AND-2
Nursing Care of Childbearing Family
Anatomy and Physiology of
Pregnancy
Lectures 1
N. Petrenko, MD, PhD
The Start of It All
In either case, the process will inevitably
involve a sperm and an egg
Or….for those women who get tired of
waiting for the “right man”
Pregnancy is a normal
physiologic process . . .
. . . not a disease!
Signs of pregnancy



Presumptive (generally subjective)
Probable (objective)
Positive (diagnostic)
Presumptive symptoms of pregnancy
(felt by woman):
Cessation of menses
 Nausea with or without vomiting
 “Morning sickness”
 Frequent urination
 Fatigue
 Breast tenderness, fullness, tingling
 Maternal perception of fetal movement
(“Quickening”) 18-20w, 16 w

Probable signs of pregnancy
(observed by examiner):
Changes in the size, shape, and consistency of
the uterus (Hegar sign-softening of the cervix )
 Enlargement of the abdomen
 Changes in the cervix (Goodell sign-softening of
the cervix )

Probable signs of pregnancy
(observed by examiner):
Bluish or purplish coloration of the vaginal
mucosa and cervix (Chadwick’s sign-a dark
blue to purplish-red congested appearance
of the vaginal mucosa )
 Palpation of Braxton-Hicks contractions
 Outlining the fetus manually
 Endocrine tests of pregnancy

Positive signs of pregnancy
(noted by examiner, confirm pregnancy)
Identification of the fetal heart beat
separately and distinctly from that of the
mother (10-12 w)
 Perception of fetal movements by the
examiner (18-20 w)
 Visualization of pregnancy on ultrasound
 Fetal recognition on X-ray

Presumptive signs of pregnancy
Increased skin pigmentation – chloasma,
linea nigra
 Appearance of striae on abdomen and
breasts

Adaptation to pregnancy
Reproductive system & Breast

Uterus: increase size, shape and position,
softness of cervix, discoloration of cervical
mucosa, leukorrhea)

Breast: tenderness, fullness, tingling
enlargement, nipple and areola
hyperpigmentation, Montgomery’s
tubercles, colostrum (16 w)
Cardiovascular System
Stroke Volume:  50%
 Cardiac Output:  30-50% (6.2±1.0 L/min)


Nonpregnant is 4.30.9 L/min
Elevated upward and rotated forward to the left
 More auddible splitting of S1,S2,S3 after 20w
 Heart Rate:  15% ( 10-20 bpm) (14-20 w)
 Sinus arrhytmia, premature atrial contraction,
premature ventricular systole

Cardiovascular System

Blood Pressure:




I trim: same as prepregnancy
II trim till 20 w:  3-5 mmHg systolic and 5-10
mmHg diastolic
III trim: returns to the patient’s prepregnant level
Supine hypotension
Hematologic Changes

Blood Volume:  45% ( 1450-1750 ml)


Plasma Volume:  45-50% ( 1200-1300 ml)


Serves to dissipate fetal heat production
Red Cell Mass:  18-30% ( 250-450 ml)


Protects the mother from devastating hemorrhage
at delivery
Necessary to  O2 transport to meet fetal needs
Based on the above, pregnancy normally
results in a “physiologic anemia”


Hgb: 10-12 g/dL (nonpregnant = 12-15 g/dL)
Hct: 32-40% (nonpregnant = 35-47%)
Hematologic Changes

WBC: 
 1st Trimester: 3,000-15,000/mm3
 (mean 9500/ mm3)
 2nd & 3rd Trimesters: 6,000-16,000/mm3
 (mean 10,500/ mm3)
 Labor: 20,000-30,000/mm3
Hematologic Changes








Fibrin:  40% at term
Plasma Fibrinogen (Factor I):  50%
Clotting time: Unchanged
Coagulation Factors V, VII, VIII, IX, X, XII all 
Coagulation Factors XI, XIII both  slightly
Prothrombin time: Unchanged or  slightly
Platelets: Unchanged
Fibrinolitic activity ↓
Respiratory System

