Mock Scenario
Midwifery
We have developed this scenario to provide an outline of the performance we expect
and the criteria that the test of competence will assess.
The Code outlines the professional standards of practice and behaviour which sets
out the expected performance and standards that are assessed through the test of
competence.
The Code is structured around four themes prioritise people, practise effectively,
preserve safety and promote professionalism and trust. These statements are
explained below as the expected performance and criteria. The criteria must be used
to promote the standards of proficiency in respect of knowledge, skills and attributes.
They have been designed to be applied across all fields of nursing and midwifery
practice, irrespective of the clinical setting and should be applied to the care needs
of all persons.
Please note - this is a mock OSCE example for education and training purposes
only.
The marking criteria and expected performance only applies to this mock scenario.
They provide a guide to the level of performance we expect in relation to nursing and
midwifery care, knowledge and attitude. Other scenarios will have different
assessment criteria appropriate to the scenario.
Evidence for the expected performance criteria can be found in the reading list and
related publications on the learning platform.
Theme from the Code
Expected Performance and Criteria
Promote professionalism
Behaves in a professional manner respecting others
and adopting non-discriminatory behaviour.
Demonstrates professionalism through practice.
Upholds the person’s dignity and privacy.
Prioritise people
Introduces self to the person at every contact.
Actively listens to the person and provides
information and clarity.
Treats each person as an individual showing
compassion and care during all interactions.
Displays compassion, empathy and concern. Takes
an interest in the person.
Respects and upholds people’s human rights.
Upholds respect by valuing the person’s opinions
and being sensitive to feelings and/or appreciating
any differences in culture.
Checks that person is comfortable, respecting the
patient’s dignity and privacy.
Infection prevention and
control
Adopts infection control procedures to prevent
healthcare-associated infections at every contact.
Applies appropriate personal protective equipment
(PPE) as indicated by the nursing or midwifery
procedure in accordance with the guidelines to
prevent healthcare associated infections.
Disposes of waste correctly and safely.
Care, compassion and
communication
Seeks permission/consent to carry out
observations/procedures at every person contact.
Checks person’s identity correctly both verbally,
and/or with identification bracelet and the respective
documentation at every person contact.
Uses a range of verbal and nonverbal
communication methods. Displays good verbal
communication skills by appropriate language use,
some listening skills, paraphrasing, and appropriate
use of tone, volume and inflection. Good non-verbal
communication including elements relating to
position (height and patient distance), eye contact
and appropriate touch if necessary.
Practice effectively
Maintains the knowledge and skills needed for safe
and effective practice in all areas of clinical practice.
Organisational aspects of
care specific to specific
skills
Ensures people’s physical, social and psychological
needs are assessed.
Completes physiological observations accurately
and safely for the required time using the correct
technique and equipment.
Ensures any information or advice given is evidence
based including using any healthcare products or
services.
Documentation
Documents all nursing and/or midwifery procedures
accurately and in full, including signature, date and
time.
Writes person’s full name and hospital number
clearly so that it can be easily read by others.
Records the date, month and year of all
observations.
Charts all observations accurately.
Scores out all errors with a single line. Additions are
dated, timed and signed.
Writes the record in ink.
Preserve safety
Supplies, dispenses or administers medicines within
the limits of training, competence, the law, the NMC
and other relevant policies, guidance and
regulations.
Medicine management
The Mock OSCE is made up of four stations: assessment, planning, implementation
and evaluation. Each station will last approximately fifteen minutes and is scenario
based. The instructions and available resources are provided for each station, along
with the specific timing.
Scenario
Lisa Molloy is currently 36 weeks gestation. This is her first pregnancy and she has
been low risk throughout. She comes to her antenatal clinic appointment and her
blood pressure is 145/100mmHg.
You will be asked to complete the following activities to provide high quality,
individualised midwifery care for the woman.
Station
You will be given the following resources
Assessment 15 minutes
You will collect, organise and
document information about the
woman.
A partially completed handheld
pregnancy record document (pages 1-
56)
Assessment overview (page 57) and
Modified Early Obstetric Warning Score
(MEOWS) chart for you to record her
observations (pages 70-71)
Planning 15 minutes
You will complete the planning
template to establish how the care
needs of the woman will be met using
an SBAR (situation, background,
assessment, recommendation)
approach.
A partially completed midwifery care plan
for two midwifery issues that you have
identified to ensure communication with
the antenatal assessment unit is woman-
centred and relevant (pages 58-60)
Implementation 15 minutes
You will administer medications while
continuously assessing the woman’s
current health status.
Implementation overview and Medication
Administration Record (MAR) (pages 61-
65)
Evaluation 15 minutes
You will document the care that has
been provided so that this is
communicated with other healthcare
professionals, provide a record of
clinical actions completed,
disseminate information and
demonstrate the order of events
relating to individual care.
Evaluation overview and transfer of care
letter for a community midwife (pages
66-69)
A blank Modified Early Obstetric Warning
Score (MEOWS) chart (pages 70-71)
On the following page, we have outlined the expected standard of clinical
performance and criteria. This marking matrix is there to guide you on the level of
knowledge, skills and attitude we expect you to demonstrate at each station.
Assessment Criteria
Clean hands with alcohol hand rub, or wash with soap and water, and dry with
paper towels.
May verbalise or make environment safe.
Introduces self to woman and gain consent.
Check ID with woman; verbally, against wristband (where appropriate) and
paperwork.
Recap antenatal history to date.
Complete maternal blood pressure, temperature, pulse, respirations and oxygen
saturations.
Asks about fetal movements.
Explains urinalysis and checks reagent strips expiry date.
Completes hand hygiene and puts on gloves.
Inserts reagent strip into the urine to cover the reagent areas.
Reads reagent strip following manufactures recommendations.
Disposes of equipment correctly.
Remove gloves and completes hand hygiene.
Documents maternal blood pressure, temperature, pulse, respirations and oxygen
saturations and urinalysis accurately.
Explains reason for referral to Antenatal Assessment Unit.
Verbal communication is clear and appropriate.
Close assessment appropriately and may check findings with the woman.
Planning Criteria
Handwriting is clear and legible for problems one and two.
Identifies and documents appropriate Situation for problems.
Identifies and documents appropriate Background for problems.
Identifies and documents appropriate Assessment for problems.
Identifies and documents appropriate Recommendations for problems.
Ensure midwifery interventions are current / relate to EBP / best practice.
Care plan is individualised and woman-centred.
Professional terminology used in care planning.
Confusing abbreviations avoided.
Ensure strike-through errors retain legibility.
Print, sign and date.
Implementation Criteria
Clean hands with alcohol hand rub, or wash with soap and water, and dry with
paper towels.
Introduce self to woman.
Seek consent prior to administering medication.
Check ID with woman; verbally, against wristband (where appropriate) and the
Medication Administration Record (MAR).
May refer to previous assessment results.
Must check allergies on chart and confirm with the woman in their care, also note
red wristband where appropriate.
Before administering any prescribed drug, look at the woman's prescription chart
and check the following:
Correct:
Person
Drug
Dose
Date and time of administration
Route and method of administration
Ensures:
Validity of prescription
Signature of prescriber
The prescription is legible
Identify and administer drugs due for administration correctly and safely.
Check the integrity of the medication to be administered; dose and expiry date.
Provide a correct explanation of what each drug being administered is for to the
woman in their care.
Omit drugs not to be administered and provides verbal rationale.
Accurately record drug administration and non-administration.
Evaluation Criteria
Clearly describe reason for initial referral.
Record date of antenatal appointment.
Identify Situation.
Identify Background.
Identify Assessment.
Identify Recommendations.
Documents allergies and reactions.
Documents plan of care and future appointments.
Identifies potential areas for parent education.
Identifies member of the MDT who need to be aware of discharge.
Ensure strike-through errors retain legibility.
Print, sign and date.
Appendices
Midwifery
PRIVATE & CONFIDENTIAL
1
These Maternity Notes are a guide to your options during pregnancy, childbirth and life with your new baby and are intended to help
you and your partner make informed choices. The explanations in these notes are a general guide only, and not everything will be
relevant to you.
Please feel free to ask any questions. Additional information is also available via NHS Choices - www.nhs.uk or in leaflets which you
may be given by your health care professionals as and when needed.
You should keep these notes with you at all times and bring them to all appointments and when you go into labour. After the birth
of your baby these notes will be kept by the hospital and filed in your records.
Postcode
Maternity Unit
Trust
Address
Notes
Perinatal
© Perinatal Institute - Version 17.2 (November 2017) Product code IPERI-58
Date of printing December 2017
For information about content, go to www.preg.info, e-mail notes@perinatal.org.uk or call 0121 607 0101
For supplies, contact Harlow Printing Ltd: www.harlowprinting.co.uk Tel 0191 496 9731, Fax 0191 454 6265
If found, please return the notes immediately to the owner, or her midwife or maternity unit.
Whilst every effort has been made to ensure the accuracy of this publication, the publishers cannot accept responsibility for any errors, omissions, or mistakes.
