
If referred later than 9+0 weeks, offer a first antenatal (booking) appointment to take place within 2 weeks if possible.
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What should healthcare professionals ask if a woman books late in pregnancy?
Ask about the reasons for the late booking because it may reveal social, psychological or medical issues that need to be addressed.
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How many routine antenatal appointments with a midwife or doctor are planned for nulliparous women?
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How many routine antenatal appointments with a midwife or doctor are planned for parous women?
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Which groups are specifically referenced for the NICE guideline on pregnancy and complex social factors?
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When should additional or longer antenatal appointments be offered?
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What interpreting services requirement is stated for antenatal care?
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Who should interpreters be independent of during antenatal appointments?
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What aim is recommended for those planning and delivering antenatal services regarding carer assignment?
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What communication standard is required between healthcare professionals involved in antenatal care?
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How should healthcare professionals involve a partner during pregnancy according to NICE antenatal care guidance?
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What should be considered when scheduling antenatal classes if the pregnant woman wishes partner attendance?
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Give examples of ways to make antenatal services welcoming for partners.
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What physical provision should be made in consultation rooms for partner involvement?
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What information should be provided specifically for partners in antenatal services?
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What option should be considered for partners attending antenatal appointments?
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At the first antenatal booking appointment, which family histories should be asked about?
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Which mental health concerns should be asked about at the first antenatal appointment?
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What should be asked about medicines at the first antenatal appointment?
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What allergy information should be collected at the first antenatal appointment?
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What should be discussed regarding the woman's occupation at the first antenatal appointment?
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Which aspects of family and home life should be asked about at the first antenatal appointment?
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What should be asked about other people in relation to the baby's care at the first antenatal appointment?
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What contact details should be recorded at antenatal booking?
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What lifestyle and social factors should be reviewed at antenatal booking?
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When should a clinician consider reviewing a woman’s previous medical records?
Consider reviewing previous medical records if needed, including records held by other healthcare providers.
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How does the maternal death rate for black women compare with white women?
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What is the maternal death rate for women with mixed ethnic background compared with white women?
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What is the maternal death rate for Asian women compared with white women?
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How does the stillbirth rate for black babies compare with white babies?
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How does the stillbirth rate for Asian babies compare with white babies?
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How does living in the most deprived areas affect maternal death risk?
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How does the stillbirth rate vary with level of deprivation?
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When should a pregnant woman be offered a referral to NHS Stop Smoking Services?
Offer a referral at 2 weeks to NHS Stop Smoking Services in line with the NICE tobacco guideline.
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When and how should you ask about domestic abuse at antenatal care?
Ask about domestic abuse at the first antenatal (booking) appointment, or at the earliest opportunity when the woman is alone, in a kind, sensitive manner with a private one-to-one discussion.
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What should you do regarding female genital mutilation (FGM) during antenatal care?
Assess the woman's risk of FGM in a kind, sensitive manner and take appropriate action in line with UK government safeguarding guidance.
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When should a pregnant woman be referred for a clinical assessment to detect cardiac conditions?
Refer for a clinical assessment by a doctor if there is concern based on the woman's personal or family cardiac history.
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When should you refer a pregnant woman to an obstetrician or other doctor?
Refer to an obstetrician or other relevant doctor if there are any medical concerns or if review of current long-term medicines is needed.
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What action should be taken regarding the woman's GP during pregnancy?
After discussion with and agreement from the woman, contact her GP to share information about the pregnancy and potential concerns or complications.
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What should be included in the risk assessment at every antenatal appointment?
Ask about general health and wellbeing; ask the woman (and partner if present) about any concerns; provide a safe environment to discuss home concerns, domestic abuse, birth concerns or mental health.
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What are two main concerns of antenatal care listed in the guideline?
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What must be updated at every antenatal contact?
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What measurements should be offered at the first face-to-face antenatal appointment?
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Which blood tests should be offered at the first face-to-face antenatal appointment?
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Which infectious disease screens should be offered at the booking appointment?
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Which genetic and fetal screening programmes should be discussed and offered at booking?
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Where should practitioners look for guidance on caring for pregnant women approaching end of life?
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What choice should a pregnant woman be informed about regarding screening programmes?
She can accept or decline any part of any of the screening programmes offered.
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When should the first routine antenatal ultrasound scan be offered?
Between 11+2 weeks and 14+1 weeks of pregnancy.