Respiratory rate unchanged or sligly increase

Tidal volume ↑ 30-40%


Vital capacity unchanged
Inspiratory capacity ↑
Exspiratory capacity ↓

Total lung capacity unchanged or sligly decrease

Oxygen consumption ↑15-25 %

Respiratory Changes During Pregnancy

pH: slight  to 7.40-7.45
 Remains
roughly at nonpregnant level
because the  PaCO2 is compensated for
by  renal excretion of bicarbonate (HCO3)

Serum HCO3:  (18-31 mEq/L)
Renal System
Kidneys enlarge with a length  of ~1 cm as
measured by intravenous pyelography
 Renal pelves & urether dilate
 Renal Plasma Blood Flow



GFR


 30-50% by the end of the first trimester
The  in Renal Plasma Flow and GFR are
responsible for decreases in the following:




 30-50% by the end of the first trimester
Uric acid (serum) 4.5 mg/dL
BUN (serum) 12 mg/dL
Creatinine (serum) 0.5-0.6 mg/dL
Creatinine Clearance 150-200 mL/min
GI System

Appetite




Mouth


Gums hyperemic, spongy, swollen, bleeding, nonspecific
gingivitis, ptyalism
Esophagus, Stomac, intestines






I trim 
II trim  because  metabolic needs
Pica (Nonfood craving)
Hiatal hernia (7-8 month)
Gastric emptying become slower
 hypochloric acid
Acid indigestion or hearburn (pyrosis)
Constipation
Hemorrhoids
GI System

Gallbladder



Liver



decreased tone
development of stones
intrahepatic holestasis
Pruritus gravidarum (severe itching) with or without
jandice
Abdominal discomfort


Pelvic heaviness
Displacement of appendix
Integumentary System





Darcening of nipples, areola, axillae, vulva
Facial melasma=chloasma
Linea Nigra
Striae gravidarum
Palmar erythema (Caucasian, African-American)
Musculoskeletal System
Change in posture
 Waddling walk
 Back Pain
 Slight relaxation and increased mobility of
the pelvic joints
 Diastasis recti abdominis

Neurological Changes







Compression of pelvic nerves or vascular stasis caused by enlargement of
the uterus may result in sensory changes in the legs.
Dorsolumbar lordosis may cause pain because of traction on nerves or
compression of nerve roots.
Edema involving the peripheral nerves may result in carpal tunnel
syndrome during the last trimester. The syndrome is characterized by
paresthesia (abnormal sensation such as burning or tingling) and pain in
the hand, radiating to the elbow. The sensations are caused by edema that
compresses the median nerve beneath the carpal ligament of the wrist.
Acroesthesia (numbness and tingling of the hands) is caused by the stoopshouldered stance.
Tension headache is common when anxiety or uncertainty complicates
pregnancy. However, vision problems, sinusitis, or migraine may also be
responsible for headaches.
Light-headedness, faintness, and even syncope (fainting) are common
during early pregnancy. Vasomotor instability, postural hypotension, or
hypoglycemia may be responsible.
• Hypocalcemia may cause neuromuscular problems such as muscle cramps
or tetany.
Endocrine System

Pituitary and placental hormones.




Progesterone & Estrogen






Initiation of lactation; however, the high levels of estrogen and progesterone inhibit lactation by blocking
the binding of prolactin to breast tissue until after birth.
Oxytocin  as the fetus matures



maintaining pregnancy (relaxing smooth muscles, decrease uterine contractility)
Deposition of the fat in subcutaneous tissues over the maternal abdomen, back, and upper thighs.
promote the enlargement of the genitals, uterus, and breasts and increases vascularity, causing
vasodilation.
relaxation of pelvic ligaments and joints.
decrease secretion of hydrochloric acid and pepsin, which may be responsible for digestive upsets such as
nausea.
Prolactin 


 estrogen and progesterone
suppress secretion of FSH & LH
amenorrhea After implantation, the fertilized ovum and the chorionic villi produce hCG, which maintains the
corpus luteum's production of estrogen and progesterone until the placenta takes over their production
(Creasy & Resnik, 1999).
stimulate uterine contractions during pregnancy, but high levels of progesterone prevent contractions until
near term
stimulates the let-down or milk-ejection reflex after birth in response to the infant sucking at the mother's
breast.
Human chorionic somatomammotropin (hCS) = human placental lactogen (hPL)

acts as a growth hormone, and contributes to breast development.
Endocrine System

