Oxford Handbook of Midwifery by Janet Medforth, Sue Battersby, Maggie Evans, Beverley Marsh, Angela Walker Read Free Book Online Page A

examination couch, bend her knees, and with her heels together let her knees fall apart. Lighting should be adjusted to give a good view of the vulva and perineum.
The speculum should be warmed (if of metal construction) and lubricated, and inserted gently into the vagina with closed blades orientated in the same direction as the vaginal opening. Once inserted, the blades should be slowly rotated until they are horizontal and opened slowly, bringing the cervix into view.
The swab can now be taken from the fornices of the upper vagina, avoiding contamination from the vaginal entrance.
Swabs for GBS are obtained from just inside the vaginal opening. At the same time a rectal swab is usually taken. There is less emphasis on avoiding contamination, as the organism inhabits both the rectum and lower genital tract.
Chapter 4
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Antenatal care
Confirmation of pregnancy 44 Adaptation to pregnancy 46 Blood values in pregnancy 50 The booking interview 51 Taking a sexual history 52
Principles of antenatal screening 54 Screening for risk in pregnancy 56 Antenatal screening 57
Screening for syphilis 58
HIV screening 59
The full blood count 60
ABO blood group and rhesus factor:
anti-D prophylaxis for the Rh-negative mother 62
Screening for Down’s syndrome risk 64
Group B haemolytic streptococcus 66
Sickle cell anaemia 68
Thalassaemia 70
Antenatal examination 72
Abdominal examination 74
Monitoring fetal growth and well-being 76
CHAPTER 4 Antenatal care
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Confirmation of pregnancy
There are a number of options for women wishing to confirm their pregnancy. A range of home pregnancy testing kits are available from pharmacies, and most pharmacies will carry out a test for a small charge. GP surgeries also provide this service.
The tests are based on detecting the presence of B-human chorionic gonadotrophin (B-hCG), in the woman’s urine or blood. This hormone is secreted by trophoblast or placental tissue from around 7–10 days after conception.
Other signs of pregnancy are:
Amenorrhoea : absence of menstrual periods in a woman who normally experiences menstruation.
Nausea and vomiting : common in the first trimester from 6 weeks’ gestation, peaking at around 10 weeks’ gestation and diminishing as the pregnancy reaches 12 weeks and beyond. It persists throughout pregnancy in some women.
Frequency of micturition : increased urine production and pressure on the bladder due to the growing uterus.
Tiredness : increased metabolic activity and rapid growth of uterine and
placental tissue.
Breast tenderness/changes : hormonal effects of oestrogen and progesterone. The breasts enlarge, become tender, and heavier.
Fetal movements : these are a late sign, appearing in the second trimester as the fetus grows and the uterus becomes a larger abdominal organ. Early movements feel like fluttering or bursting bubbles. First-time mothers notice these later (18–20 weeks) than those undergoing a second or subsequent pregnancy (16–18 weeks).
Pica : or craving for unusual foods, or combinations of foods— hormonal influences on the gastrointestinal tract alter the mother’s perception of taste.
Dating the pregnancy
Ascertain the following:
The first day of the LMP. This may be difficult to ascertain accurately, unless the woman is in the habit of recording this.
The length of the menstrual cycle in days and its regularity.
The number of days of bleeding and if the LMP was a normal bleed.
The woman’s usual method of contraception, and when this was stopped. If the LMP was a withdrawal bleed after oral contraceptive, this date is unreliable.
Calculate the EDD for a 28-day cycle by adding 7 days and 9 months to date of the LMP. Make adjustments for shorter or longer cycles. b See also Taking a menstrual history, p. 16.
Confirm the dates by ultrasound scan. Most women will be offered a scan at around 14 weeks’ gestation to coincide with serum fetal screening tests.
CONFIRMATION OF PREGNANCY
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The earlier the scan the more accurate the