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What are the purposes of the ultrasound offered at 11+2–14+1 weeks?
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When should the second routine antenatal ultrasound scan be offered?
Between 18+0 weeks and 20+6 weeks of pregnancy.
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What are the purposes of the ultrasound offered at 18+0–20+6 weeks?
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What blood tests should be offered at the antenatal appointment at 28 weeks?
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Who should be offered anti-D prophylaxis at 28 weeks?
Rhesus D-negative women who are not known to be sensitised to the rhesus D antigen.
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What should be done if antenatal examinations or investigations produce unexpected results?
Offer referral according to local pathways and ensure appropriate information provision and support.
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When should a pregnant woman's risk factors for venous thromboembolism (VTE) be assessed during antenatal care?
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What should be considered when assessing VTE risk in pregnancy?
Consider using guidance by an appropriate professional body, for example the Royal College of Obstetricians and Gynaecologists' guideline on reducing the risk of VTE during pregnancy.
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For pregnant women admitted to hospital or a midwife-led unit, where should clinicians look for intervention guidance?
See the section on interventions for pregnant women and women who gave birth or had a miscarriage or termination in the past 6 weeks in the NICE guideline on venous thromboembolism in over 16s.
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What action is recommended for pregnant women identified as being at risk of VTE?
Offer referral to an obstetrician for further management.
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When should an oral glucose tolerance test be offered for women at risk of gestational diabetes?
Offer referral for an oral glucose tolerance test between 24+0 weeks and 28+0 weeks of pregnancy.
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What action should be taken if a woman is identified as at risk of gestational diabetes?
Offer referral for an oral glucose tolerance test to take place between 24+0 weeks and 28+0 weeks.
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When should a woman's risk factors for pre-eclampsia be assessed?
At the first antenatal (booking) appointment and again in the second trimester.
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What advice should be given to women at risk of pre-eclampsia?
Advise those at risk to take aspirin, following recommendations for antiplatelet use in pregnancy.
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How often should a woman's blood pressure be measured during routine antenatal care?
Measure and record blood pressure at every routine face-to-face antenatal appointment using a device validated for use in pregnancy.
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What should be done for women under 20+0 weeks who have hypertension?
Follow the recommendations on the management of chronic hypertension in pregnancy.
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What is the recommended action for a first episode of hypertension occurring after 20+0 weeks?
Refer women over 20+0 weeks with a first episode of hypertension (blood pressure ≥140/90 mmHg) to secondary care to be seen within 24 hours.
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At what blood pressure should a pregnant woman with severe hypertension be urgently referred to secondary care?
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When should a urine dipstick test for proteinuria be offered during antenatal care?
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When should a risk assessment for fetal growth restriction be offered?
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When should symphysis fundal height (SFH) be measured in a singleton pregnancy?
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What is the recommended maximum frequency for measuring symphysis fundal height?
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When should symphysis fundal height measurements be plotted on a growth chart?
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What should be considered if the symphysis fundal height is large for gestational age?
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What should be offered if the symphysis fundal height is small for gestational age?
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Should routine ultrasound scans be offered after 28 weeks for uncomplicated singleton pregnancies?
No. Do not routinely offer ultrasound scans after 28 weeks for uncomplicated singleton pregnancies.
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When should healthcare professionals discuss babies' movements with a pregnant woman?
Discuss babies' movements with the woman after 24+0 weeks of pregnancy.
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What should clinicians ask at each antenatal contact after 24+0 weeks regarding fetal movements?
Ask if she has any concerns about her baby's movements at each antenatal contact after 24+0 weeks.
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What advice should be given to women who are concerned about reduced fetal movements after 24+0 weeks?
Advise her to contact maternity services at any time of day or night if she has concerns or notices reduced fetal movements after 24+0 weeks.
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What action should be taken if there are concerns about a baby's movements?
Assess the woman and baby if there are any concerns about the baby's movements.
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Have structured fetal movement awareness packages been shown to reduce stillbirth rates?
No. Structured fetal movement awareness packages, such as the one studied in the AFFIRM trial, have not been shown to reduce stillbirth rates.
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When should abdominal palpation be offered to identify possible breech presentation in a singleton pregnancy?
Offer abdominal palpation at all appointments after 36+0 weeks to identify possible breech presentation for women with a singleton pregnancy.
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If breech presentation is suspected on abdominal palpation, what should be offered to determine presentation?