Thyroid gland.





Parathyroid gland.


slight hyperparathyroidism, a reflection of increased fetal requirements for calcium and
vitamin D. The peak level of parathyroid hormone occurs between 15 and 35 weeks of
gestation when the needs for growth of the fetal skeleton are greatest. Levels return to
normal after birth.
Pancreas.



 gland activity and hormone production.
moderate enlargement of the thyroid gland caused by hyperplasia of the glandular tissue
and increased vascularity
Thyroxine-binding globulin increases as a result of increased estrogen levels (20 weeks).
Total (free and bound) thyroxine (T4)  between 6 and 9 weeks of gestation and plateaus at
18 weeks of gestation. Free T4 and free triiodothyronine (T3) return to nonpregnant levels
after the first trimester. Despite these changes in hormone production, the pregnant woman
usually does not develop hyperthyroidism .
Maternal insulin does not cross the placenta to the fetus. As a result, in early pregnancy, the
pancreas decreases its production of insulin.
Placental hormones (hCS, estrogen, and progesterone).
Adrenal glands.


aldosterone , resulting in reabsorption of excess sodium from the renal tubules.
Cortisol 
Gravida and Para

Gravida means a woman who has been, or
currently is, pregnant

Para means a woman who has given birth

Nulligravida – never been pregnant
Primigravida – pregnant for the first time
Primipara – has delivered once
Multipara – has delivered more than once



GTPAL
G – GRAVIDA (how many pregnancies)
 T – TERM (how many term deliveries)
 P – PRETERM (how many preterm
deliveries)
 A – ABORTIONS (how many abortions,
spontaneous or induced)
 L – LIVING – how many children currently
living

Term, Preterm, Abortion
TERM means delivery occurring in weeks
38-42
 PRETERM means delivery occurring in
weeks 20-37
 ABORTION means delivery occurring
before 20 weeks
 POSTTERM means delivery occurring after
week 42


Duration 280 days =40 weeks= 10 lunar
months = 9 calendar month

1st Trimester 1-13 weeks
 Accepting

reality of pregnancy
2nd Trimester 14-26 weeks
 Resolving
feelings about her own mother;
defining herself as a mother

3rd Trimester 27-40 weeks
 Active
preparation for childbirth and baby
Assessment of Gestational Age

By LMP

By physical exam

By ultrasound
Nagele’s Rule
Subtract 3 months from that date then add 7
days
 1st day of LNMP (last normal menstrual
period)

Example: LNMP: September 10, 2006
Expected Due Date (EDD): June 17, 2007
Uterine Sizing

6 weeks – globular with softening of the
isthmus, size of a tangerine

8 weeks – globular, size of a baseball

10 weeks – globular with irregularity
around one cornua (Piskacek’s sign), size
of a softball

12 weeks – globular, size of a grapefruit
Uterine Sizing
Uterine enlargement
 12 weeks – At Symphysis
 16 weeks – Midway between symphysis
and umbilicus
 20 weeks – At the umbilicus
 36 weeks - Near xyphoid process

Uterine Sizing
Accuracy of Dating by Ultrasound
Gestational Age
weeks)
Ultrasound
Measurements
Range of
Accuracy
<8
Sac size
+ 10 days
8-12
CRL
+ 7 days
12-15
CRL, BPD
+ 14 days
15-20
BPD, HC, FL, AC
+ 10 days
20-28
BPD, HC, FL, AC
+ 2 weeks
> 28
BPD, HC, FL, AC
+ 3 weeks
Review of Systems – 1st Trimester






