Makindo Medical Notes

Normal pregnancy is a physiological process lasting around 40 weeks from the last menstrual period (LMP). Antenatal care aims to promote maternal and fetal health, identify complications early, and provide education and support.

🧬 Physiology of Normal Pregnancy

• 🔄 Hormonal changes: Progesterone and oestrogen rise, maintaining pregnancy and promoting uterine growth.
• 🫀 Cardiovascular adaptations: ↑ plasma volume (~40%), ↑ cardiac output, ↓ systemic vascular resistance → common palpitations and systolic murmurs.
• 🫁 Respiratory: Tidal volume increases; mild dyspnoea may be normal.
• 🩸 Haematology: Dilutional anaemia due to plasma > red cell expansion. Hypercoagulable state → ↑ VTE risk.
• 🩻 Musculoskeletal: Relaxin causes pelvic ligament laxity → back/hip pain.

📅 Antenatal Care Schedule (NICE UK)

• 👩‍⚕️ Booking visit (by 10 weeks): Full history, BMI, BP, urine (protein/glucose), bloods (FBC, group & screen, HIV, hepatitis B, syphilis, rubella immunity), offer screening (Down’s, Edwards, Patau’s).
• 🔍 Scans:
  • Dating scan: 8–14 weeks.
  • Anomaly scan: 18–21 weeks (structural abnormalities).
• 🧪 Bloods repeated: Anaemia screen at 28 weeks, glucose tolerance test if risk factors.
• 💉 Vaccinations: Pertussis at 16–32 weeks; influenza vaccine if in season.
• 📅 Routine visits:
  • Primigravida: 10 visits.
  • Multigravida: 7 visits.
  • Monitor BP, urine, symphysis–fundal height (growth), fetal movement, well-being.

⚕️ Health Promotion

• 🍎 Healthy diet (avoid unpasteurised cheeses, raw meats, certain fish).
• 💊 Folic acid 400 µg daily preconception → 12 weeks; Vit D 10 µg daily throughout.
• 🚭 Smoking cessation, avoid alcohol and recreational drugs.
• 🛡️ Discuss domestic abuse, safeguarding, and mental health openly.

🩺 Common Normal Symptoms

• 🤢 Morning sickness (usually resolves by 16 weeks).
• 💨 Dyspnoea, palpitations (due to increased circulation).
• 🦵 Oedema and varicose veins.
• 🔥 Heartburn and constipation (due to progesterone).

🚩 Red Flags in Pregnancy

• ⚠️ Severe headache, visual changes, epigastric pain → pre-eclampsia.
• ⚠️ PV bleeding or abdominal pain → miscarriage, ectopic, abruption, placenta praevia.
• ⚠️ Reduced fetal movements after 24 weeks → possible fetal compromise.
• ⚠️ Fever, dysuria, flank pain → UTI/pyelonephritis.

🎯 Key Exam Points

• Normal pregnancy = physiological but requires close monitoring.
• UK antenatal care is structured and evidence-based (NICE CG62).
• Always consider safeguarding, domestic abuse, and mental health in consultations.

📚 References

• NICE CG62: Antenatal Care
• Williams Obstetrics, 25th Edition.