Offer an ultrasound scan to determine the presentation.
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For an uncomplicated singleton pregnancy with breech confirmed after 36+0 weeks, what options should be discussed with the woman?
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What is the purpose of external cephalic version (ECV)?
To turn the baby from bottom to head down (cephalic).
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When should external cephalic version be offered to women who prefer a cephalic vaginal birth?
Offer ECV for women with uncomplicated singleton breech who prefer cephalic vaginal birth after breech is confirmed post 36+0 weeks.
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To which group of pregnancies do the recommendations about discussing options and offering ECV apply?
Women with an uncomplicated singleton pregnancy with breech presentation confirmed after 36+0 weeks.
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What should you do when caring for a pregnant woman regarding communication and needs?
Listen to her and be responsive to her needs and preferences.
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What must be discussed when offering any assessment, intervention or procedure in antenatal care?
The risks, benefits and implications, and that she has a right to decline.
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How should healthcare professionals treat a woman's decisions that conflict with their own view?
The woman's decisions should be respected even if contrary to the professional's views.
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How should information about antenatal care be communicated in terms of language and timing?
Use clear language and tailor timing, content and delivery to the woman's needs, preferences and stage of pregnancy.
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List the delivery formats for antenatal information that should be offered and supplemented.
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When should antenatal information be offered to a woman?
Information should be offered throughout the woman's care.
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What qualities should antenatal information have regarding how it is presented to women and partners?
Individualised, sensitive, supportive and respectful.
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What standards should antenatal information meet in terms of content?
It should be evidence-based and consistent.
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What provision should be made if a woman needs antenatal information in another language?
Information should be translated into other languages if needed.
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What should clinicians explore with the woman (and her partner) about antenatal topics?
Explore the woman’s (and partner’s) knowledge and understanding about each topic to individualise the discussion.
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What must clinicians check regarding information given to the woman and her partner?
Check that they understand the information, how it relates to them, provide chances to ask questions, and allow enough time to discuss concerns.
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What should be discussed and provided at the first antenatal (booking) appointment?
Discuss antenatal care with the woman (and partner) and provide her schedule of antenatal appointments.
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Which topics should be discussed at the first antenatal appointment (and later if appropriate)?
What antenatal care involves and why it is important, and the planned number of antenatal appointments.
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Which additional guideline and standard are cited for more guidance on communication and information provision?
The NICE guideline on patient experience in adult NHS services and the NHS Accessible Information Standard.
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Which evidence reviews contain full details and committee discussion related to antenatal information provision?
Evidence review B: approaches to information provision; evidence review A: information provision; and evidence review J: referral and delivery of antenatal care.
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Where should the first antenatal (booking) appointment include discussion about?
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How should women be informed about contacting maternity services for urgent concerns?
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What screening programmes should be discussed in antenatal care?
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What fetal topics should be covered during antenatal appointments?
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Which maternal changes should antenatal care address?
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What guidance should be given about partner support?
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Which immunisations in pregnancy are mentioned?
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Which infections that can impact the baby are listed?
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What infection prevention advice should be discussed in antenatal care?
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What medication and product guidance should be provided during pregnancy?
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What support resources should antenatal care provide information about?
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What lifestyle topics should antenatal care discuss in a non-judgemental, personalised way?
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What should be explained about alcohol at the booking appointment?
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When should alcohol consumption be discussed during pregnancy?
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What personal topics should be discussed throughout pregnancy?
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What parental support and bonding topics should be provided during pregnancy?
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What information about tests should be given during pregnancy?
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What antenatal guidance is recommended for pelvic floor issues?
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When should healthcare professionals discuss babies' movements with pregnant women?
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Before 28 weeks, what should be discussed with the woman regarding birth?
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From 28 weeks, what topics should be discussed and information given about preparing for labour and birth?
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Which postnatal topics should be discussed and given as information after 28 weeks?
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After 28 weeks, how should the woman's birth preferences be managed?
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From 38 weeks, what discussion should be held about pregnancy?
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When should the guideline on preterm labour and birth be consulted?
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What key elements should be included when discussing birth before 28 weeks versus after 28 weeks?
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Who should be offered antenatal classes according to recommendation 1.3.20?
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Name the topics antenatal classes should include for nulliparous women and partners.
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Which evidence reviews contain the full details of the guideline committee's discussion on antenatal care?