All rights reserved. No part of this publication may be reproduced in any form, stored in a retrieval system of any nature, or transmitted in any form or by any
means including electronic, mechanical, photocopying, recording, scanning or otherwise without the prior written permission of the copyright owners except in
accordance with the Copyright, Designs and Patents Act 1988.
www.uk-sands.org0808 164 3332Stillbirth & Neonatal Death Charity (SANDS)
www.hmrc.gov.uk/taxcredits/0345 300 3900Tax Credit Information
www.tommys.org0800 014 7800Tommys Pregnancy Line
www.workingfamilies.org.uk0300 012 0312Working Families (Rights & Benefits)
116 123Samaritans
www.samaritans.org
RCM information for women
www.rcm.org.uk/your-pregnancy-resources-for-women
Support Groups/additional information
www.alcoholconcern.org.uk0203 907 8480
www.citizensadvice.org.ukCitizens Advice Bureau (CAB)
Antenatal Results & Choices (ARC) www.arc-uk.org0845 077 2290
www.bladderandbowelfoundation.orgBladder and Bowel Foundation Helpline 01926 357 220
www.childline.org.ukChildline 0800 1111
www.cafamily.org.uk
0808 808 3555
Contact a family (Disability)
Alcohol Concern
www.talktofrank.com0300 123 6600Frank About Drugs
www.gingerbread.org.uk0808 802 0925Gingerbread
www.laleche.org.uk0345 120 2918La Leche League (breast feeding)
www.maternityaction.org.uk
www.mind.org.uk
0808 802 0029Maternity Action Advice Line
www.miscarriageassociation.org.uk01924 200 799Miscarriage Association
www.nationalbreastfeedinghelpline.org.uk0300 100 0212National Breastfeeding Helpline
www.nct.org.uk0300 330 0700National Childbirth Trust (NCT)
www.gbss.org.uk Group B Strep Support Group
0300 123 3393MIND – for better mental health
www.nationaldomesticviolencehelpline.org.uk
www.nhs.uk
www.nhsdirect.nhs.uk
www.nhs.uk/start4life
www.smokefree.nhs.uk/smoking-and-pregnancy
www.nspcc.org.uk
0808 200 0247
0300 123 1044
111
National Domestic Violence Helpline
National Pregnancy Smoking Helpline
www.familylives.org.uk0808 800 2222Parentline Plus
0800 028 3550NSPCC’s FGM Helpline
NHS Information Service for Parents
NHS Choices
NHS Non-Emergency Number
0144 441 6176
2
TATTERELL NHS TRUST
TATTERELL MATERNITY HOSPITAL
WALNUT STREET
TATTERELL
HOSPITAL 01457 278 123
DELIVERY SUITE 01457 278 456
L L 1 2 V W X
page
a
D M YD M YD M Y
Age ParityBooking BMI EDD
Next of Kin
Name
Address
Relation
Emergency Contact
Name
Address
Centre
Primary care contacts
Other(s)
Maternity contacts
Named Midwife
Maternity Unit
Antenatal Clinic
Community Office
Delivery Suite
Ambulance
GP
Postcode
(GP)
Initial Surname
Plan of care
Depending on your circumstances, you and your partner will have the choice between midwifery based care or maternity team based care during
your pregnancy. Please discuss your choices/options with your midwife. This will be based on your individual medical and obstetric history.
Date recorded Planned place of birth Lead professional Reason if changedJob title
Communication needs
Assistance required
Yes
Details Your preferred name
Interpreter
Do you speak English
What is your first language
No
YesNo
Preferred language
D M YD M YD M YD M Y
D M YD M Y
D M YD M Y
Date
of birth
Unit
No.
Address
Postcode
First name Surname
D M YD M YD M Y
Personal details
NHS
No.
PERSONAL DETAILS
NHS Information Service for Parents
Sign up for emails and texts at www.nhs.uk/start4life
Health Visitor/Family
Nurse Practitioner
3
LISA
MOLLOY
41 ALMOND CLOSE, TATTERELL
01457 278 648
07123 456 789
0 1 0 1 9 6
0 1 4
5 6 9
2 4 9 8
LISA
ENGLISH
ENGLISH
N/A
SALLY BROWN
JANET EDGLEY
PAUL CLARKE
41 ALMOND CLOSE, TATTERELL
PARTNER
L L 1 2 T B U
23
26
0
N/A
TATTERELL HOSPITAL
SALLY BROWN
MW
BOOKING
TATTERELL MATERNITY HOSPITAL
01457 278 012
01457 278 789
01457 278 456
01457 278 345
01457 278 123
01457 278 678
BROWNLANDS
SMITH
L L 1 2 Y Z A
R
01457 278 648
PAUL CLARKE
07987 654 321
41 ALMOND CLOSE, TATTERELL
01457 278 648
page
b
Signatures
PostGMC / NMC numberName
(print clearly)
Signature
Anyone writing in these notes should record their name and signature here.
Name
Unit No/
NHS No
4
AINE DARCEY
SONOGRAPHER
MIDWIFE
SALLY BROWN
0 1 4 5 6 9 2 4 9 8
LISA MOLLOY
Sally Brown
Aine Darcey
page
c
You will be offered appointments during your pregnancy to check you and your baby’s well-being. The date and time
of these can be recorded below.
Name
Unit No/
NHS No
Appointments
Day of weekDate Time ReasonWhere With
D M Y YMD
5
8 WE E K S
1 2 WE E K S
FRIDAY
14:00
U/S
A DARCEY
DATING & NTUSS
1 2 WE E K S
FRIDAY
14:30
HOSPITAL
PHLEBOTOMY
CONFIRMED SCREENING BLOODS
1 6 WE E K S
TUESDAY
10:30
GP
S BROWN
ANTENATAL APPT
1 9 WE E K S
MONDAY
09:00
USS
A DARCEY
ANOMALY USS
2 5 WE E K S
TUESDAY
09:30
GP
S BROWN
ANTENATAL APPT
2 8 WE E K S
MONDAY
11:00
GP
S BROWN
ANTENATAL APPT & BLOODS
3 1 WE E K S
TUESDAY
10:30
GP
S BROWN
ANTENATAL APPT
3 4 WE E K S
TUESDAY
11:00
GP
S BROWN
ANTENATAL APPT
3 6 WE E K S
TUESDAY
10:00
GP
S BROWN
ANTENATAL APPT
BOOKING
S BROWN
GP
TUESDAY
10:00
0 1 4 5 6 9 2 4 9 8
LISA MOLLOY
Mental health
page
d
* Signatures must be listed on page b for identification
Name
Unit No/
NHS No
Complete risk assessment page 12 and management plan page 13.
Pregnancy and having a baby can be an exciting but also a demanding time. This can result in pre-existing symptoms
getting worse. It's not uncommon for women to feel anxious, worried or 'down' at this time. The range of mental
health problems women may experience or develop is the same during pregnancy and after birth as at other times in
her life, but some illnesses/ treatments may be different. Some women who have a mental health problem stop taking
their medication when they find out they are pregnant. This can result in symptoms worsening. You should not alter
your medication without specialist advice from your GP, mental health team or midwife.
Women with a severe mental illness such as psychosis, schizophrenia, schizoaffective disorder or bipolar disorders are
more likely to become unwell again than at other times. Severe mental illness may develop more quickly immediately
after childbirth and can be more serious requiring urgent treatment.
At your 1st appointment you will be asked how you are feeling now and if you have or have had any problems with
your mental health in the past. You will be asked about your emotional wellbeing at your appointments during
pregnancy and after the birth of your baby. These questions are asked to every pregnant woman and new mother.
The maternity team supporting you during pregnancy and after birth may identify that you are at risk of developing a
mental health problem. If this happens they will discuss with you options for support and treatment. You may be
offered a referral to a mental health team/specialist midwife/obstetrician.
If you are concerned about your thoughts, feelings or behaviour, you should seek help and advice.
Further information can be found about mental health including medication in pregnancy and breastfeeding via:
www.medicinesinpregnancy.org
www.nice.org.uk/guidance/cg192/ifp/chapter/about-this-information
1st Assessment. Have you ever been diagnosed with any of the following:
Psychotic illness, bipolar disorders, schizophrenia, schizoaffective disorder, post-partum psychosis
Depression
Generalised anxiety disorder, OCD, panic disorder, social anxiety, PTSD
Eating disorder e.g. anorexia nervosa, bulimia nervosa or binge eating disorder
Personality disorder
Self-harm
Is there anything in your life (past/present) which might make the pregnancy/childbirth difficult?
e.g. tokophobia, trauma, childhood sexual abuse, sexual assault
Help received (current or previous):
GP/Midwife/Health visitor support
Counselling/cognitive behavioural therapy (CBT)
Specialist perinatal mental health team
Hospital or community based mental health team
Inpatient (hospital name) Date(s)
Psychiatrist
Medication (list current or previous) drug name, dose and frequency
Partner
Does your partner have any history of mental health illness?
Family History
Has anyone in your family had a severe perinatal mental illness? (first degree relative e.g. mother, sister)
No Yes
Psychiatric nurse/care
coordinator
Depression identification questions
During the past month, have you often been bothered by feeling down,
depressed or hopeless?
During the past month, have you often been bothered by having little interest
or pleasure in doing things?
If yes to either of these questions, consider offering self-reporting tools e.g. PHQ 9
YesNoNo Yes
1st 2nd
YesNoYesNo
No
Yes
No Yes
Anxiety identification questions
During the past 2 weeks, have you been bothered by feeling nervous, anxious or on edge?
During the past 2 weeks, have you been bothered by not being able to stop
or control worrying?
Do you find yourself avoiding places or activities and does this cause you problems?
If yes to any of these questions, consider offering self-reporting tool e.g. GAD 7
6
0 1 4 5 6 9 2 4 9 8
LISA MOLLOY
page
1
PREGNANCY
My Pregnancy Planner
25 weeks -
for women having their first baby/or
women receiving increased surveillance
Date
42 weeks
41 weeks
40 weeks -
for women having their first baby/or
women receiving increased surveillance
38 weeks
36 weeks
34 weeks
31 weeks -
for women having their first baby/or
women receiving increased surveillance
28 weeks
Anomaly scan at 18 to 20 weeks
16 weeks
Screening results
Dating scan
Screening tests
First Contact
Booking Appointment
LMP
D M Y
D MMD Y Y
Estimated wks
gestation
ks
+
DW
During your pregnancy, you will be offered regular appointments with your healthcare team. They check that you and
your baby are well and provide support and information about your pregnancy to help you make informed choices. How
often these are, varies from woman to woman, and the frequency may need to be adjusted if your circumstances change.
As a minimum, you should be offered appointments at the following weeks of your pregnancy. You can write the date of
these appointments in the spaces provided. After each of your appointments, it is important you know when your next
one is, where it will take place and who it is with.
Health Visitor
Antenatal visit from 28 weeks
7
8 WEEKS
8 WEEKS
8 2
12 WEEKS
16 WEEKS
19 WEEKS
25 WEEKS
28 WEEKS
28 WEEKS
31 WEEKS
page
2
Complete risk assessment page 12/ management plan page 13
Your Details
Partner’s Details
Needs help understanding Pregnancy Notes
Has difficulty understanding English
Needs help completing forms
YesNo
Social Assessment-booking
Employment status
Occupation
Age leaving full
time education
Any difficulties reading / writing English
2nd Assessment
YesNo
Referred
Address
if different
Family name at birth
Faith /
Religion
Country
of birth
If not UK,
year of entry
Citizenship
status
Single WidowedMarried / CP Partner Separated Divorced
Sensory/physical
Disability
No Yes
Details
F/T P/T
Retired Student Home Sick U/E Voluntary
NFA Housing: Owns
Rents
With family/ friends UKBA
OccupationEmployed
U/E
First name Surname
Postcode:
Any household member had/has social services support
Do you have support from partner / family / friend
Entitled to claim benefits
(income support, child tax credits, job seeker etc.)
