Remote Primary Health Care Manuals

Preconception care

Health check for women planning pregnancy

  • Find and treat problems that might put woman or baby at risk
  • Make sure woman’s medical problems are well managed
  • Give education on health, nutrition, fertility
  • Investigate any problems, eg fertility problems (trouble getting pregnant), recurrent miscarriages
  • Best done at least 3 months before woman tries to become pregnant, if possible
  • Offer before stopping contraception or removing Long Acting Removable Contraception (eg ENG-implant) — for advice regarding return of fertility — see Long Acting Removable Contraception
  • Can offer opportunistically to any woman of childbearing age 
  • Important to be discreet and private.  Woman may not want others from the community knowing she is trying to get pregnant

Check

Do

  • Ensure follow-up of problems from last pregnancy completed
    • If woman had GDM and 75g OGTT not done after last pregnancy — do now

Medical consult if

  • High risk of baby with anomaly — previous baby with congenital anomaly or family history of inherited disorder
  • Previous obstetric (pregnancy) issues that could affect future pregnancy or birth, eg baby with neural tube defect, multiple pregnancy, several miscarriages
  • More than 35 years old, especially if first baby
  • Chronic medical or mental health condition
  • Taking any prescription medicine
  • History of substance use

Talk with woman about

  • General health issues — especially if first pregnancy or woman has medical, mental health or substance use issues
  • ​Optimising control of chronic conditions — high BP, diabetes, asthma, epilepsy, depression
  • Encourage healthy weight (BMI 20–25) before getting pregnant
  • Encourage starting of folic acid supplement 
    • Give folic acid oral — 0.4mg in multivitamin designed for pregnancy once a day until 12 weeks pregnant
    • OR if woman has diabetes, epilepsy, BMI over 30 or had previous baby with neural tube defect — give folic acid oral — 5mg, once a day until 12 weeks pregnant

Immunisations

  • If rubella serology non-immune or unclear — offer MMR
    • Advise not to get pregnant for 28 days after MMR
    • Do not give if woman pregnant
  • If not immune to varicella — medical consult about immunisation
    • Do not give if woman already pregnant
  •  If influenza immunisation due — offer immunisation
    • Pregnant women are at high risk of complications from flu and COVID
  • Offer any other immunisations due, if unsure call PHU for advice

Menstrual cycle

  • Best times to have sex (try for baby) — see fertile times in menstrual cycle diagram — Ovulation usually 2 weeks after first day of the start of last period
  • Give advice about stopping contraception

Signs and symptoms of pregnancy

  • Good opportunity to talk with woman about why antenatal care is important
  • Tell her to come to clinic as soon as she thinks she might be pregnant

Family and social circumstances

  • Talk with woman about family help and support, any domestic/family violence issues
  • Financial capacity to look after baby, cost of essential baby items, Centrelink payments
    • Remind woman to attend Centrelink and have 100 points of identification ready

Education

Follow-up

  • Arrange to see woman again and talk about test results, any other worries she is having in relation to trying to get pregnant
  • Medical follow-up if not pregnant
    • After 12 months of regular unprotected sex
    • OR after 6 months if over 35 years old
  • See Infertility