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What should antenatal care include regarding planning for the baby's feeding?
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When should antenatal classes be considered for multiparous women?
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How should antenatal classes be provided to meet local needs?
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Who should antenatal classes be welcoming and accessible for?
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What are three potential benefits of peer support for pregnant women?
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What should clinicians do about peer support during antenatal care?
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What information should be offered about peer support services?
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After which week of pregnancy should women be advised to avoid going to sleep on their back?
After 28 weeks of pregnancy
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What sleeping aid is suggested to help maintain a side position during sleep in late pregnancy?
Consider using pillows to help maintain position while sleeping
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What possible risk is explained to women about going to sleep on their back in late pregnancy?
There may be a link between going to sleep on the back and stillbirth after 28 weeks
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How should healthcare professionals reassure women about mild to moderate nausea and vomiting in pregnancy?
Reassure that mild to moderate nausea and vomiting are common and are likely to resolve before 16 to 20 weeks
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What should clinicians recognise about women seeking advice for nausea and vomiting in pregnancy?
Recognise that women may have already tried several interventions before seeking professional advice
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Which non-pharmacological option is suggested for pregnant women with mild-to-moderate nausea and vomiting who prefer it?
Suggest trying ginger
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What should be discussed when considering pharmacological treatments for nausea and vomiting in pregnancy?
Discuss advantages and disadvantages of different antiemetics, taking into account the woman’s preferences and experience in previous pregnancies
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For pregnant women with nausea and vomiting who choose pharmacological treatment, what should be offered?
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For pregnant women with moderate-to-severe nausea and vomiting, which outpatient treatment should be considered?
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What adjunct treatment should be considered for moderate-to-severe nausea and vomiting in pregnancy?
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When should inpatient care be considered for vomiting in pregnancy?
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Which specific severe condition is included among women who may need inpatient care for vomiting in pregnancy?
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What information should be given to pregnant women with heartburn?
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What pharmacological trial should be considered for pregnant women with heartburn?
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What should you tell a pregnant woman about experiencing vaginal discharge?
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Which symptoms alongside vaginal discharge suggest an infection that needs investigation?
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When should a vaginal swab be considered for a pregnant woman with symptomatic discharge?
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What action should be taken if a sexually transmitted infection is suspected in pregnancy?
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What is the recommended treatment for vaginal candidiasis in pregnant women?
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How should bacterial vaginosis in pregnant women be treated according to the guideline?
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For pregnancy-related pelvic girdle pain, what referral should be considered?
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When should anti-D immunoglobulin be offered for vaginal bleeding after 13 weeks of pregnancy?
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What immediate action is recommended for pregnant women with unexplained vaginal bleeding after 13 weeks?
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Which factors should be considered when deciding whether to admit a pregnant woman with unexplained bleeding after 13 weeks?
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What interventions may physiotherapy provide for pregnancy-related pelvic girdle pain?
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What should be offered to pregnant women with unexplained vaginal bleeding when the placental site is not known?
Offer placental localisation by ultrasound.
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When should corticosteroids for fetal lung maturation be considered for pregnant women with unexplained vaginal bleeding who are admitted to hospital?
Consider corticosteroids if there is an increased risk of preterm birth within 48 hours.
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What important factor should be taken into account when considering corticosteroids for fetal lung maturation?
Take into account gestational age.
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What discussion should be considered with women who have unexplained vaginal bleeding?
Consider discussing the increased risk of preterm birth.
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Define 'bonding' as used in the guideline.
Bonding is the positive emotional and psychological connection that the parent develops with the baby.
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What is 'emotional attachment' according to the guideline?
Emotional attachment is the relationship between baby and parent, driven by innate behaviour, ensuring proximity and safety and depending on sensitive, emotionally attuned parent interactions.
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What right do people have regarding decisions about their antenatal care?
People have the right to be involved in discussions and make informed decisions about their antenatal care.
Which sources should healthcare professionals follow to ensure women can give informed consent in pregnancy?
Name some ways antenatal care can be started to meet women's needs.
What should be provided at the point of antenatal care referral to simplify the process?
Provide an easy-to-complete referral form.
What early information should be offered before the antenatal booking appointment?
Early pregnancy health and wellbeing information, including modifiable factors that may affect pregnancy.
Which modifiable factors should early pregnancy information include?
What topics do the NICE guidelines mentioned in the text cover related to pregnancy?
What accessibility requirement is specified for antenatal materials?