Name of social worker(s)/ Other multi-agency professionals
Does your partner have any other children. If yes, who looks after them?
(
Date of
birth
D M YD MMD Y Y
Citizenship
status
If not born in UK,
year of entry
Y Y Y Y
Y Y Y Y
Y Y
Temporary accommodation Care services
Other
Have you had a full medical exam since coming to the UK?
(if no refer to GP)
When did you stop?
Was this in the last 12 months?
Anyone else at home smoke?
Tobacco use - booking
Have you ever used tobacco?
If in pregnancy, how many weeks?
Are you a smoker?
No
Yes
W KS
D M YD MMD Y Y
record plan on page13
YesNo
(If mixed, tick more than one box) - is to describe where your family originates from, as distinct from where you were born.
Ethnic Origin
East African (e.g. Ethiopia, Kenya)
Central African (e.g. Cameroon, Congo)
South African – Black (Botswana, South Africa)
South African – Euro (South Africa)
West African (Gambia, Ghana)
Middle Eastern (e.g Iraq, Turkey)
Indian (e.g India, Sri Lanka)
This information is needed to produce a customised growth chart for your baby (page 14).
How long have you lived at your current address?
How many people live in your household?
Declined
British European
(e.g England, Wales)
East European
(e.g Poland, Romania)
Irish European (e.g Northern Ireland, ROI)
North European (e.g Sweden, Denmark)
South European (e.g Greece, Spain)
West European (e.g France, Germany)
North African (e.g Egypt, Sudan)
Babys fatherYou
Babys fatherYou
Pakistani (e.g Pakistan)
Bangladeshi (e.g Bangladesh)
Chinese (e.g China)
Other Far East (e.g Japan, Korea)
South East Asia (e.g Thailand, Philippines)
Caribbean (e.g Barbados, Jamaica)
Other
Babys fatherYou
Alcohol - booking
Drug use - booking
Alcohol units:
Pre-pregnancy
Do you drink alcohol?
YesNo YesNo
In the last 12 months, how often have you had a drink containing alcohol?
How many units of alcohol do drink on a typical day when you are drinking?
2nd
Do you currently use?
Details
Are you receiving treatment?
YesNo
YesNo
2nd
Details
Currently
record plan on page 13
record plan on page13
Have you ever injected drugs?
Have you ever shared drugs paraphernalia?
Have you ever used street drugs, cannabis,
or psychoactive substances (legal highs)?
1st
Any drug or alcohol concerns in the home?
Substance misuse referral
Declined Declined
record plan on page 13
e.g. daily, weekly
Smoking cessation referral
Smoke cigarettes
Smoke roll ups
Use NRT
Chew tobacco
Do you:
No Yes
No. per day
Use e-cigarettes
Result
Declined
CO screening?
1st 2nd
No Yes No. per day
Declined
Result
Consider using an alcohol screening tool
e.g. AUDIT-C
8
PAUL
CLARKE
MOLLOY
CHRISTIAN
0 1 0 1 9 5
BRITISH
BUILDER
N/A
N/A
N/A
N/A
N/A
UK
HAIRDRESSER
1 8
5 YEARS
2
N/A
0 3
0 0
0 0
page
3
Name
Unit No/
NHS No
The term ‘family’ here means blood relatives only - e.g. your children, your parents, grandparents, brothers and
sisters, uncles and aunts and their children (i.e. first cousins). Update management plan (page 13) if indicated.
Family History
* Signatures must be listed on page b for identification
Medical History
Complete risk assessment page 12 and management plan page 13.
Do you have / have you had:
Haematological (Haemaglobinopathies)
High blood pressure
Liver disease inc. hepatitis
Migraine or severe headache
Folic acid tablets
Vaginal bleeding in this pregnancy
Musculo-skeletal problems
Incontinence
(urinary / faecal)
Other
(provide details)
Pelvic injury
Operations
TB exposure
Thrombosis
Medication in the last 6 months
Infections
(e.g. MRSA, GBS)
Thyroid / other endocrine problems
No Yes
Details
Diabetes
Epilepsy / Neurological problems
Fertility problems
(this pregnancy)
Female circumcision / cutting
Cancer
Back problems
Exposure to toxic substances
Allergies
(inc. latex)
Anaesthetic problems
Cervical smear
Admission to A & E in last 12 months
On epilepsy medication?
Blood transfusions
Blood / Clotting disorder
Autoimmune disease
Physical Examination
Details
performed
Gynae history / operations
(excl. caesarean)
0.4mg
No Yes
5mg
Dose changed?
D M Y
D MMD Y Y
Start date
Gastro-intestinal problems
(eg Crohns)
Genital Infections
(e.g. Chlamydia, Herpes)
Hepatitis
B
C
Date
Result
D M Y
D MMD Y Y
D M Y
Admission to ITU / HDU
Cardiac problems
Inherited disorders
Renal disease
Respiratory diseases
Chickenpox / Shingles
No Yes
- thrombosis (blood clots)
- high blood pressure / eclampsia
- a disease that runs in families
Has anyone in your family had:
Has anyone had:
in your family in family of babys father
- need for genetic counselling
- a sudden infant death
- hearing loss from childhood
No Yes No Yes
- hip problems from birth
- learning difficulties
- stillbirths or multiple miscarriages
- heart problems from birth
- abnormalities present at birth
Is your partner the baby’s father
Is the baby’s father a blood relation
First cousin
Second cousin Other
- diabetes Type
Age of baby’s father
Details
- MCADD
Declined
9
2 3
0 1 4 5 6 9 2 4 9 8
LISA MOLLOY
PENICILLIN - ANAPHYLAXIS
ANAEMIA
FERROUS SULPHATE
page
4
Feel free to ask your midwife or doctor – or look at NHS Choices: www.nhs.uk
Miscarriages. A miscarriage (sometimes called spontaneous abortion) is when you lose a baby before 24 weeks
of pregnancy. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. This is very
common with 10-20% of pregnancies ending this way. Late miscarriages, after 3 months but before 24 weeks are
less common, (only 1-2% of pregnancies). When a miscarriage happens 3 or more times in a row, this is called
recurrent miscarriage. Sometimes there is a reason found for recurrent or late miscarriage.
What if I’ve had a termination (abortion) but do not want anyone to know? This information can be kept
confidential between yourself, your midwife and obstetrician and can be recorded elsewhere.
Previous Pregnancies
Details of previous pregnancies and births are relevant when making decisions about the care you will be offered.
Your healthcare team will need to know important facts such as: where you gave birth, a summary of how your
pregnancy went and if you developed any complications, the weight of your baby and how you and your baby were
after the birth. Some of the main topics are outlined below and further information can be found on page 19 about
pregnancy complications and page 24 about labour and types of birth. This information will help you and your
healthcare team develop a personalised plan together which will support your choices/preferences. If there is anything
else you think may be important, please tell your midwife or obstetrician.
Para. This is a term which describes how many babies you already have. Usually early pregnancy losses are also
listed after a ‘plus’ sign. For example, the shorthand for two previous births and one miscarriage is ‘2 + 1’.
High blood pressure and/or pre-eclampsia. If you had this condition last time, you are more likely to have it
again, although it is usually less severe and starts later in pregnancy. It is more likely to happen again if you have a
new partner (page 19).
Intrahepatic Cholestasis in Pregnancy (ICP) (obstetric cholestasis) is a liver condition in pregnancy that causes
itching especially at night (page 19). If you were diagnosed with ICP in a previous pregnancy, you are at an increased
risk of developing it again.
Gestational Diabetes (GDM) can develop during pregnancy causing blood glucose (sugar) levels to become too
high (page 19). You are at increased risk if you developed GDM in a previous pregnancy.
Premature birth. This means any birth before 37 weeks. The earlier the baby is born, the more likely that it will
have problems and need special or intensive neonatal care. The chance of premature birth is increased because of
smoking, infection, ruptured membranes, bleeding, or growth restriction with your baby. Having had baby prematurely
increases the chances of it happening again.
Small babies (fetal growth restriction). If one of your previous babies was growth restricted, there is a chance
of it happening again. Arrangements will be made to monitor this baby’s growth more closely, offering ultrasound
scans and other tests as necessary (page 14).
Big babies (macrosomia). A baby over 4.5 kg is usually considered big - but this also depends on your size and
how many weeks pregnant you were when the baby was born. You may be offered a blood test to check for
gestational diabetes, which can be linked to having bigger babies.
Congenital anomaly. These are also known as birth defects or deformities. Some congenital anomalies are detected
during pregnancy, at birth or others as the baby grows older.
Placenta praevia describes the position of the placenta if it lies low in the womb. If you had this confirmed in the
last months of any previous pregnancy, you are at an increased risk of this happening again.
Placenta acreta happens when the placenta embeds itself too deeply in the wall of the womb. This is more common
with placenta praevia.
Bleeding after birth. Postpartum haemorrhage (PPH) means a significant loss of blood after birth (usually 500mls
or more). Often this happens when the womb does not contract strongly and quickly enough. There is an increased
risk of it happening again, so you will be advised to have a review with an obstetrician during pregnancy to discuss
options for your place of birth.
Postnatal wellbeing. The postnatal period lasts up to 6 weeks after the birth and it is during this time your body
recovers. However, for some women problems can occur e.g. slow perineal or wound healing, concerns with passing
urine, wind and/or stools. Some women may also experience mental health problems (page d).
Group B Streptococcus (GBS). If you’ve previously had a baby who was diagnosed with a GBS infection after
birth, you will be offered intravenous (drip) antibiotics when labour begins. The aim of offering you antibiotics in
labour is to reduce the risk of a GBS infection for this baby.
