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[6 min read] Supporting patients with pregnancy in primary care

The general practitioner is often the first place a woman turns to after finding out she is pregnant. It is important to remain open-minded and non-judgemental when faced with a new pregnancy, and to use plain language to communicate.

A confirmatory pregnancy test should be performed in the clinic as a first-line investigation as over-the-counter pregnancy tests can provide inaccurate results, or the results may be interpreted incorrectly. A discussion then may naturally take place with regard to if this pregnancy will continue, or if the woman is seeking termination services.

In either scenario, it is prudent to attempt to ascertain the gestation of the pregnancy. This can be calculated from the last menstrual period (LMP), provided the woman has a regular cycle and is not taking any hormonal contraception.

If the woman is seeking termination of pregnancy, it is important to be able to efficiently signpost the woman to appropriate termination services, without judgement. In these circumstances, it’s essential to explore the woman’s reasons for termination, and ensure she is in a safe place and is not being coerced or forced into such a decision.

If the woman plans to continue with the pregnancy, it’s important to ascertain her level of knowledge with regard to pregnancy, and provide useful education applicable to early pregnancy. Pregnancy is an ideal opportunity to discuss and explore lifestyle factors such as diet, smoking, alcohol intake, and drug use. It is crucial to discuss these factors with specific reference to effects on the pregnancy, and to be able to signpost to support services where appropriate.

It is prudent to explore the introduction of recommended vitamins – folic acid and vitamin D, if the woman has not already been taking these – and to advise on what types of foods to avoid during pregnancy.

Vaccination history should also be discussed, including offering routine vaccinations such as seasonal influenza where applicable.

It is important to organise routine antenatal tests such as height, wight, urinalysis, blood pressure, and testing for sexually transmitted infections. Routine blood tests are indicated to test for anaemia, to ascertain the woman’s blood group and rhesus status, and to test for certain blood borne viruses such as HIV and hepatitis B.

It’s important to also discuss any pre-existing medical conditions and regular medications that may impact the woman’s antenatal care. This is also a time to explore the antenatal care options available, including where the woman would prefer to deliver the baby. Most women will attend for an ultrasound scan to confirm the gestation of the pregnancy, and to provide a more accurate “due date”. At this time, screening tests can be discussed with the woman, including what conditions can be screened for, how and when.

It’s important to ask the woman if she is suffering from any troublesome symptoms of pregnancy, for example nausea and vomiting, dyspepsia or pelvic pain, and manage these accordingly. Explore the support structure the woman has, and if there are any issues surrounding domestic abuse, gender-based violence or sex work.

The general practitioner is well-placed to signpost the woman and her family to additional support groups, antenatal classes and reliable advice on how to keep healthy during pregnancy.

Learn more about women’s health in primary care with the Professional Diploma of Women’s Health program.

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  1. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2019). Antenatal Care during Pregnancy. https://ranzcog.edu.au/womens-health/patient-information-resources/antenatal-care-during-pregnancy
  2. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2019). Routine Antenatal Care in the Absence of Pregnancy Complications. https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Routine-antenatal-assessment-in-the-absence-of-pregnancy-complications-(C-Obs-3b)_2.pdf?ext=.pdf
  3. National Institute for Health and Care Excellence (2016). Antenatal care for uncomplicated pregnancies. https://www.nice.org.uk/guidance/cg62/resources/antenatal-care-for-uncomplicated-pregnancies-pdf-975564597445
  4. The Australian Government Department of Health (2020). Clinical Practice Guidelines: Pregnancy Care. https://www.health.gov.au/resources/pregnancy-care-guidelines

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