Ensure materials are available in different languages or formats such as digital, printed, braille or Easy Read.
What should the referral form for starting antenatal care enable healthcare professionals to identify?
What contact detail must be included on the antenatal referral form?
Include contact details about the woman's GP.
By when should the first antenatal (booking) appointment with a midwife be offered?
Offer a first antenatal (booking) appointment with a midwife to take place by 10+0 weeks of pregnancy.
If a woman contacts or is referred later than 9+0 weeks, when should the booking appointment be offered?
If referred later than 9+0 weeks, offer a first antenatal (booking) appointment to take place within 2 weeks if possible.
What should healthcare professionals ask if a woman books late in pregnancy?
Ask about the reasons for the late booking because it may reveal social, psychological or medical issues that need to be addressed.
How many routine antenatal appointments with a midwife or doctor are planned for nulliparous women?
How many routine antenatal appointments with a midwife or doctor are planned for parous women?
Which groups are specifically referenced for the NICE guideline on pregnancy and complex social factors?
When should additional or longer antenatal appointments be offered?
What interpreting services requirement is stated for antenatal care?
Who should interpreters be independent of during antenatal appointments?
What aim is recommended for those planning and delivering antenatal services regarding carer assignment?
What communication standard is required between healthcare professionals involved in antenatal care?
How should healthcare professionals involve a partner during pregnancy according to NICE antenatal care guidance?
What should be considered when scheduling antenatal classes if the pregnant woman wishes partner attendance?
Give examples of ways to make antenatal services welcoming for partners.
What physical provision should be made in consultation rooms for partner involvement?
What information should be provided specifically for partners in antenatal services?
What option should be considered for partners attending antenatal appointments?
At the first antenatal booking appointment, which family histories should be asked about?
Which mental health concerns should be asked about at the first antenatal appointment?
What should be asked about medicines at the first antenatal appointment?
What allergy information should be collected at the first antenatal appointment?
What should be discussed regarding the woman's occupation at the first antenatal appointment?
Which aspects of family and home life should be asked about at the first antenatal appointment?
What should be asked about other people in relation to the baby's care at the first antenatal appointment?
What contact details should be recorded at antenatal booking?
What lifestyle and social factors should be reviewed at antenatal booking?
When should a clinician consider reviewing a woman’s previous medical records?
Consider reviewing previous medical records if needed, including records held by other healthcare providers.
How does the maternal death rate for black women compare with white women?
What is the maternal death rate for women with mixed ethnic background compared with white women?
What is the maternal death rate for Asian women compared with white women?
How does the stillbirth rate for black babies compare with white babies?
How does the stillbirth rate for Asian babies compare with white babies?
How does living in the most deprived areas affect maternal death risk?
How does the stillbirth rate vary with level of deprivation?
When should a pregnant woman be offered a referral to NHS Stop Smoking Services?
Offer a referral at 2 weeks to NHS Stop Smoking Services in line with the NICE tobacco guideline.
When and how should you ask about domestic abuse at antenatal care?
Ask about domestic abuse at the first antenatal (booking) appointment, or at the earliest opportunity when the woman is alone, in a kind, sensitive manner with a private one-to-one discussion.
What should you do regarding female genital mutilation (FGM) during antenatal care?
Assess the woman's risk of FGM in a kind, sensitive manner and take appropriate action in line with UK government safeguarding guidance.
When should a pregnant woman be referred for a clinical assessment to detect cardiac conditions?
Refer for a clinical assessment by a doctor if there is concern based on the woman's personal or family cardiac history.
When should you refer a pregnant woman to an obstetrician or other doctor?
Refer to an obstetrician or other relevant doctor if there are any medical concerns or if review of current long-term medicines is needed.
What action should be taken regarding the woman's GP during pregnancy?
After discussion with and agreement from the woman, contact her GP to share information about the pregnancy and potential concerns or complications.
What should be included in the risk assessment at every antenatal appointment?
Ask about general health and wellbeing; ask the woman (and partner if present) about any concerns; provide a safe environment to discuss home concerns, domestic abuse, birth concerns or mental health.
What are two main concerns of antenatal care listed in the guideline?
What must be updated at every antenatal contact?
What measurements should be offered at the first face-to-face antenatal appointment?
Which blood tests should be offered at the first face-to-face antenatal appointment?
Which infectious disease screens should be offered at the booking appointment?