Nausea
Vomiting
Headaches
Dizziness
Cramping
Urinary frequency
Pain with urination
 Changes in discharge
(amount, color, odor)
 Pruritis
 Bleeding

Review of System – 2nd Trimester
Gums bleeding
 Nose bleeding
 Constipation
 Fetal movement






Cramping
Bleeding
Dysuria
Abnormal discharge
pruritis
Review of Systems – 3rd Trimester





Indigestion
Swelling
Leg cramps
Fetal movement
Difficulty sleeping






Contractions
Bleeding
Calf pain
Headaches
Epigastric pain
Visual changes
History - Menstrual
 Menarche
 Interval
 Length
 Recent
birth
control or
lactation
 LMP
 Sure
of date?
 Normal in length
& flow
 Other helpful
tidbits
 Date of
conception
 ER sonogram
Obstetric History
Dates of all pregnancies (include previous
miscarriage or termination)
 GA
 Gender, weight
 Length of labor
 Coping techniques
 Route of delivery
 Special events AP, IP, PP, Neo

Gynecologic History
Last Pap
 Abnormal pap
 Gyn surgery or problems (e.g. infertility)
 Family planning methods
 Sexually transmitted infections

Medical/Surgical History
Serious illnesses
 Hospitalizations
 Surgery
 Drug allergies or unusual reactions
 Meds since LMP

Family History

Maternal
Diabetes
 CAD
 Pre-eclampsia
 Preterm delivery
 Cancers (breast,
ovarian, colon)
 Depression, bipolarity
 Twins
 Anesthesia reactions


Maternal or Paternal
Birth defects
 Mental retardation
 Bleeding disorders
 Chromosomal
abnormalities (e.g.
Dpwn Syndrome)

Vital Signs




Temperature  Elevated BP suggests the presence of preeclampsia.
Blood pressure
 Elevated BP may be defined as a persistently
Respirations
greater than 140 systolic or 90 diastolic.
Radial pulse
Usually, if one is elevated, both are elevated.
 Elevated temperature suggests the possible
presence of infection.
 Many pregnant women normally have oral
temperatures of as much as 99+. These mild
elevations can also be an early sign of
infection.
 While a pregnant pulse of up to 100 BPM or
greater may be normal, rapid pulse may also
indicate hypovolemia.
Additional Measurements
Height
 Weight
 BMI (Body mass index )

 BMI
Categories:
 Underweight = <18.5
 Normal weight = 18.5-24.9
 Overweight = 25-29.9
 Obesity = BMI of 30 or greater
The First Prenatal Visit: History
Past medical history
 Family medical history
 Gynecologic history
 Past OB history
 Exposures to infections, teratogens,
genetic problems
 Social history
 Nutritional status

The First Prenatal Visit: Exam









HEENT
Fundoscopic exam
Teeth
Thyroid
Breasts
Lungs
Heart
Abdomen
Extremities
Skin
 Lymph nodes

The First Prenatal Visit: Pelvic Exam

Vulva
Vagina
Cervix
Uterine size
Adnexae
Rectum

Labs:







Pap
GC & chlamydia

Clinical pelvimetry:
Diagonal conjugate
 Ischial spines
 Sacrum
 Subpubic arch
 Gynecoid pelvic type?

