Obstetrics

Antenatal

Full Pregnancy Care Plan

Your pregnancy care will be entirely looked after by me, which will give you expert consultation with compassionate care. You will have the reassurance of continuity of professional care throughout your journey, from your initial consultation to your six-week post delivery check. Each woman is treated individually and hence it may be necessary to be seen more or less frequently depending on circumstances.

Top of the range ultrasound machine (GE Voluson E8 machines) is used for all scans, providing high definition quality images including 3D and 4D scans.

Upon initial registration we will meet and discuss a pregnancy care plan.

Below is a guideline of a pregnancy care plan:

1) Initial Registration and Consultation

     Viability Scan 7-14 Weeks:

During the initial registration, I will take a full medical and obstetrics history and do necessary blood tests. We will discuss any questions or concerns you may have about your pregnancy and address these accordingly. We will draft your individual pregnancy care plan including a schedule of your return visits.

Usually, the viability scan is performed trans-abdominally however in certain cases it may be required to perform a trans-vaginal scan (by inserting a small probe into the vagina).

Initial scan is done to:

• Establish viability (heartbeat) and determine the location of the pregnancy (intrauterine or ectopic site)
• Confirm expected date of delivery
• Determine size and number of embryos

2) 11-14 weeks scan: First trimester screening (FTS)

You will have a scan at 11-14 weeks to confirm normality and reestablish your due date. You will have booking bloods done and be given an information pack to take home with you.

During this visit you will also be given information on first trimester screening (FTS) and greater information is provided at your request.

First trimester screening is a non-invasive screening test to give you a personalized risk number for Down’s (Trisomy 21), Edwards (Trisomy 18) and Patau’s  (Trisomy 13) syndromes.

FTS involves combination of information obtained from your age, nuchal translucency scan (NT) and levels of two proteins (FB-hcg and PAPPA-A) in your blood sample and provides your risk number for syndromes. The result will be available in 1-3 days and you can decide whether you are reassured or need a diagnostic test for confirmation for a definite diagnosis of a chromosomal problem. These tests are Chorionic Villous Sampling or Amniocentesis, which are invasive and carry a small risk of miscarriage, about 0.5 – 1.0%.

NT scan determines the amount of fluid present at the back of the baby’s neck, which is a soft marker and may be increased when there is a presence of Downs or/other syndromes.

2) Anomaly Scan at 20 – 22 weeks

During this visit, I will examine the baby’s growth and anatomy, the full length of the spine, skull and brain, limbs and organs to ensure normality. However, ultrasound has its limitations and can never completely guarantee that the baby is normal, but it is very reassuring and can give you a piece of mind. We will also have a look at your placenta and check its position.  Other necessary tests including taking your blood pressure and urine analysis will be carried out and we will address any issues that may arise to assure the safe health of you and your baby.

3) Gender scan: 20-22 weeks

If you wish, you may find out the sex of your baby from the 20 weeks scan. However it is important to note that sometimes it may not be possible at that moment to identify the baby’s gender due to its position, if he or she is crossing their legs. The accuracy of the ultrasound in determining gender is about 97%.

4) Subsequent Visits involve assessment of fetal growth, placental localization, fetal position and liquor volume

Generally subsequent visits are usually weeks 24,28,32,36,38,39,40 and 41 weeks, however in certain cases there may be the need to have extra subsequent visits.

During each visit I will check in detail your health and also the health of your baby, assessing baby’s growth, liquor volume and maturity of the placenta. Blood flow studies on the umbilical artery will be checked using a Doppler ultrasound examination to detect any concerns arising which need more detailed and frequent assessment when there is a problem.

3D/4D scan: All mothers are offered 3D/4D scans between 28-32weeks.      

3D scans are still images, while 4D will show a live high-resolution video of your baby.

4) Delivery

During 36-38 weeks period we will discuss again your delivery plan and any questions regarding any aspect of your care. 

Your labour and delivery will be in St Luke’s Hospital, Kilkenny. Upon admission we will re-discuss options for your pain relief in labour. There is a 24-hour epidural service in St Luke’s Hospital most of the times.

I will attend to your care during labour and delivery and look after you afterwards until you are discharged from the hospital.

5) Postnatal Check

Recovery after delivery can vary due to different factors e.g. mode of delivery. After six weeks post delivery we will meet again and see how your recovery is progressing. We will discuss any issues which you may have and also about contraception and cervical smear.

6) Preterm labour

Screening for pre-term labour by ultrasound assessment of cervical length is important when there is past history of late miscarriage or second trimester loss. Also other prophylactic measures are required for preterm labour especially antenatal steroids for enhancement of fetal lung maturation to prevent respiratory distress in a premature baby.

7). Cervical cerclage

 Cervical cerclage is considered when the cervix is short at 14 weeks scan and is carried out after full counseling.

24 Hour Support:

In the event of an unexpected problem, 24 hour service is available at the St Luke’s Hospital, Maternity Unit (056 7785288) and the attending midwife will contact me directly about your attendance day or night. Although I will do my very best to present, if there is an instance where I am on leave, one of my colleagues will attend to you.