Which genetic and fetal screening programmes should be discussed and offered at booking?
Where should practitioners look for guidance on caring for pregnant women approaching end of life?
What choice should a pregnant woman be informed about regarding screening programmes?
She can accept or decline any part of any of the screening programmes offered.
When should the first routine antenatal ultrasound scan be offered?
Between 11+2 weeks and 14+1 weeks of pregnancy.
What are the purposes of the ultrasound offered at 11+2–14+1 weeks?
When should the second routine antenatal ultrasound scan be offered?
Between 18+0 weeks and 20+6 weeks of pregnancy.
What are the purposes of the ultrasound offered at 18+0–20+6 weeks?
What blood tests should be offered at the antenatal appointment at 28 weeks?
Who should be offered anti-D prophylaxis at 28 weeks?
Rhesus D-negative women who are not known to be sensitised to the rhesus D antigen.
What should be done if antenatal examinations or investigations produce unexpected results?
Offer referral according to local pathways and ensure appropriate information provision and support.
When should a pregnant woman's risk factors for venous thromboembolism (VTE) be assessed during antenatal care?
What should be considered when assessing VTE risk in pregnancy?
Consider using guidance by an appropriate professional body, for example the Royal College of Obstetricians and Gynaecologists' guideline on reducing the risk of VTE during pregnancy.
For pregnant women admitted to hospital or a midwife-led unit, where should clinicians look for intervention guidance?
See the section on interventions for pregnant women and women who gave birth or had a miscarriage or termination in the past 6 weeks in the NICE guideline on venous thromboembolism in over 16s.
What action is recommended for pregnant women identified as being at risk of VTE?
Offer referral to an obstetrician for further management.
When should an oral glucose tolerance test be offered for women at risk of gestational diabetes?
Offer referral for an oral glucose tolerance test between 24+0 weeks and 28+0 weeks of pregnancy.
What action should be taken if a woman is identified as at risk of gestational diabetes?
Offer referral for an oral glucose tolerance test to take place between 24+0 weeks and 28+0 weeks.
When should a woman's risk factors for pre-eclampsia be assessed?
At the first antenatal (booking) appointment and again in the second trimester.
What advice should be given to women at risk of pre-eclampsia?
Advise those at risk to take aspirin, following recommendations for antiplatelet use in pregnancy.
How often should a woman's blood pressure be measured during routine antenatal care?
Measure and record blood pressure at every routine face-to-face antenatal appointment using a device validated for use in pregnancy.
What should be done for women under 20+0 weeks who have hypertension?
Follow the recommendations on the management of chronic hypertension in pregnancy.
What is the recommended action for a first episode of hypertension occurring after 20+0 weeks?
Refer women over 20+0 weeks with a first episode of hypertension (blood pressure ≥140/90 mmHg) to secondary care to be seen within 24 hours.
At what blood pressure should a pregnant woman with severe hypertension be urgently referred to secondary care?
When should a urine dipstick test for proteinuria be offered during antenatal care?
When should a risk assessment for fetal growth restriction be offered?
When should symphysis fundal height (SFH) be measured in a singleton pregnancy?
What is the recommended maximum frequency for measuring symphysis fundal height?
When should symphysis fundal height measurements be plotted on a growth chart?
What should be considered if the symphysis fundal height is large for gestational age?
What should be offered if the symphysis fundal height is small for gestational age?
Should routine ultrasound scans be offered after 28 weeks for uncomplicated singleton pregnancies?
No. Do not routinely offer ultrasound scans after 28 weeks for uncomplicated singleton pregnancies.
When should healthcare professionals discuss babies' movements with a pregnant woman?
Discuss babies' movements with the woman after 24+0 weeks of pregnancy.
What should clinicians ask at each antenatal contact after 24+0 weeks regarding fetal movements?
Ask if she has any concerns about her baby's movements at each antenatal contact after 24+0 weeks.
What advice should be given to women who are concerned about reduced fetal movements after 24+0 weeks?
Advise her to contact maternity services at any time of day or night if she has concerns or notices reduced fetal movements after 24+0 weeks.
What action should be taken if there are concerns about a baby's movements?
Assess the woman and baby if there are any concerns about the baby's movements.
Have structured fetal movement awareness packages been shown to reduce stillbirth rates?
No. Structured fetal movement awareness packages, such as the one studied in the AFFIRM trial, have not been shown to reduce stillbirth rates.