Bones and Joints of the Pelvis
The Diagonal Conjugate


The obstetric conjugate
extends from the middle of
the sacral promontory to the
posterior superior margin of
the pubic symphysis. This is
the most important diameter
of the pelvic inlet.
The diagonal conjugate
extends from the subpubic
angle to the middle of the
sacral promontory and can
be measured clinically to
estimate the obstetric
conjugate.
The Ischial Spines

The transverse
diameter, between
the ischial spines, is a
measurement of the
dimensions of the
pelvic cavity
The Pelvic Outlet

Subpubic arch

Bituberous
(transverse) diameter

Inferior pubic rami
The First Prenatal Visit: Labs
ABO blood type
 D (Rh) type
 Antibody screen
 CBC
 Rubella
 VDRL or RPR
 HBsAg
 HIV (optional)
 Hemoglobin electrophoresis (as
appropriate)

The First Prenatal Visit: Counseling






What to expect during
the course of prenatal
care
Risk factors
encountered
Nutrition
Exercise
Work
Sexual activity






Travel, seat belts
Smoking cessation
Avoidance of drugs
and alcohol
Warning signs
Where to go or call in
case of problems
Prenatal vitamins
The Return Prenatal Visit

REVIEW THE CHART!
 Calculate
the EGA
 Check the labs
 Review weight gain
 Review blood pressure
 Review results of UA
Leopold's Maneuvers - are used to determine the
orientation of the fetus through abdominal
palpation.

1. Using two
hands and
compressing
the
maternal
abdomen, a
sense of
fetal
direction is
obtained
(vertical or

.
2. The sides of the uterus are palpated to determine the
position of the fetal back and small parts.
3. The presenting part (head or butt) is palpated above
the symphysis and degree of engagement determined
4. The fetal occipital prominence is
determined.
Measuring Fundal Height
Auscultating Fetal Heart Tones
The Routine OB Visit Schedule

Every 4 weeks until 28 weeks

Every 2 weeks from 28 until 36 weeks

Every week from 36 weeks until delivery

Six weeks postpartum
Other Routine OB Labs

15-20 weeks


24-28 weeks


35-37 weeks

Quad Screen
Diabetes Screen
 H&H
 Rhogam workup &
injection
Group B strep culture
Pregnancy is a normal physiologic
process, not a disease . . .
 however,
pregnancy tends to be
UNCOMFORTABLE.
Your challenge is to differentiate
common discomforts of pregnancy
from pathology!
Дякую за Увагу!
Nausea with or without Vomiting
Starts at 4-6 weeks, peaks at 8-12 weeks,
resolves by 14-16 weeks
 Causes: unknown; may be rapidly
increasing and high levels of estrogen,
hCG, thyroxine; may have a psychological
component


Rule out: hyperemesis gravidarum
Nausea and vomiting
in early pregnancy
Most cases of nausea and vomiting
in pregnancy will resolve
spontaneously within 16 to 20
weeks of gestation.
Nausea
and vomiting are not
usually associated with a poor
A
pregnancy outcome.
Nausea and vomiting in early pregnancy
If
a woman requests or would like to
consider treatment, the following
interventions appear to be effective in
reducing symptoms:
non-pharmacological
– ginger
– P6 acupressure

pharmacological
– antihistamines.
A
Ptyalism

Excessive salivation
accompanied by
nausea and inability
to swallow saliva

Cause: unknown; may
be related to
increased acidity in
the mouth
Fatigue

Causes: unknown;
may be related to
gradual increase in
BMR

Rule out: anemia,
thyroid disease
Backache
Women should be informed
that exercising in water,
massage therapy might
help to ease backache
during pregnancy.
A
Upper Backache

Cause: increase in size and weight of the
breasts

Relief: well-fitting, supportive bra
Low Backache

Cause: weight of the
enlarging uterus
causing exaggerated
lumbar lordosis

Rule out:
pyelonephritis (CVAT)
Leukorrhea

Definition: a profuse, thin or thick white
vaginal discharge consisting of white blood
cells, vaginal epithelial cells, and bacilli;
acidic due to conversion of an increased
amount of glycogen in vaginal epithelial
cells into lactic acid by Doderlein’s bacilli

Rule out: vaginitis, STI, ruptured
membranes
Urinary Frequency



1st trimester: increased
weight, softening of the
isthmus, anteflexion of
the uterus
3rd trimester: pressure of
the presenting part
Rule out: UTI
Heartburn




