Uk Primary and Maternity Care

...

• 1935 Perinatal mortality rate: 70 per 1,000 births

• 1993 Confidential Enquiries into Stillbirths and Deaths in Infancy • 2012 Perinatal mortality rate: 7.1 per 1,000 births

Almost three-quarters (74.0 per cent) of all infant deaths and 85.9 per cent of all neonatal deaths were related to events occurring before the onset of labour.

Office for National Statistics 2012

Causes of Death in the UK 2012

• 74% of Infant deaths

• 85.9% of Neonatal deaths

Were related to events occurring before the onset of labour, they were –

• congenital anomalies

• antepartum infections

• immaturity related conditions, (respiratory and cardiovascular disorders)

What should any Health Service provide during pregnancy to try to improve outcomes?

First Antenatal visit

• In the first trimester, preferably at 10 weeks but aim for <12 weeks

• At home, a community clinic or hospital

• Aim: To decide on an appropriate pattern of care

woman’s wishes +

known existing problems + risk assessment

J.D.Halsey 02/10

Embryo Development

There are critical and sensitive periods in the development of the pre-embryo and embryo, when cell division, cell differentiation, and morphogenesis are at their peak

Embryology

Gastrulation

Organogenesis/ morphogenesis

Risk assessment – information gathering

• Present pregnancy

• Previous obstetric history

• Medical and surgical history • Family history

• Social history

Appropriate pattern of care

• Aims: Safety Efficient care

Emotionally pleasing

Meets social and domestic needs

• Woman’s ‘informed’ choice

• What is available – finite resources • Screening tests – ‘routine’

J.D.Halsey 02/10

What sort of information about the present pregnancy will help us plan care?

• Age

• Dating the pregnancy

• Height and weight - B.M.I.

Obesity

49% of all the women in the 2009-2012 report who died were overweight or obese (BMI 25-30), 27% had a BMI of 30 or more.



Obstetric History

• Antenatal

• Intrapartum

• Postnatal

• Children’s health

jdh

Medical and Surgical History

• Diabetes

• Thrombophillia or DVT • Epilepsy

• Hypertension

• Renal disease

• Mental health issues

• Medication?

• Uterine • Cervical • Pelvic

• Spinal

• Previous anaesthesia/ reactions

Family History

• Diabetes

• Hypertension

• Ovarian or breast carcinoma • Twins

• Consanguinity



Social History

• Does she have support?

• Financial, employment and housing changes • Domestic abuse

• Safeguarding

• Substance misuse jdh



Appropriate pattern of care

• Aims: Safety Efficient care

Emotionally pleasing

Meets social and domestic needs

• Woman’s ‘informed’ choice

• What is available – finite resources • Screening tests – ‘routine’

J.D.Halsey 02/10

Role of the Midwife in Public Health, Health Education and Health Promotion.

GENDER – The Lifespan Approach

• Recognition that the health status of a woman in one phase of her life affects not only the subsequent phases but also the lives of her existing and future children.

• “Women’s greater healthcare in early years diminishes the severity of their problems compared to same age men, and it ultimately extends their lives”

Verbrugge

Health Education

• Much of modern antenatal care aimed at health promotion and disease prevention

• Women can be motivated to improve their health for pregnancy

• Society (& tax payer!) values the health and welfare of pregnant women

• Health education to women in pregnancy affects the next generation and other family members

Which communicable diseases would you ‘routinely’ screen for in pregnancy?

Infectious Diseases in Pregnancy Screening (IDiPS) Programme

‘Routine