When should abdominal palpation be offered to identify possible breech presentation in a singleton pregnancy?
Offer abdominal palpation at all appointments after 36+0 weeks to identify possible breech presentation for women with a singleton pregnancy.
If breech presentation is suspected on abdominal palpation, what should be offered to determine presentation?
Offer an ultrasound scan to determine the presentation.
For an uncomplicated singleton pregnancy with breech confirmed after 36+0 weeks, what options should be discussed with the woman?
What is the purpose of external cephalic version (ECV)?
To turn the baby from bottom to head down (cephalic).
When should external cephalic version be offered to women who prefer a cephalic vaginal birth?
Offer ECV for women with uncomplicated singleton breech who prefer cephalic vaginal birth after breech is confirmed post 36+0 weeks.
To which group of pregnancies do the recommendations about discussing options and offering ECV apply?
Women with an uncomplicated singleton pregnancy with breech presentation confirmed after 36+0 weeks.
What should you do when caring for a pregnant woman regarding communication and needs?
Listen to her and be responsive to her needs and preferences.
What must be discussed when offering any assessment, intervention or procedure in antenatal care?
The risks, benefits and implications, and that she has a right to decline.
How should healthcare professionals treat a woman's decisions that conflict with their own view?
The woman's decisions should be respected even if contrary to the professional's views.
How should information about antenatal care be communicated in terms of language and timing?
Use clear language and tailor timing, content and delivery to the woman's needs, preferences and stage of pregnancy.
List the delivery formats for antenatal information that should be offered and supplemented.
When should antenatal information be offered to a woman?
Information should be offered throughout the woman's care.
What qualities should antenatal information have regarding how it is presented to women and partners?
Individualised, sensitive, supportive and respectful.
What standards should antenatal information meet in terms of content?
It should be evidence-based and consistent.
What provision should be made if a woman needs antenatal information in another language?
Information should be translated into other languages if needed.
What should clinicians explore with the woman (and her partner) about antenatal topics?
Explore the woman’s (and partner’s) knowledge and understanding about each topic to individualise the discussion.
What must clinicians check regarding information given to the woman and her partner?
Check that they understand the information, how it relates to them, provide chances to ask questions, and allow enough time to discuss concerns.
What should be discussed and provided at the first antenatal (booking) appointment?
Discuss antenatal care with the woman (and partner) and provide her schedule of antenatal appointments.
Which topics should be discussed at the first antenatal appointment (and later if appropriate)?
What antenatal care involves and why it is important, and the planned number of antenatal appointments.
Which additional guideline and standard are cited for more guidance on communication and information provision?
The NICE guideline on patient experience in adult NHS services and the NHS Accessible Information Standard.
Which evidence reviews contain full details and committee discussion related to antenatal information provision?
Evidence review B: approaches to information provision; evidence review A: information provision; and evidence review J: referral and delivery of antenatal care.
Where should the first antenatal (booking) appointment include discussion about?
How should women be informed about contacting maternity services for urgent concerns?
What screening programmes should be discussed in antenatal care?
What fetal topics should be covered during antenatal appointments?
Which maternal changes should antenatal care address?
What guidance should be given about partner support?
Which immunisations in pregnancy are mentioned?
Which infections that can impact the baby are listed?
What infection prevention advice should be discussed in antenatal care?
What medication and product guidance should be provided during pregnancy?
What support resources should antenatal care provide information about?
What lifestyle topics should antenatal care discuss in a non-judgemental, personalised way?
What should be explained about alcohol at the booking appointment?
When should alcohol consumption be discussed during pregnancy?
What personal topics should be discussed throughout pregnancy?
What parental support and bonding topics should be provided during pregnancy?
What information about tests should be given during pregnancy?
What antenatal guidance is recommended for pelvic floor issues?
When should healthcare professionals discuss babies' movements with pregnant women?
Before 28 weeks, what should be discussed with the woman regarding birth?
From 28 weeks, what topics should be discussed and information given about preparing for labour and birth?
Which postnatal topics should be discussed and given as information after 28 weeks?
After 28 weeks, how should the woman's birth preferences be managed?
From 38 weeks, what discussion should be held about pregnancy?
When should the guideline on preterm labour and birth be consulted?
What key elements should be included when discussing birth before 28 weeks versus after 28 weeks?
Who should be offered antenatal classes according to recommendation 1.3.20?