Baby Weight Conversion Chart
lb oz g
2 0 907
2 2 964
2 4 1021
2 6 1077
2 8 1134
2 10 1191
2 12 1247
2 14 1304
3 0 1361
3 2 1417
3 4 1474
3 6 1531
3 8 1588
3 10 1644
3 12 1701
3 14 1758
lb oz g
4 0 1814
4 2 1871
4 4 1921
4 6 1984
4 8 2041
4 10 2098
4 12 2155
4 14 2211
5 0 2268
5 2 2325
5 4 2381
5 6 2438
5 8 2495
5 10 2551
5 12 2608
5 14 2665
lb oz g
6 0 2722
6 2 2778
6 4 2835
6 6 2892
6 8 2948
6 10 3005
6 12 3062
6 14 3118
7 0 3175
7 2 3232
7 4 3289
7 6 3345
7 8 3402
7 10 3459
7 12 3515
7 14 3572
lb oz g
8 0 3629
8 2 3685
8 4 3742
8 6 3799
8 8 3856
8 10 3912
8 12 3969
8 14 4026
9 0 4082
9 2 4139
9 4 4196
9 6 4252
9 8 4309
9 10 4366
9 12 4423
9 14 4479
lb oz g
10 0 4536
10 2 4593
10 4 4649
10 6 4706
10 8 4763
10 10 4819
10 12 4876
10 14 4933
11 0 4990
11 2 5046
11 4 5103
11 6 5160
11 8 5216
11 10 5273
11 12 5330
11 14 5216
10
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page
5
Name
Unit No
Name
Unit No/
NHS No
Complete risk assessment p12/management plan p13
Para
Early Pregnancy Losses
Previous Births
Insert additional sheets here, and number them 5.1, 5.2 etc
Is current pregnancy with a new partner?
No Yes
Year Gestation CommentsNature of loss
Y Y Y Y
W ks
Y Y Y Y
W ks
Y Y Y Y
W ks
+
Child’s Name & Surname Date of birth Age GestationBirthweight
Place of booking / Place of birth
Anaesthetic
None
Epidural/Spinal
General
Normal
Assisted
Caesarean
Delivery
Normal
Retained placenta
Haemorrhage
3rd stage
Intact
Episiotomy
Tear
Perineum
1
o
3
o
2
o
Postnatal summary
Labour
onset
Spontaneous
Induced
Planned Caesarean
Labour details
Condition since Where now
Antenatal summary
/4
o
G m s
Boy
Girl
ks
+
DW
Formula
Breast
Mixed
D M Y
D MMD Y Y
Complications
SGA or FGR
Congenital Anomaly
HELLPPIH
PND
PP
PET
GDM
ICP
Placenta praevia
Placenta accreta
Centile
Baby GBS Infection
Child’s Name & Surname Date of birth Age GestationBirthweight
Place of booking / Place of birth
Anaesthetic
None
Epidural/Spinal
General
Normal
Assisted
Caesarean
Delivery
Normal
Retained placenta
Haemorrhage
3rd stage
Intact
Episiotomy
Tear
Perineum
1
o
3
o
2
o
Postnatal summary
Labour
onset
Spontaneous
Induced
Planned Caesarean
Labour details
Condition since Where now
Antenatal summary
/4
o
G m s
Boy
Girl
ks
+
DW
Formula
Breast
Mixed
D M Y
D MMD Y Y
Complications
SGA or FGR
Congenital Anomaly
HELLPPIH
PND
PP
PET
GDM
ICP
Placenta praevia
Placenta accreta
Centile
Baby GBS Infection
Child’s Name & Surname Date of birth Age GestationBirthweight
Place of booking / Place of birth
Anaesthetic
None
Epidural/Spinal
General
Normal
Assisted
Caesarean
Delivery
Normal
Retained placenta
Haemorrhage
3rd stage
Intact
Episiotomy
Tear
Perineum
1
o
3
o
2
o
Postnatal summary
Labour
onset
Spontaneous
Induced
Planned Caesarean
Labour details
Condition since Where now
Antenatal summary
/4
o
G m s
Boy
Girl
ks
+
DW
Formula
Breast
Mixed
D M Y
D MMD Y Y
Complications
SGA or FGR
Congenital Anomaly
HELLPPIH
PND
PP
PET
GDM
ICP
Placenta praevia
Placenta accreta
Centile
Baby GBS Infection
Child’s Name & Surname Date of birth Age GestationBirthweight
Place of booking / Place of birth
Anaesthetic
None
Epidural/Spinal
General
Normal
Assisted
Caesarean
Delivery
Normal
Retained placenta
Haemorrhage
3rd stage
Intact
Episiotomy
Tear
Perineum
1
o
3
o
2
o
Postnatal summary
Labour
onset
Spontaneous
Induced
Planned Caesarean
Labour details
Condition since Where now
Antenatal summary
/4
o
G m s
Boy
Girl
ks
+
DW
Formula
Breast
Mixed
D M Y
D MMD Y Y
Complications
SGA or FGR
Congenital Anomaly
HELLPPIH
PND
PP
PET
GDM
ICP
Placenta praevia
Placenta accreta
Centile
Baby GBS Infection
11
0 1 4 5 6 9 2 4 9 8
LISA MOLLOY
page
6
Feel free to ask your midwife or doctor – or look at NHS Choices: www.nhs.uk
Screening for Down’s (T21), Edwards’ (T18) and Patau’s (T13) syndromes
Blood Tests and Investigations
The first half of pregnancy is a time when various tests are offered to check for potential problems, by blood tests (pages
6-7) and ultrasound scans (pages 8-9). The tests listed here are the ones offered by the NHS. Further information is available
in the leaflet, ‘Screening tests for you and your baby’ from your midwife or via www.gov.uk. Do not hesitate to ask what
each test means. The choice is yours and you should have all the relevant information to help you make up your mind,
before the visit when the test(s) are done.
Prenatal Screening and Diagnosis
Family Origin
Family history - first degree relative BMI 30
>
kg/m
Gestational diabetes
Polycystic ovarian syndrome Previous baby’s birth weight > 4.5kg or >90th centile Antipsychotic medication
The screening tests are designed to find out how likely it is that the baby has Down’s, Edwards’ or Patau’s syndrome. Inside
the cells of our bodies there are tiny structures called chromosomes. There are 23 pairs of chromosomes in each cell. With
each of the individual syndromes there is an extra copy of a particular chromosome in each cell. The tests available will
depend on how many weeks pregnant you are. If you are too far on in your pregnancy to have the combined test for Down’s
syndrome, you can choose to have the quadruple test. If you are too far on in your pregnancy to have the combined test
for Edwards’ and Patau’s syndrome, the only other screening test is a mid-pregnancy (anomaly) scan which will look for
physical abnormalities. These tests are available for women with a singleton (1 baby) or twin pregnancy.
The combined test involves having a blood test and an ultrasound scan. A blood sample is taken from you, between 10
and 14 weeks to measure the levels of substances naturally found in the blood. The ultrasound scan is performed between
11 weeks and 2 days and 14 weeks and 1 day, to measure the fluid at the back of the baby’s neck (nuchal translucency
measurement, NT). A computer programme is used to work out a result for you. You will be given two separate results: -
one for Down’s syndrome and another for Edwards’ and Patau’s syndrome.
The quadruple test is available if you are too far on in your pregnancy to have the combined test. This test is for
Down’s syndrome only. A blood sample is taken from you, between 14 weeks and 20 weeks to measure the levels of
substances naturally found in the blood. A computer program is used to work out a result for you. The result: your
midwife or obstetrician will discuss your results with you. Higher-chance result: you will be offered a diagnostic test to
find out for certain if your baby has Down’s, Edwards’ or Patau’s syndrome. There are two tests: – CVS or amniocentesis.
For more information about these tests see page 8. Lower-chance result: if your result is lower than the recommended
national cut off, you will not be offered a diagnostic test. A lower-chance result does not mean that there is no chance
at all of the baby having Down’s, Edwards’ or Patau’s syndrome.
Mid-stream urine - a sample of your urine is tested to look for asymptomatic bacteriuria (a bladder infection with no symptoms).
Treating it with antibiotics can reduce the risk of developing a kidney infection.
Anaemia is caused by too little haemoglobin (Hb) in the blood. Hb carries oxygen and nutrients around the body and to the
baby. Anaemia can make you feel very tired, faint/feel dizzy, and have a pale complexion. If you have any of these symptoms,
speak to your midwife. If you are anaemic, you will be offered iron supplements and advice on your diet.
Blood group & antibodies. It is important to know whether you are rhesus positive (Rh+ve) or negative (Rh-ve), and whether
you have any antibodies (foreign blood proteins). If you are Rh-ve, you will be offered further blood tests to check for antibodies.
If your baby has inherited the Rh+ve gene from the father, antibodies to the baby’s blood cells can develop in your blood. To
prevent this, you will be advised to have an anti-D injection if there is a chance of blood cells from the baby spilling into your
blood stream (e.g. due to vaginal bleeding, amniocentesis or CVS and after the birth). It is recommended that anti-D is given
routinely to all Rh-ve mothers in later pregnancy.
Sickle Cell and Thalassaemia are inherited blood disorders which affect haemoglobin and can be passed from parent to child.
All pregnant women in England are offered a blood test to find out if they carry a gene for thalassaemia, and those at high risk
of being a sickle cell carrier are also offered a test for sickle cell. Genes are the codes in our bodies for things such as eye colour
and blood group. Depending on your results, a test from the baby’s father may be requested. If the baby’s father is a carrier
you will be offered diagnostic tests to find out if the baby is affected.
Hepatitis B is a virus which infects the liver and can cause immediate or long-term illness. Specialist care is needed for pregnant
women with hepatitis B. If you are a carrier, or have become infected during pregnancy, you will be advised to have your baby
vaccinated in the first year of life to reduce the risk of the baby developing hepatitis B.
Syphilis is a sexually transmitted disease which, if left untreated, can seriously damage your baby, or cause miscarriage or stillbirth.
If detected, you will be referred to a specialist team and offered antibiotic treatment. Your baby will need an examination and
blood tests after birth and may need to be treated with antibiotics.
HIV (Human Immunodeficiency Virus) affects the body’s ability to fight infection. This test is important because any woman can
be at risk. It can be passed to your baby during pregnancy, at birth or through breastfeeding. Treatment given in pregnancy can
greatly reduce the risk of infection being passed from mother to child. If you decline testing for hepatitis B, syphilis or HIV, your
midwife will refer you to a specialist screening team, who will discuss your decision in more detail. You can request retesting for
hepatitis B, HIV or syphilis at any time if you change your sexual partner or think you are at risk. If any of these tests are positive
e.g. hepatitis B, syphilis or HIV, you will be referred to a specialist screening team as soon as possible for an individualised plan
or care. Your partner will be offered testing to see if they need any treatment.
