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Antenatal Care: Routine Care for the Healthy Pregnant Woman

Antenatal Care: Routine Care for the Healthy Pregnant Woman

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK)

Version: March 2008

Screening for haematological problems

The most common cause of anaemia in pregnancy worldwide is iron deficiency. Maternal iron requirements increase in pregnancy because of the requirements of the fetus and placenta and the increase in maternal red cell mass. Iron absorption increases to meet this increased demand. In normal pregnancy, maternal plasma volume increases by up to 50% and the red cell mass gradually increases by about 20%. Hence, the haemoglobin (Hb) concentration drops. This normal physiological response may resemble iron deficiency anaemia.

Lifestyle considerations

Many common physiological, psychosocial and emotional changes occur during pregnancy. Many of these changes may be due to the normal hormonal changes that are taking place in a pregnant woman’s body or due to worries associated with pregnancy, such as concerns about the birth or the baby’s wellbeing. The Pegnancy Book has a chapter on feelings and relationships in pregnancy as well as a chapter on feelings that the father of the child may be encountering.

Summary of recommendations and care pathway

Pregnant women should be offered information based on the current available evidence together with support to enable them to make informed decisions about their care. This information should include where they will be seen and who will undertake their care.

Management of common symptoms of pregnancy

The causes of nausea and vomiting in pregnancy are not known and, although the rise in human chorionic gonadotrophin (hCG) during pregnancy has been implicated, data about its association are conflicting. Nausea and vomiting occurs more commonly in multiple pregnancies and molar pregnancies. Nausea is the most common gastrointestinal symptom of pregnancy, occurring in 80–85% of all pregnancies during the first trimester, with vomiting an associated complaint in approximately 52% of women., [EL = 3] Hyperemesis gravidarum refers to pregnant women in whom fluid and electrolyte disturbances or nutritional deficiency from intractable vomiting develops early in pregnancy. This condition is much less common with an average incidence of 3.5/1000 deliveries 168 and usually requires hospital admission.

Evidence tables

[All other abbreviations will be found in the list of abbreviations on page ix]

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