Read Online Oxford Handbook of Midwifery by Janet Medforth, Sue Battersby, Maggie Evans, Beverley Marsh, Angela Walker - Free Book Online
Ads: Link
difficult, it may not be professionally acceptable to go ahead with tests.
The use of interpreters is problematic, but there is usually a protocol, and advice can be sought from a specialist midwife.
If the client is not mentally competent, then she cannot effectively give consent as an autonomous person. The principle of beneficence
could be invoked to provide care that is in the best interests of the
client. Paternalism may be justified in any number of circumstances, notwithstanding the limited mental capacity of the client.
Grayson A (1996). Fetal screening. The triple test decision. Modern Midwife 6 (8), 16–19 .
Marteau TM, Drake H. (1995). Attributions for disability: the influence of genetic screening.
Social Science and Medicine 40 (8), 1127–32.
CHAPTER 4 Antenatal care
56
Screening for risk in pregnancy
Risk screening during pregnancy aims to identify those women at risk, so that a suitable pattern of care can be planned for the pregnancy with the appropriate professional.
For women deemed to be healthy and at low risk, midwife or midwife/ GP care, based in the community, is a suitable alternative to consultant- or hospital-based care programmes.
Assessment of risk should be ongoing, so that deviations from the normal or the development of complications can be identified at any stage of pregnancy and referral to appropriate care arranged. This assessment starts at the booking interview or initial appointment. For many women this takes place in their own home and is conducted by the community midwife.
Women with any of the following need care over and above that recommended for low-risk healthy women by the NICE guidelines: 1
Cardiac disease including hypertension
Renal disease
• Endocrine disorder or diabetes requiring insulin
Psychiatric disorder (on medication)
Haematological disorder (including thrombo-embolic disease)
Epilepsy requiring anticonvulsant medication
Malignant disease
Severe asthma
Drug misuse (heroin, cocaine, ecstasy)
HIV or hepatitis B
Autoimmune disorders
Obesity: BMI 30kg/m 2 or above (or underweight – BMI <18kg/m 2)
Women at higher risk, e.g. age >40 or <14 years
Women who are particularly vulnerable or who lack social support.
Women who have experienced any of the following in previous pregnancies are at higher risk:
Recurrent miscarriage (three or more)
Preterm birth
Severe pre-eclampsia, eclampsia, or HELLP syndrome
Rh isoimmunization or other significant blood group antibodies
Uterine surgery—caesarean section, myomectomy, or cone biopsy
Ante- or postpartum haemorrhage on two occasions
Puerperal psychosis
Grand multiparity (>6)
A stillbirth or neonatal death
A small for gestational age infant (<5th centile)
A large for gestational age infant (>95th centile)
A baby weighing <2.5kg or >4.5kg
A baby with a congenital anomaly (structural or chromosomal).
1 National Institute for Health and Clinical Excellence (2008). Antenatal care: Routine care for the healthy pregnant mother. Clinical guideline 62. London: NICE. Available at: M www.nice.org. uk/cg62.
ANTENATAL SCREENING
57
Antenatal screening
The Department of Health has published standards to support the UK Antenatal Screening Programme on screening for infectious diseases in pregnancy. 1 These standards are both generic and specific and are part of a wider initiative to establish a quality assured national screening programme. Responsibilities in the trust/strategic health authority, clinic, or laboratory are clarified in the standards. The information below con- centrates on the responsibilities at clinical level.
Generic standards for infectious diseases
All pregnant women are offered screening for rubella antibody, syphilis, HIV, and hepatitis B as an integral part of their antenatal care during their first and all subsequent pregnancies. Repeat testing during pregnancy is not usually necessary. The women have a right to decline screening.
Pregnant women arriving in labour who have not had antenatal care elsewhere
The use of interpreters is problematic, but there is usually a protocol, and advice can be sought from a specialist midwife.
If the client is not mentally competent, then she cannot effectively give consent as an autonomous person. The principle of beneficence
could be invoked to provide care that is in the best interests of the
client. Paternalism may be justified in any number of circumstances, notwithstanding the limited mental capacity of the client.
Grayson A (1996). Fetal screening. The triple test decision. Modern Midwife 6 (8), 16–19 .
Marteau TM, Drake H. (1995). Attributions for disability: the influence of genetic screening.
Social Science and Medicine 40 (8), 1127–32.
CHAPTER 4 Antenatal care
56
Screening for risk in pregnancy
Risk screening during pregnancy aims to identify those women at risk, so that a suitable pattern of care can be planned for the pregnancy with the appropriate professional.
For women deemed to be healthy and at low risk, midwife or midwife/ GP care, based in the community, is a suitable alternative to consultant- or hospital-based care programmes.
Assessment of risk should be ongoing, so that deviations from the normal or the development of complications can be identified at any stage of pregnancy and referral to appropriate care arranged. This assessment starts at the booking interview or initial appointment. For many women this takes place in their own home and is conducted by the community midwife.
Women with any of the following need care over and above that recommended for low-risk healthy women by the NICE guidelines: 1
Cardiac disease including hypertension
Renal disease
• Endocrine disorder or diabetes requiring insulin
Psychiatric disorder (on medication)
Haematological disorder (including thrombo-embolic disease)
Epilepsy requiring anticonvulsant medication
Malignant disease
Severe asthma
Drug misuse (heroin, cocaine, ecstasy)
HIV or hepatitis B
Autoimmune disorders
Obesity: BMI 30kg/m 2 or above (or underweight – BMI <18kg/m 2)
Women at higher risk, e.g. age >40 or <14 years
Women who are particularly vulnerable or who lack social support.
Women who have experienced any of the following in previous pregnancies are at higher risk:
Recurrent miscarriage (three or more)
Preterm birth
Severe pre-eclampsia, eclampsia, or HELLP syndrome
Rh isoimmunization or other significant blood group antibodies
Uterine surgery—caesarean section, myomectomy, or cone biopsy
Ante- or postpartum haemorrhage on two occasions
Puerperal psychosis
Grand multiparity (>6)
A stillbirth or neonatal death
A small for gestational age infant (<5th centile)
A large for gestational age infant (>95th centile)
A baby weighing <2.5kg or >4.5kg
A baby with a congenital anomaly (structural or chromosomal).
1 National Institute for Health and Clinical Excellence (2008). Antenatal care: Routine care for the healthy pregnant mother. Clinical guideline 62. London: NICE. Available at: M www.nice.org. uk/cg62.
ANTENATAL SCREENING
57
Antenatal screening
The Department of Health has published standards to support the UK Antenatal Screening Programme on screening for infectious diseases in pregnancy. 1 These standards are both generic and specific and are part of a wider initiative to establish a quality assured national screening programme. Responsibilities in the trust/strategic health authority, clinic, or laboratory are clarified in the standards. The information below con- centrates on the responsibilities at clinical level.
Generic standards for infectious diseases
All pregnant women are offered screening for rubella antibody, syphilis, HIV, and hepatitis B as an integral part of their antenatal care during their first and all subsequent pregnancies. Repeat testing during pregnancy is not usually necessary. The women have a right to decline screening.
Pregnant women arriving in labour who have not had antenatal care elsewhere
Similar Books
