Normal pregnancy and Antenatal care
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