Relaxation of the cardiac
sphincter due to progesterone
Decreased GI motility due to
smooth muscle relaxation
(progesterone)
Lack of functional room for the
stomach because of its
displacement and compression
by the enlarging uterus
Rule out: GI disease
Heartburn
Women
who present with symptoms
of heartburn in pregnancy should be
offered information regarding GPP
lifestyle and diet modification.
Antacids may be offered to women
whose heartburn remains
troublesome
A
Constipation
Decreased peristalsis due to
relaxation of the smooth
muscle of the large bowel
under the influence of
progesterone
 Displacement of the bowel
by the enlarging uterus
 Administration of iron
supplements

Constipation
Women who present with
constipation in pregnancy
should be offered information
regarding diet modification,
such as bran or wheat fibre
supplementation.
A
Hemorrhoids



Relaxation of vein walls and
smooth muscle of large
bowel under influence of
progesterone
Enlarging uterus causes
increased pressure, impeding
circulation and causing
congestion in pelvic veins
Constipation
Hemorrhoids
Women
should be offered
information concerning diet
modification.
If clinical symptoms remain
troublesome, standard
hemorrhoids creams should be
considered.
GPP
Leg Cramps

Cause: unknown. ? inadequate calcium, ? Imbalance in
calcium-phosphorus ratio

Relief: straighten the leg and dorsiflex the foot:
Dependent Edema

Cause: impaired
venous circulation and
increased venous
pressure in the lower
extremities

Rule out: preeclampsia
Varicosities
Impaired venous circulation and increased
venous pressure in lower extremities
 Relaxation of vein walls and surrounding smooth
muscle under the influence of progesterone
 Increased blood volume
 Familial predisposition

Varicose veins
Varicose
veins are a common
symptom of pregnancy that will not
cause harm
and
Compression stockings can
improve the symptoms but will not
prevent varicose veins from
A
emerging.
Vaginal discharge
Women should be informed
that an increase in vaginal
discharge is a common
physiological change that
occurs during pregnancy.
GPP
Vaginal discharge
If vaginal discharge is associated
with itching, soreness, offensive
smell or pain on passing urine
there may be an infective cause
and investigation should be
considered.
GPP
Vaginal discharge
A 1-week course of a topical
imidazole is an effective
treatment and should be
considered for vaginal
candidiasis infections in
pregnant women.
A
Vaginal discharge
The effectiveness and safety
of oral treatments for
vaginal candidiasis in
pregnancy is uncertain and
these should not be offered.
GPP
Insomnia
Discomfort of the enlarged uterus
 Any of the common discomforts of pregnancy
 Fetal activity
 Psychological causes

Round Ligament Pain


Round ligaments attach
on either side of the
uterus just below and in
front of insertion of
fallopian tubes, cross the
broad ligament in a fold
of peritoneum, pass
through the inguinal
canal, insert in the
anterior portion of the
labia majora
When stretched, they
hurt!
Hyperventilation
and Shortness of Breath

Causes:





