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

information so that future care during pregnancy and birth can be planned. Both verbal and written information is given to enable parents to make informed decisions about screening tests.
The following is a guide to the information given and obtained, and the investigations that can be performed during this appointment. All the information gained and given should be carefully recorded. As the interview proceeds it will be possible to establish a rapport and judge when it is appropriate to ask some of the more sensitive questions.
Social considerations
Confirm the woman’s name, age, and other relevant biographical details.
Is she in a stable supportive relationship?
What is her (and/or her partner’s) occupation?
Sensitive enquiry about whether she has experienced domestic abuse and if she is still in that relationship.
Emotional and psychological considerations
Is the pregnancy planned?
Is she happy to be pregnant?
Has she any history of mental health problems?
Has she any concerns about her health or her pregnancy?
Health considerations
Ask about present health and the current pregnancy, are there any problems?
Ask about previous obstetric history, number of pregnancies and births (gravida and parity), and whether these were normal.
Are her previous children healthy?
Ask about menstrual history and calculate the EDD.
Ask about previous medical and family history such as twins, diabetes, epilepsy, hypertension, mental health issues, previous operations, and blood transfusions.
Verify the blood group and rhesus (Rh) status.
Measure the body mass index (BMI) and blood pressure, and test the urine for proteinuria.
Educational considerations
Information and discussion to obtain consent for the following:
Offer screening for anaemia, red cell antibodies, hepatitis B, HIV, Rubella antibodies, and syphilis.
Offer screening for asymptomatic bacteriuria.
Offer screening for Down’s syndrome.
Offer an early ultrasound scan for gestational age assessment.
Offer ultrasound screening for structural anomalies.
Ask about lifestyle issues, diet, alcohol consumption, smoking, and any medications. Give advice and information as appropriate.
CHAPTER 4 Antenatal care
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Taking a sexual history
Unprotected sexual intercourse resulting in pregnancy may also put a woman at risk of contracting an STI.
Sensitive discussion about her past and current sexual health will determine the need for STI testing.
It is important to raise the issue of sexual health and STIs early in pregnancy to initiate diagnostic testing, appropriate referral to the sexual health service and sexual health promotion, if applicable.
The rates of STIs in the UK have risen sharply in the past decade. The highest rates are found in women, gay men, teenagers, young adults, and black and ethnic minority groups. 1
While a programme of chlamydia screening in the 16–24-year age group has been instituted in the UK, this common STI is by no means limited to this age group and it is good practice to offer every pregnant woman urine-based screening, as a prevention for her ongoing, long- term sexual health and to prevent vertical transmission to her baby during vaginal birth.
• Unrecognized/untreated STIs may be vertically transmitted to the baby following rupture of the membranes and vaginal birth. b See Chapter 3 for more specific discussion on individual infections.
The discussion should include:
Length of current relationship
Number of sexual partners in the past 12 months.
Symptoms
Change in vaginal discharge
Vulval/vaginal soreness or irritation
Intermenstrual bleeding
Postcoital bleeding
Pain during sex (dyspareunia)
Abdominal pain
Contact of STI
Past history of STI
Contraceptive method(s)
Condom use
Is she an intravenous drug user past or present?
Has she had sex with an intravenous drug user?
Has she been paid for sex?
Is her partner bisexual?
Has any partner been of non-UK origin, in this country or abroad?
Investigations
Investigations may