Rubella (German measles). Testing is not routinely offered. Avoid being in contact with anyone who has a rash at any time
during your pregnancy. If you come into contact with someone with a rash or you develop a rash, contact your midwife/GP
immediately for advice. If you delay getting advice, it may not be possible to give you a diagnosis or the right treatment.
Additional tests are offered as necessary, such as to check for infections which can cause damage to your baby, but rarely cause
problems for you. Contact your midwife /GP immediately for advice, if you develop any rashes or if you think you have been in
contact with: Chickenpox, Cytomegalovirus (CMV), Parvovirus (slapped cheek) or Toxoplasmosis (page 20).
Chlamydia is a sexually transmitted infection which can result in problems for you and your baby e.g. pelvic inflammatory
disease, miscarriage and premature birth. If you are under 25, you may be offered either a vaginal swab or urine test. If positive,
you and your partner will be offered antibiotics.
Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacterium which sometimes cause wound infections and can be
difficult to treat as it is resistant to some antibiotics. Hospitals may offer testing if you are booked for an elective caesarean
section, have any wounds or have previously tested positive for MRSA.
Oral Glucose Tolerance Test (OGTT) is to find out if you have gestational diabetes (page 19). A blood test is taken after fasting
and you will be advised how long to not eat. You will then be asked to drink a glucose drink and a further blood test will be taken
two hours later. You may be offered this test if you have a history of the following:
Anxiety identification questions
During the past 2 weeks, have you been bothered by feeling nervous, anxious or on edge?
During the past 2 weeks, have you been bothered by not being able to stop
or control worrying?
Do you find yourself avoiding places or activities and does this cause you problems?
If yes to any of these questions, consider offering self-reporting tool e.g. GAD 7
12
page
7
Action
Signed*
Screening explained
NHS Screening
Programme leaflet
given
Screening offered
YesNo
Results
YesNo
Accepted by mother
Signed*
Date taken
D D M M Y Y
Gestation
Site
Dose
Signed*Batch No.
Anti D prophylaxis If Rh-ve
Leaflet(s)
given
Care provider Care provider
Date
*Signed
Comments
Signed*
Date given
YesNo
Accepted
D D M M Y Y D D M M Y Y
W ks
W ks
Gestation
D D M M Y Y
D D M M Y Y
OGTT
MRSA
Results Action Signed*Date taken
Care provider Care provider
Comments
Signed*
Additional tests
Date
*Signed
Explained Accepted
D D M M Y Y D D M M Y Y
Leaflet(s)
given
Date
(if indicated)
YesNo
D D M M Y YD D M M Y Y
Explained
YesNo
Accepted
by mother
Haemoglobin
Blood group
Antibodies
Hepatitis B
Syphilis
HIV
Booking
Results Action Signed*Date taken
Thalassaemia
Mid-stream urine
Sickle cell
Date
D D M M Y Y
D D M M Y Y
If no:
why
Choice of screening
T21, T18/T13 (All the conditions)
T21 only T18/13 only
YesNo
Screening for Down’s (T21), Edwards’ (T18) and Patau’s (T13) syndromes
Test
type
Care provider
*Signed
Date
D M Y
T21
T18
T13
OGTT
Date
*Signed
YesNo
Care provider Care provider
Comments
Signed*
D D M M Y Y D D M M Y Y
Results Action
Signed*Date taken
Care provider Care provider
Comments
Signed*
Tests from Father
Date
*Signed
Explained Accepted
D D M M Y Y D D M M Y Y
Leaflet(s)
given
D D M M Y Y
D D M M S Y
D D M M Y Y
D D M M Y Y
Date
Leaflet(s)
given
Care provider Care provider
Comments
Signed*
Date
*Signed
D D M M Y Y D D M M Y Y
28-week check
Haemoglobin
Antibodies
Results Action
Signed*
Date taken
Explained
YesNo
Accepted
Date
Results to be recorded above
D D M M Y Y
D D M M Y Y
D D M M Y Y
D D M M Y Y
D D M M Y Y
Re-offer tests for
infections
if
declined at
booking
D M Y
* Signatures must be listed on page b for identification
Name
Unit No/
NHS No
Investigations
If additional blood tests / investigations are required update management plan p13.
13
BOOK ING
9 WEE KS
BOOK ING
9 WEE KS
BOOK ING
9 WEE KS
BOOK ING
9 WEE KS
BOOK ING
9 WEE KS
BOOK ING
9 WEE KS
BOOK ING
9 WEE KS
9 WEE KS
BOOKING
BOOK ING
NAD
COMBINED
LISA MOLLOY
0 1 4 5 6 9 2 4 9 8
BOOK ING
9 WEE KS
BOOK ING
NAD
110
O
POS
NAD
NAD
NAD
NAD
NAD
BOOKING
9 WEE KS
BOOK ING
NAD
9 WEE KS
BOOKING
BOOKING
28 WEEKS
95
NAD
29 WE E KS
29 WE E KS
28 WEEKS
NAD
28 WEEKS
28 WEEKS
28 WEEKS
B O O K I N G
1 2 WEEKS
1:1864
1:2306
1:2306
FERRITIN STUDY - NAD
NA - RH +VE (POSITIVE)
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
page
8
Feel free to ask your midwife or doctor – or look at NHS Choices: www.nhs.uk
You will be offered one or two routine ultrasound scans in the first half of pregnancy (i.e. usually by 20 weeks). There are no
known risks to the baby or you from having a scan, but it is important to think carefully about whether to have a scan or not.
The scan may provide information that means you may have to make some difficult decisions. For example, you may be offered
further tests that have a risk of miscarriage. Some people want to find out if their baby has problems and some do not.
Further information can be found in the leaflet “Screening Tests for You and Your Baby” available from your midwife or
via www.gov.uk.
It is important to be aware of what the scans are intended for. Most scans fall into one
of three categories:
n Early scans to: date the pregnancy, check the number of babies,
look for possible physical problems and take specific measurements of
the baby if you have agreed to first trimester screening.
n Anomaly scan is recommended to be performed between 18 to 20+6
weeks of pregnancy to look for possible physical problems with the baby.
n Scans later in pregnancy are not for screening but are carried out
to monitor the baby’s wellbeing and development.
Ultrasound Scans
Diagnostic Tests for Chromosomal Abnormalities
Accepted
by mother
Explained
YesNo
Reasons for Scans
Dating pregnancies. It is important to know the size of the baby in your womb so that we know how mature the fetus is. Scan
dates are more accurate than menstrual dates if done before 22 wks. This is because it looks at the actual age of the fetus,
whereas menstrual dates are based on the first day of the last period which assumes fertilisation occurred 14 days later, this is
not always the case. Most babies are NOT born on their expected due date, but during a 4 week period around it. Usually babies
come when they are ready.
First trimester (early pregnancy). All pregnant women are offered an ultrasound scan at between 8-14 weeks of pregnancy.
This is called the dating scan. It is done to confirm the pregnancy and number of babies in the womb, calculate the expected date
of delivery and to check for major problems with the baby that may be detected at this early stage. You may also be offered
screening for Down’s, Edwards’ and Patau’s syndromes (page 6) at this time. This will depend on whether you have agreed to
have the screening test done and how many weeks pregnant you are at the time of scan.
Mid-pregnancy (anomaly). You will be offered a scan between 18 weeks and 20 weeks and 6 days. The purpose of this scan is
to look for structural problems in the way the baby is developing (sometimes called anomalies). The scan will look in detail at the
baby’s head, spinal cord, limbs, abdomen, face, kidneys, brain, bones and heart. In most cases the baby will be developing well,
but sometimes a problem is found. If a problem is suspected, you will be referred to a specialist team to discuss the options
available to you. However, it is important to know that ultrasound may not identify all problems. Detection rates will vary depending
on the type of anomaly, the position the baby is lying in, previous surgery to your abdomen and maternal size.
Later pregnancy. Scans can be performed in later pregnancy to check the baby’s well-being. This may be required if there are
concerns about how the baby is growing, or if you have any risk factors identified early in your pregnancy, that may affect the growth
and wellbeing of the baby e.g. high blood pressure/diabetes. The main measurement for this is the abdominal circumference, which
includes the size of the liver (the main nutritional store of the growing baby) and the abdominal wall thickness (related to fat reserves).
An assessment of liquor (fluid around the baby) and Doppler flow can be done if there are any concerns with the baby’s growth
(Doppler flow indicates how well the placenta is managing the blood supply needed for the baby). If the scan suggests any
concerns/problems, you will be referred to a specialist doctor to discuss the options available to you. Scans are sometimes also
done to identify the position of the placenta, which may have been low in the womb at an earlier scan. A low placenta increases
the risk of heavy bleeding later in pregnancy (page 19).
Sex of the Baby. Although we can sometimes tell the sex of the baby, they are NOT done for personal requests to find out what
the sex of the baby is.
Signed*: Care ProviderDate
D M Y
D MMD Y Y
Diagnostic tests (Amniocentesis or CVS) are usually offered to diagnose whether a baby has a chromosomal condition such as
Down’s, Edwards’ and Patau’s syndrome. They are not offered on a routine basis but in certain circumstances such as: a family
history of an inherited problem, a result of a screening test reported as a higher-chance result (page 6), abnormal scan findings
or you have had a previous pregnancy/or baby affected by a genetic condition. It is up to you whether you have further tests.
The risk of miscarriage from either of these tests is about 1 or 2 in a 100 (0.5% to 1%). The health care professionals looking
after you will discuss the options available.
Amniocentesis: involves removing a small amount of the fluid from around the baby using a fine needle. It is usually performed
after 15 weeks of pregnancy.
CVS (Chorionic Villus Sampling): involves removing a tiny sample of tissue from the placenta (afterbirth), using a fine needle.
It is usually performed from 11 weeks to 14 weeks of pregnancy. Occasionally results from a CVS are not clear and you will then
be offered an amniocentesis. There are two types of laboratory test which can be used to look at the baby’s chromosomes – a
full karyotype and a rapid test (PCR). A full karyotype checks all the baby’s chromosomes and takes 2 to 3 weeks for the results
to be available. PCR checks for specific chromosomes and results take up to 3 to 4 working days.