Name the topics antenatal classes should include for nulliparous women and partners.
Which evidence reviews contain the full details of the guideline committee's discussion on antenatal care?
What should antenatal care include regarding planning for the baby's feeding?
When should antenatal classes be considered for multiparous women?
How should antenatal classes be provided to meet local needs?
Who should antenatal classes be welcoming and accessible for?
What are three potential benefits of peer support for pregnant women?
What should clinicians do about peer support during antenatal care?
What information should be offered about peer support services?
After which week of pregnancy should women be advised to avoid going to sleep on their back?
After 28 weeks of pregnancy
What sleeping aid is suggested to help maintain a side position during sleep in late pregnancy?
Consider using pillows to help maintain position while sleeping
What possible risk is explained to women about going to sleep on their back in late pregnancy?
There may be a link between going to sleep on the back and stillbirth after 28 weeks
How should healthcare professionals reassure women about mild to moderate nausea and vomiting in pregnancy?
Reassure that mild to moderate nausea and vomiting are common and are likely to resolve before 16 to 20 weeks
What should clinicians recognise about women seeking advice for nausea and vomiting in pregnancy?
Recognise that women may have already tried several interventions before seeking professional advice
Which non-pharmacological option is suggested for pregnant women with mild-to-moderate nausea and vomiting who prefer it?
Suggest trying ginger
What should be discussed when considering pharmacological treatments for nausea and vomiting in pregnancy?
Discuss advantages and disadvantages of different antiemetics, taking into account the woman’s preferences and experience in previous pregnancies
For pregnant women with nausea and vomiting who choose pharmacological treatment, what should be offered?
For pregnant women with moderate-to-severe nausea and vomiting, which outpatient treatment should be considered?
What adjunct treatment should be considered for moderate-to-severe nausea and vomiting in pregnancy?
When should inpatient care be considered for vomiting in pregnancy?
Which specific severe condition is included among women who may need inpatient care for vomiting in pregnancy?
What information should be given to pregnant women with heartburn?
What pharmacological trial should be considered for pregnant women with heartburn?
What should you tell a pregnant woman about experiencing vaginal discharge?
Which symptoms alongside vaginal discharge suggest an infection that needs investigation?
When should a vaginal swab be considered for a pregnant woman with symptomatic discharge?
What action should be taken if a sexually transmitted infection is suspected in pregnancy?
What is the recommended treatment for vaginal candidiasis in pregnant women?
How should bacterial vaginosis in pregnant women be treated according to the guideline?
For pregnancy-related pelvic girdle pain, what referral should be considered?
When should anti-D immunoglobulin be offered for vaginal bleeding after 13 weeks of pregnancy?
What immediate action is recommended for pregnant women with unexplained vaginal bleeding after 13 weeks?
Which factors should be considered when deciding whether to admit a pregnant woman with unexplained bleeding after 13 weeks?
What interventions may physiotherapy provide for pregnancy-related pelvic girdle pain?
What should be offered to pregnant women with unexplained vaginal bleeding when the placental site is not known?
Offer placental localisation by ultrasound.
When should corticosteroids for fetal lung maturation be considered for pregnant women with unexplained vaginal bleeding who are admitted to hospital?
Consider corticosteroids if there is an increased risk of preterm birth within 48 hours.
What important factor should be taken into account when considering corticosteroids for fetal lung maturation?
Take into account gestational age.
What discussion should be considered with women who have unexplained vaginal bleeding?
Consider discussing the increased risk of preterm birth.
Define 'bonding' as used in the guideline.
Bonding is the positive emotional and psychological connection that the parent develops with the baby.
What is 'emotional attachment' according to the guideline?
Emotional attachment is the relationship between baby and parent, driven by innate behaviour, ensuring proximity and safety and depending on sensitive, emotionally attuned parent interactions.
For moderate–severe cases consider IV fluids (outpatient if possible) and acupressure as adjunct; admit if refractory or hyperemesis gravidarum.
Heartburn
Advise lifestyle/dietary measures and consider a trial of antacid or alginate.
Symptomatic vaginal discharge
Treat candidiasis with vaginal imidazole; consider antibiotics for bacterial vaginosis per antimicrobial stewardship.
Pelvic girdle pain
Consider physiotherapy for exercise advice and/or a non-rigid lumbopelvic belt.
Unexplained vaginal bleeding after 13 weeks
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