Increase in the BMR
Pressure of the uterus on
the diaphragm
Changes in the oxygencarbon dioxide balance
Exertion of carrying extra
weight
Rule out: asthma,
pneumonia, TB, anxiety
Supine Hypotensive Syndrome
Screening for
hematological
conditions
Anemia
Pregnant
women should be offered
screening for anaemia.
Screening should take place early
in pregnancy (at the first
appointment) and at 28 weeks.
This allows enough time for
treatment if anaemia is detected. B
Anemia
Hemoglobin levels outside the
normal range for pregnancy
(that is, 11 g/dl at first contact and
10.5 g/dl at 28 weeks)
should be investigated and
iron supplementation considered
if indicated.
A
Blood grouping and
red cell alloantibodies
Women should be offered
testing for blood group
and RhD status in early
pregnancy.
B
Blood grouping and
red cell alloantibodies
If a pregnant woman is RhDnegative, offer partner testing
to determine whether the
administration of anti-D
prophylaxis is necessary.
B
Blood grouping and
red cell alloantibodies
It is recommended that
routine antenatal antiD prophylaxis is
offered to all nonNICE
2002
sensitized pregnant
Blood grouping and
red cell alloantibodies
Women should be screened for
atypical red cell alloantibodies
in early pregnancy and again
at 28 weeks regardless of their
D
RhD status.
Blood grouping and
red cell alloantibodies
Pregnant women with clinically
significant atypical red cell
alloantibodies should be offered
referral to a specialist centre for
further investigation and advice on
subsequent antenatal management.
GPP
Screening for
fetal anomalies
Screening for
structural anomalies
Pregnant women should be offered an
ultrasound scan
to screen for structural anomalies,
ideally between 18 and 20 weeks’
gestation, by an appropriately trained
sonographer and with equipment of
an appropriate standard. A
Screening for Down’s syndrome
Pregnant women should be
offered screening for Down’s
syndrome with a test which
provides the current standard
of a detection rate above 60%
and a false-positive rate of less
than 5%.
B
The following tests meet this standard:
from 11 to 14 weeks
– nuchal translucency (NT)
– the combined test (NT, hCG and PAPP-A)
from 14 to 20 weeks
– the triple test (hCG, AFP and uE3)
– the quadruple test (hCG, AFP, uE3,
inhibin A)
B
Screening for
infections
Asymptomatic
bacteriuria
Pregnant
women should be offered
routine screening for asymptomatic
bacteriuria by midstream urine
culture early in pregnancy.
Identification and treatment of
asymptomatic bacteriuria reduces the
risk of preterm birth.
A
Asymptomatic bacterial
vaginosis
Pregnant women should not be offered
routine screening for bacterial
vaginosis because the evidence
suggests that the identification and
treatment of asymptomatic bacterial
vaginosis does not lower the risk for
preterm birth and other adverse
reproductive outcomes.
A
Chlamydia
trachomatis
Pregnant women should
not be offered routine screening
for asymptomatic chlamydia
because there is insufficient
evidence on its effectiveness and
cost effectiveness.
C
Cytomegalovir
us
The available evidence does
not support routine
cytomegalovirus screening
in pregnant women and it
should not be offered.
B
Hepatitis B virus
Serological
screening for hepatitis
B virus should be offered to
pregnant women
So that effective postnatal
intervention can be offered to
infected women to decrease the risk
of mother-to-child-transmission. A
Hepatitis C virus
Pregnant women should
not be offered routine screening
for hepatitis C virus because
there is insufficient evidence on
its effectiveness and cost
effectiveness.
C
HIV infection
Pregnant women should be offered
screening for HIV infection early
in antenatal care because
appropriate antenatal
interventions can reduce
mother-to-child transmission of
D
HIV infection.
Rubella
Rubella-susceptibility screening should
be offered early in antenatal care to
identify women at risk of contracting
rubella infection and to enable
vaccination in the postnatal period for
the protection of future pregnancies.
B
Streptococcus group B
Pregnant women should not be
offered routine antenatal
screening for group B
streptococcus (GBS)
because evidence of its clinical
effectiveness and cost effectiveness
C
remains uncertain.
Syphilis
Screening for syphilis should be
offered to all pregnant women at
an early stage in antenatal care
because treatment of syphilis is
beneficial to the mother and
fetus.
B
Toxoplasmosis
Routine antenatal serological
screening for toxoplasmosis
should not be offered because
the harms of screening may
outweigh the potential
B
benefits.
Toxoplasmosis
 Pregnant women should be informed of primary
prevention measures to avoid toxoplasmosis
infection, such as:
1. Washing hands before handling food
2. Thoroughly washing all fruit and
vegetables, before eating
C
3. Thoroughly cooking raw meats
4. Wearing gloves and thoroughly washing
hands after handling soil and gardening
5. Avoiding cat faeces in cat litter or in soil.