14
B O O K I N G
Sally Brown
page
9
* Signatures must be listed on page b for identification
Name
Unit No
Name
Unit No/
NHS No
Diagnostic Tests
Ultrasound Scan Details
MRI Scan Details
Date BPD HC AC FL EFW Plac
Lie/
Pres
Doppler Signed *AFGA
Comments
Comments
Comments
Comments
Comments
Comments
Tests explained
NHS Fetal Anomaly
Screening leaflet given
YesNo
YesNo
Comments
No. uterine insertions
Blood stained tap
Needle/cannula gauge
Aspiration method
Results
Date performed
Test offered
Test accepted
Test type Indication
*Signed
D D M M Y Y
D D M M Y Y
Care provider
*Signed
Date
D M Y
D MMD Y Y
D M Y
D MMD Y Y
Anti D required
Comments
Comments
Dating Scan
Anomaly Scan
Date
D M Y
D MMD Y Y
Signed*
LMP
Dates
Special points
for screening
To be entered also on page 17, and in the
customised growth chart programme
This date is used to determine the
best time for the dating scan
Anomaly
leaflet
Pregnancy Assessment
D M Y
D MMD Y Y
Agreed EDD
D M Y
D MMD Y Y
Print out attached to notes
Signed *
Gestation Comments
Yes No
Gestation
W ks
NT
ks DW
W
ks D
Skull & Ventricles
Cerebellum
Heart 4-chamber view
Heart outflows
Arms - 3 bones left
Arms - 3 bones right
Legs - 3 bones left Legs - 3 bones right Placental site
Spine - long
Cord insertion
Stomach / Diaphragm
Spine - Transverse
Kidneys & Bladder
Face
Insert additional sheets here for multiples (eg twins or triplets)
Date FH CRL BPD HC
Print out
(Y/N)
No. of
fetuses
FL
Method of dating
D
FH - Fetal Heart, CRL - Crown Rump Length, BPD - Biparietal Diameter, HC - Head Circumference, FL - Femur Length, NT - Nuchal Translucency
GA - Gestational Age, Pres - Presentation, AC - Abdominal Circumference, EFW - Estimated Fetal Weight,
Plac - Placenta, AF - Amniotic Fluid.
Comments
15
1 9 W E E K S
POSTERIOR
19 WEEKS
1 9+ 3
171.2
152
31.9
POST
NORMAL
FHHR
N/A
N/A
USS
NIL
Y
1
Y
58.4
1.2
1
+4
2
12 WEEKS
N/A
GENDER NOT DEFINED. NO OBVIOUS ABNORMALITIES NOTED
ALTHOUGH ALL ANOMALIES CANNOT BE EXCLUDED.
LISA MOLLOY
0 1 4 5 6 9 2 4 9 8
Aine Darcey
Sally Brown
Aine Darcey
Sally Brown
page
10
Name
Unit No/
NHS No
Feel free to ask your midwife or doctor – or look at NHS Choices: www.nhs.uk
www.saferpregnancy.org.uk
Blood or blood products are only ever prescribed in specific medical conditions or emergency situations. If you have any
objections about receiving these, please discuss this with your midwife and obstetrician, so that a personalised plan of care
can be made.
Treatment discussed
YesNo
Agrees to receiving blood
or blood products
Management plan initiated
YesNo
YesNo
Signed*
Date
Blood products
Agrees to baby receiving
blood or blood products
YesNo
Pregnant women are more at risk from serious complications of seasonal flu such as bronchitis, chest infection and pneumonia.
Flu in pregnancy also increases the risk of miscarriage, prematurity, fetal growth restriction and stillbirth. It is recommended
you should have the seasonal flu vaccine. It is safe to have at any stage in pregnancy and will pass on protection to your baby
which will last for the first few months of their lives. The vaccine is available from September until January/February and is free
to pregnant women. Ask your GP/pharmacist/ midwife where you can get vaccinated. If you develop flu like symptoms, you
must seek medical advice immediately. There is treatment to reduce the risk of complications.
Seasonal Flu
Flu vaccine given
Antiviral medication
Date given
Medication Dose Signed*
Date commenced
Seasonal flu discussed
No Yes
Agrees flu vaccine
If no, reason declined
Duration of course
Given by whom
No Yes
No Yes
D M YD MMD Y Y
D M Y
D MMD Y Y
D M Y
D MMD Y Y
Some of the information in these notes, about you and your baby will be recorded electronically, this is to help your health professionals
provide the best possible care.
The National Health Service (NHS) also wishes to collect some of this information about you and your baby, to help it to:
monitor health trends increase our understanding of adverse outcomes
strive towards the highest standards make recommendations for improving maternity care.
The NHS has very strict confidentiality and data security procedures in place to ensure that personal information is not given to unauthorised
persons. The data is recorded and identified by NHS number, and your name and address is removed to safeguard confidentiality. Other
information such as date of birth and postcode are included to help understand the influences of age and geography. In some cases, details
of the care are looked at by independent experts working for the NHS, as part of special investigations (e.g. confidential enquiries) by regional
and/or national organisations, but only after the records have been completely anonymised. While it is important to collect data to improve
the standard and quality of the care of all mothers and babies, you can ‘opt out’ and have information about you or your baby excluded. This
will not in any way affect the standard of care you receive. For further details, please ask your lead professional (page a).
However your information will be shared with other agencies such as safeguarding teams, where there are concerns for you or your child’s
safety. In these cases information will be shared without your consent.
Signed*
Care Provider
Date
Data collection and record keeping discussed
Information Sharing
D M Y
D MMD Y Y
Important symptoms
Most pregnancy symptoms are normal, however, it is important to be aware that certain symptoms might suggest the possibility of
serious pregnancy complications. The ticked boxes indicate which topics have been explained to you. (For further details see pages
14, 17 & 19 or www.nhs.uk for more information). Contact your midwife or maternity unit immediately if any of these occur:
Abdominal (stomach) pains
Membranes (waters) breaking early
Severe headaches
Blurred vision
Itching, especially at night
Changed or reduced fetal movements
Further advice / Comments
Care provider should sign, following discussion with mother
Signature*
Symptom or complaint
Vaginal bleeding
Date
D M YD M Y
Leaflet given
Whooping cough is a serious disease that can lead to pneumonia and permanent brain damage, in some cases a risk of dying.
If you have the whooping cough vaccination during pregnancy, it can help protect your baby from getting the disease in their
first weeks of life. Babies are at an increased risk until they are vaccinated. If you have been vaccinated before or had whooping
cough yourself, the vaccine is still recommended. You should be offered the vaccine from 16 weeks of your pregnancy. If you
have not been offered the vaccine, please ask your midwife or GP where you can get it done. It can be given at the same time
as the flu vaccine.
Whooping cough (Pertussis)
Pertussis discussed
No Yes
Agrees to vaccine
If no, reason declined
No Yes
Vaccination given
Date given
Given by whom
No Yes
D M Y
D MMD Y Y
16
B O O K I N G
3 1 W E E K S
SALLY BROWN
3 4 W E E K S
SALLY BROWN
B O O K I N G
BOOKING
BOOKING
BOOKING
BOOKING
BOOKING
BOOKING
LISA MOLLOY
0 1 4 5 6 9 2 4 9 8
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
Sally Brown
page
11
Name
Unit No
Name
Unit No/
NHS No
* Signatures must be listed on page b for identification
Antenatal venous thromboembolism (VTE) assessment - booking and repeat if admitted
Yes
High risk thrombophilia and no VTE
Hospital Admission
Any surgical procedure e.g. appendicectomy
Medical Co-morbidities e.g. cancer, heart failure,
active SLE, IBD or inflammatory polyarthropathy,
nephrotic syndrome, type 1 DM with nephropathy,
sickle cell disease, current IVDU
Any previous VTE except a single event related
to major surgery
Complete risk assessment and update management plan as necessary (page 13)
Age>35 years
Family history of unprovoked or oestrogen-
provoked VTE in first degree relative
Parity 3
OHSS (first trimester only)
BMI >30
Smoker
Gross varicose veins
No risks identified
Immobility e.g. paraplegia, PGP
Current pre-eclampsia
Transient risk factors:
Dehydration / hyperemesis
Current systemic infection
Long distance travel
Signature*
Date
M YD MMD Y Y
High risk
Requires antenatal prophylaxis with LMWH
Refer to Trust-nominated thrombosis in pregnancy expert team
Intermediate risk
Consider antenatal prophylaxis with LMWH
Seek Trust-nominated thrombosis in pregnancy expert
team for advice
Lower risk
Mobilisation and avoidance of dehydration
fewer than three risk factors
Update management
plan as necessary
Signature*
Date
D MMD Y YD MMD Y YD MMD Y Y
Four or more risk factors:
prophylaxis from first trimester
Three risk factors:
prophylaxis from 28 weeks
Single previous VTE related to major surgery
IVF/ART
Low risk thrombophilia
High risk thrombophilia and no VTE
Hospital Admission
Any surgical procedure e.g. appendicectomy
Medical Co-morbidities
e.g. cancer, heart failure,
active SLE, IBD or inflammatory polyarthropathy,
nephrotic syndrome, type 1 DM with nephropathy,
sickle cell disease, current IVDU
Any previous VTE except a single event related
to major surgery
Gestation
Age>35 years
Family history of unprovoked or oestrogen-
provoked VTE in first degree relative
Parity 3
OHSS (first trimester only)
Smoker
Gross varicose veins
Immobility e.g. paraplegia, PGP
Current pre-eclampsia
BMI > 30
Single previous VTE related to major surgery
IVF/ART
Low risk thrombophilia
Transient risk factors:
Dehydration / hyperemesis
Current systemic infection
Long distance travel
No risks identified
Multiple pregnancy
Multiple pregnancy
Yes
W
ks D
+
Yes
W
ks D
+
Yes
W
ks D
+
17
B OO K I NG
3 6 WE E K S
3 6
LISA MOLLOY
0 1 4 5 6 9 2 4 9 8
Sally Brown
Sally Brown
page
12
* Signatures must be listed on page b for identification
Name
Unit No/
NHS No
Anaesthetic assessment
D M YD MMD Y Y
Seen by:
Signature*
Date
(Please tick which pathway is indicated)
Manual handling/tissue viability risk assessment
Maternity Payment Pathway System
Referred: to:
NoYes
Signature*
Date
D M YD MMD Y Y
D M YD MMD Y Y
Referred: to:
NoYes
Signature*
Date
Standard Intermediate Intensive
Signature
& date
D M YD MMD Y Y
Risk assessment
Obstetric factors
Mental health factors
Medical factors
Social factors
No Yes
Booking assessment
Referral required
No Yes
Second assessment
No Yes
Gestation
VTE assessment performed
VTE pathway initiated
OGTT booked
Asprin required
To
Review of primary care/GP records
Signature*
D M YD M Y D M YD M Y
Date
BMI pathway initiated
Management Plan updated
W
ks D
W
ks D
Low/Med/
High Risk
Low/Med/
High Risk
+
+
It is important to reassess your individual circumstances throughout the pregnancy as it may mean a change to your plan of care.
Your care providers can record these below.
Comment
Comment
Smoking
Drug/alcohol use
18
LISA MOLLOY
0 1 4 5 6 9 2 4 9 8
8 W E E K S
2 8 W E E K S
Sally Brown
Sally Brown
page
13
* Signatures must be listed on page b for identification
Name
Unit No
Name
Unit No/
NHS No
Insert continuation sheets here, and number them 13.1, 13.2 etc
Management plan
Date/Signed *
Referred to
Management plan
Risk factor / special features
Highlight key points in special features box (page 17). If necessary, update the lead professional box on page a.
To deal with special issues during pregnancy, a personalised management plan will outline specific treatment and care agreed between you
and your care providers, including specialists. The aim is to keep you and your baby safe, and to ensure that everyone involved in your care
is aware of your individual circumstances. This plan will be updated and amended during pregnancy to reflect your needs.
Booking
Regular Medication
Drug Dose Frequency Date recorded Comments
e.g. discontinued, dose changed
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
If you are taking any medicines or tablets, your midwife or doctor will write them here. If your care providers need to change how much
you take as your pregnancy progresses, or you need other medicines, they can also be written here.
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
D MMD Y Y
19
BOOKING
LISA MOLLOY
0 1 4 5 6 9 2 4 9 8
1 6 WEE KS
200 mg
3/12
LONG TERM FOR ANAEMIA
FERROUS SULPHATE
MIDWIFE LED CARE - UNCOMPLICATED
BOOKING
Sally Brown
page
14
PRINTER: Affix special tape here
Feel free to ask your midwife or doctor – or look at NHS Choices: www.nhs.uk
Insert customised growth chart here
Insert customised growth chart here
Antenatal Checks
Cephalic TransverseBreech
Assessing Fetal Growth
It is very important to attend antenatal and scan appointments that are made for you during your pregnancy. If you
cannot attend any appointments, please contact your midwife or the hospital to re-arrange. Your midwife or doctor
will check you and your baby’s health and wellbeing at each of these appointments. Please discuss any worries or
questions that you may have. If you have had any tests or investigations (pages 6 & 8), make sure that you ask for the
results at your next appointment.
Blood pressure (BP) is checked to detect pregnancy induced hypertension or pre-eclampsia (page 19). High blood
pressure may cause severe headaches or flashing lights. If this happens, tell your midwife or doctor immediately.
Urine tests You will also be asked to supply a sample of your urine at each visit to check for protein (recorded as +
or ++ = presence of), which may be a sign of pre-eclampsia and glucose which may be a sign of gestational diabetes.
Fetal movements You will usually start feeling some movements between 16 and 24 weeks. A baby’s movements
can be described as anything from a kick, flutter, swish or roll. You will very quickly get to know the pattern of your
baby’s movements. At each antenatal contact your midwife will talk to you about this pattern of movements, which
you should feel each day up to the time you go into labour and whilst you are in labour too. Become familiar with your
baby’s usual daily pattern of movements and contact your midwife or maternity unit immediately if you feel that
the movements have altered. Do not put off calling until the next day. It is important for your doctors and midwives
to know if your baby’s movements have slowed down or stopped. A change, especially slowing down or stopping,
can sometimes be an important warning sign that the baby is unwell and the baby needs checking by ultrasound and
Doppler. If, after your check up, you are still not happy with your baby’s movements, you must contact either your
midwife or maternity unit straight away, even if everything was normal last time. NEVER HESITATE to contact your
midwife or maternity unit for advice, no matter how many times this happens.
Fetal heart (FH or FHHR - fetal heart heard and regular). If you wish, your midwife or doctor can listen to the baby’s
heart with either a Pinard (stethoscope) or a fetal Doppler. With a Doppler, you can hear the heartbeat yourself. The use
of home fetal Doppler to listen to your baby’s heart beat is not recommended. Even if you detect a heartbeat this does
not mean your baby is well and you may be falsely reassured.
Liquor refers to the amniotic fluid, the water around the baby. A gentle examination of the abdomen can give an idea
of whether the amount is about right (recorded as NAD - no abnormality detected, or just N), or whether there is
suspicion of there being too much or too little, in which case an ultrasound is needed.
Lie and Presentation.
This describes the way the baby lies in the womb
(e.g. L = longitudinal; O = oblique, T = transverse), and which
part it presents
towards the birth canal (e.g. head first or cephalic = C,
also called vertex = Vx;
bottom first or breech = B or Br).
Engagement is how deep the presenting part - e.g. the baby’s head
is below the brim of the pelvis. It is measured by how much can be still felt through the abdomen, in fifths: 5/5 = free;
4/5 = sitting on the pelvic brim; 3/5 = lower but most is still above the brim; 2/5 = engaged, as most is below the brim;
and 1/5 or 0/5 = deeply engaged, as hardly still palpable from above. In first time mothers, engagement tends to happen
in the last weeks of pregnancy; in subsequent pregnancies, it may occur later, or not until labour has commenced.
Accurate assessment of the baby's growth inside the womb is one of the key tasks of good antenatal care. Problems
such as growth restriction can develop unexpectedly, and is linked with a significantly increased risk of adverse outcomes,
including stillbirth, fetal distress during labour, neonatal problems, or cerebral palsy. Therefore it is essential that the
baby's growth is monitored carefully.
Fundal height is
measured every 2-3 weeks from 26-28 weeks onwards, ideally by the same midwife or doctor. The
measurements are taken with a centimetre tape, from the fundus (top of the uterus) to the top of the symphysis (pubic
bone), then plotted on the growth chart. The slope of the measurements should be similar to the slope of the three
curves printed on the chart, which predict the optimal growth of your baby
.
Customised Growth Charts. These notes have been developed to support the use of customised growth charts
which are individually adjusted for you and your baby. The information required includes:
n Your height and weight in early pregnancy
n Your ethnic origin
n Number of previous babies, their name, sex, gestation at birth and birthweight
n The expected date of delivery (EDD) which is usually calculated from the ‘dating ultrasound’
The chart is usually printed after your pregnancy dates have been determined by ultrasound (preferably) or by last
menstrual period. If neither dates are available, regular ultrasound scans are recommended to check that the baby is
growing as expected. For further information about customised growth charts see www.perinatal.org.uk
After the chart is printed, it is attached as page 16, using the stick-on tape on the right of this page.
Growth restriction.
Slow growth is one of the most common problems that can affect the baby in the womb. If the fundal
height measurements suggest there is a problem, an ultrasound scan should be arranged and the estimated fetal weight (degree
of error 10-15%) plotted on the customised chart to assess whether the baby is small for gestational age. If it does record as
small, assessment of Doppler flow is recommended, which indicates how well the placenta is managing the blood supply needed
for the baby. If there is a serious problem, your obstetric team will need to discuss with you the best time to deliver the baby.
Large baby (macrosomia). Sometimes the growth curve is larger than expected. A large fundal height measurement is
usually no cause for concern, but if the slope of subsequent measurements is too steep, your carers may refer you for an
ultrasound scan to check the baby and the amniotic fluid volume. Big babies may cause problems either before or during birth
(obstructed labour, shoulder dystocia etc.). However, most often they are born normally.
20
page
* Signatures must be listed on page b for identification
Name
Unit No
17
Name
Unit No/
NHS No
Special features
Labour, delivery & postnatal
Paediatrician
to be present
Seniority
Reason
EDD
ParaAge
Medications
Key points (from management plan, page 13)
Allergies
BMIHeight
Weight
booking
+
Y YMD D M
Weight
3rd trimester
Paediatric alert form
Yes
SGA or FGR on scan
k g sk g sc m s
+-
BP
booking
Blood
group
Flu vaccine given Yes Declined
Antenatal visits
Care provider should reiterate discussion of important pregnancy symptoms including altered or reduced fetal movements (see pages 10 & 14)
Gest - Gestation; BP - Blood Pressure; Pres - Presentation; Eng - Engagement; Hb - Haemoglobin.
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
HbGest
Fetal
heart
BP Urine Pres Lie Eng
LiquorDate/Time
Next
contact
Fetal Movements
Felt
Discussed
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
CO
level
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Mental health and wellbeing discussed
Yes
Mental health and wellbeing discussed
Yes
Mental health and wellbeing discussed
Yes
Mental health and wellbeing discussed
Yes
21
2 6
0
MIDWIFE LED CARE
FERROUS SULPHATE
PENICILLIN
PARTNER
PARTNER
-
-
LISA MOLLOY
0 1 4 5 6 9 2 4 9 8
2 3
110/60
1 5 7
6 5
O +
BOO K I NG
8
1 10/60
NAD
NAD
-
YES
-
-
-
128
-
1 6 / 4 0
1 6 WE E K S
1 6
1 10/60
NAD
NAD
-
YES
-
-
-
-
142
-
25 / 4 0
2 5 WE E K S
2 5
1 15/60
NAD
NAD
YES
YES
CEPH
LONG
-
NORM
140
-
2 8 / 4 0
2 8 WE E K S
2 8
1 15/60
NAD
NAD
YES
YES
CEPH
LONG
NAD
NAD
142
-
3 1 / 4 0
BOOKING COMPLETE, LONG TERM ANAEMIA - WELL CONTROLLED WITH FERROUS SULPHATE
200 mg. REVIEW BY GENERAL PRACTITIONER REGULARLY, HAPPY TO SEE GP FOR ANAEMIA.
OTHERWISE WELL.
WELL. NAUSEA HAS SETTLED NOW. BREAST FEEDING DISCUSSED. FERROUS SULPHATE
CONTINUES.
FEELS WELL. MAT B1 COMPLETED AND GIVEN. DISCUSSION REGARDING BIRTH PLAN.
ANTENATAL INFORMATION CLASS BOOKED. PREPARING FOR BABY INFORMATION GIVEN. SAW
HAEMATOLOGIST; FERROUS SULPHATE CONTINUES.
REMAINS WELL. GOOD DIET. CONTINUING TO WORK. NO PROBLEMS. FETAL MOVEMENTS FELT +
++
Sally Brown
Sally Brown
Sally Brown
Sally Brown
page
18
Antenatal visits
Care provider should reiterate discussion of important pregnancy symptoms including altered or reduced fetal movements (see pages 10 & 14)
* Signatures must be listed on page b for identification
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Insert continuation sheets here, and number them.
HbGest
Fetal
heart
BP Urine Pres Lie Eng
LiquorDate/Time
Next
contact
Fetal Movements
Felt
Discussed
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
CO
level
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
HbGest
Fetal
heart
BP Urine Pres Lie Eng LiquorDate/Time
Next
contact
Fetal Movements
Felt
Discussed
CO
level
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Signed*
Details and advice:(inc. infant feeding, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Emotional wellbeing discussed
Yes
Important symptoms discussed
Yes
Signed*
Details and advice:(inc. infant feeding, smoking, lifestyle choices, pelvic floor exercises etc.)
/
D MMD Y Y
H M
M
H
W ks
D
+
revisedManagement plan:reviewedAccompanied With
No Yes
Mental health and wellbeing discussed
Yes
Mental health and wellbeing discussed
Yes
Mental health and wellbeing discussed
Yes
Mental health and wellbeing discussed
Yes
Mental health and wellbeing discussed
Yes
Mental health and wellbeing discussed
Yes
22
-
-
PARTNER
3 1 WE E K S
3 1
1 15/60
NAD
NAD
YES
YES
CEPH
LONG
NAD
NAD
138
-
34 / 4 0
3 4 WE E K S
3 4
120/70
NAD
NAD
YES
YES
CEPH
LONG
NAD
NAD
128
-
3 6 / 4 0
3 6 WE E K S
3 6
145 75
NAD
NAD
YES
YES
CEPH
LONG
NAD
NAD
128
3 8 / 4 0
TIRED BUT WELL. DISCUSSION REGARDING GOOD HYDRATION - COMPLAINED OF A HEADACHE
TODAY. BABY REMAINS ACTIVE.
REMAINS WELL. BABY ACTIVE. HAS NOW FINISHED WORK. FURTHER DISCUSSION REGARDING
LABOUR. ATTENDING PARENT EDUCATION CLASSES.
TIRED. BACKACHE. BLOOD PRESSURE RAISED - REFERRAL TO AN ANTENATAL ASSESSMENT
WARD.
Sally Brown
Sally Brown
Sally Brown
page
19
Feel free to ask your midwife or doctor – or look at NHS Choices: www.nhs.uk
www.saferpregnancy.org.uk
Pregnancy symptoms/complications
Common pregnancy symptoms. You may experience some symptoms during pregnancy. Most are normal and will not harm you or
your baby, but if they are severe or you are worried about them, speak to your midwife or doctor. You may feel some tiredness, sickness,
headaches or other mild aches and pains. Some women experience heartburn, constipation or haemorrhoids. There may also be some
swelling of your face, hands or ankles or you may develop varicose veins. Changes in mood and sex drive are also common. Sex is safe
unless you are advised otherwise by your health care team. Complications in pregnancy require additional visits for extra surveillance of
you and your baby’s well-being. Many conditions will only improve after the birth; therefore it may be necessary to induce your labour
or undertake a planned (elective) caesarean section.
Pregnancy sickness is common and for most women symptoms can be managed with changes to their diet and lifestyle. However, it
is not uncommon for pregnancy sickness to be severe and have a serious negative impact on the quality of your life and your ability to
eat and drink and function normally. If this happens, speak to your GP and request anti-sickness medication. These are safe to take at
any stage of pregnancy. It is important to treat pregnancy sickness at an early stage to prevent it from developing into the more serious
condition called hyperemesis gravidarum. If you are sick, wait at least 30 minutes before brushing your teeth or using a mouthwash. This
helps to protect your teeth from tooth decay. For further information visit www.pregnancysicknesssupport.org.uk
Abdominal pain. Mild pain in early pregnancy is not uncommon and you may have some discomfort due to your body stretching and
changing shape. If you experience severe pain, or pain with vaginal bleeding or need to pass urine more frequently - contact your midwife
or nearest maternity unit immediately for advice. Don’t wait until your next appointment.
Vaginal bleeding may come from anywhere in the birth canal, including the placenta (afterbirth). Occasionally, there can be an ‘abruption’,
where a part of the placenta separates from the uterus, which puts the baby at great risk. If the placenta is low lying, tightenings or
contractions may also cause bleeding. Any vaginal blood loss should be reported immediately to your midwife or nearest maternity
unit. You will be asked to go into hospital for tests, and advised to stay until the bleeding has stopped or the baby is born. If you have
rhesus negative blood, you will require an anti-D injection (page 6).
Abnormal vaginal discharge. It is normal to have increased vaginal discharge when you are pregnant. It should be clear or white and
not smell unpleasant. You need to seek medical advice if the discharge changes colour, smells or you feel sore or itchy.
Diabetes is a condition that causes a person's blood glucose (sugar) level to become too high. It may be pre-existing diabetes that is
present before pregnancy, or some women can develop diabetes during their pregnancy (gestational diabetes). High levels of glucose
can cross the placenta and cause the baby to grow large (macrosomia - page 14). If you have pre-existing or gestational diabetes during
your pregnancy, you will be looked after by a specialist team who will check you and your baby’s health and wellbeing closely. Keeping
your blood glucose levels as near normal as possible can help prevent problems/complications for you and your baby. Gestational diabetes
usually disappears after the birth, but can occur in another pregnancy. To reduce your future risks of diabetes: - be the right weight for
your height (normal BMI); eat healthily, cut down on sugar, fatty and fried foods and increase your physical activity (page 20).
High blood pressure. Your blood pressure will be checked frequently during pregnancy. A rise in blood pressure can be the first sign
of a condition known as pre-eclampsia or pregnancy induced hypertension. Contact your midwife or nearest maternity unit immediately
if you get: a severe headache/s, blurred vision or spots before your eyes, obvious swelling (oedema) especially affecting your hands and
face, severe pain below your ribs and or vomiting as these can be signs that your blood pressure has risen sharply. If there is protein in
your urine, you may have pre-eclampsia which in its severe form can cause blood clotting problems and fits. It can be linked to problems
for the baby such as growth restriction. Treatment may start with rest, but some women will need medication that lowers high blood
pressure. Occasionally, this may be a reason to deliver your baby early.
Thrombosis (clotting in the blood). Your body naturally has more clotting factors during pregnancy which helps prevent losing too much
blood during labour and birth. However, this means that all pregnant women are at a slightly increased risk of developing blood clots during
pregnancy and the first weeks after the birth. The risk is higher if you are over 35, have a BMI >30, smoke, or have a family history of
thrombosis. Contact your midwife or nearest maternity unit immediately if you have any pain or swelling in your leg, pain in your chest or
cough up blood.
Intrahepatic cholestasis in pregnancy (ICP) also known as obstetric cholestasis, is a liver condition in pregnancy that causes itching
on the hands and feet, but may occur anywhere on your body and is usually worse at night. It affects 1 in 140 women in the UK every
year. Having this condition may increase your risk of having a stillbirth, so you will receive closer monitoring of you and your baby’s health
during your pregnancy. If you have itching, blood tests will be offered to check if you have ICP. Treatment includes medication, regular
blood tests and having your baby at or around 37-38 weeks. After the birth, the itching should disappear quite quickly. A blood test to
check your liver function will be carried out before you are discharged from hospital after the birth and repeated about 6-12 weeks later.
Prematurity. Labour may start prematurely (before 37 weeks), for a variety of reasons. If you are planned to give birth in a birth
centre/midwifery unit or at home, you will be advised to transfer your care to a maternity unit with a neonatal unit/special care baby
facility. If labour starts before 34 weeks, most maternity units have a policy of trying to stop labour for at least 1-2 days, whilst offering
you steroid injections that help the baby’s lungs to mature. However, once labour is well established it is difficult to stop. Babies born
earlier than 34 weeks may need extra help with breathing, feeding and keeping warm.
Breech. If your baby is presenting bottom or feet first this is called a breech position (page 14). If your baby is breech at 36 weeks, your
health care team will discuss the following options with you: trying to turn your baby (ECV = external cephalic version); planned (elective)
caesarean section or a planned vaginal breech birth.
Multiple pregnancies. Twins, triplets or other multiple pregnancies need closer monitoring which includes frequent tests and scans,
under the care of a specialist healthcare team. You will be advised to have your babies in a consultant led maternity unit that has a neonatal
unit. Your healthcare team will discuss your options on how best to deliver your babies. It will depend on how your pregnancy progresses,
the position that your babies are lying and whether you have had a previous caesarean section.
Infections .Your immune system changes when you are pregnant and you are at a higher risk of developing an infection. It is very important
that if you are unwell and are experiencing any of the following symptoms, please seek immediate medical advice as treatment may be
required: - high temperature of 38C or higher, fever and chills, foul smelling vaginal discharge, painful red blisters/sores around the
vagina/bottom or thighs, pain or frequently passing urine, abdominal pain, rash, diarrhoea and vomiting, sore throat or respiratory infection.
Avoid unprotected sexual contact if your partner has genital herpes and avoid oral sex from a partner with a cold sore. Wash your hands
if you touch the sores. Wherever possible, keep away from people with an infection e.g. diarrhoea and sickness, cold/flu, any rash illness.
Group B Streptococcus (GBS) is a common bacterium carried by some women and rarely causes symptoms or harm. It can be detected
by testing a urine sample or a vaginal or rectal swab. In some pregnancies, it can be passed on to the baby around the time of birth, which
can lead to serious illness in the baby. The national recommendation is to offer antibiotics to women as soon as labour starts if: -
• GBS has been detected during the current pregnancy. • you have previously had a baby who developed a GBS infection. • you have a
high temperature (38
o
C or over) in labour. • you go into labour prematurely. • GBS was detected in a previous pregnancy and your baby
was not affected, you should be offered antibiotics in labour or be offered a test to screen for GBS late in pregnancy. If the test is positive
you will be offered antibiotics in labour.
23