ABSTRACT
Early pregnancy complications are important to record, as recurrent miscarriage increases the risk of fetal loss and growth restriction. The use of assisted conception techniques may influence the subsequent course of the pregnancy, as donor gametes increase the chance of developing pre-eclampsia, and women may require increased support during pregnancy. Legally, the history of assisted conception should not be recorded without written permission from the patient. (2 marks)
Previous maternal complications of pregnancy including pre-eclampsia and gestational diabetes carry a risk of recurrence and will often prompt increased monitoring during subsequent pregnancies, including early glucose tolerance testing. (1 mark)
Fetal problems including growth restriction, congenital abnormalities and preterm delivery should all be noted. Previous preterm delivery increases the chance of a second preterm delivery. Previous intrauterine growth restriction will often prompt measurement of umbilical artery Doppler flow in the third trimester and extra ultrasound scans. Congenital abnormalities will usually require referral to a genetic counsellor to discuss the recurrence risk in detail. (3 marks)
Late pregnancy and intrapartum problems are important for managing future pregnancies. Placental abruption has an increased risk of recurrence. Previous delivery by Caesarean section may influence planning for subsequent deliveries. Previous Caesarean section carries an increased risk of placenta praevia, uterine rupture and intraoperative complications if a repeat Caesarean section is performed. (3 marks)
2 Discuss how maternity care has changed since its inception. The modern National Health Service (NHS) was established by an Act of Parliament in 1946. This bill instigated free maternity care for all women. (1 mark)
Antenatal care was perceived as beneficial, acceptable and available for all. This was reinforced by the finding that the perinatal mortality rate seemed to be inversely proportional to the number of antenatal visits. (2 marks)
The co-operation card was launched on the NHS maternity services in the 1950s. This allowed a continuous record to be held by the mother and improved the communication between all health-care professionals involved in the delivery of maternity care. (2 marks)
The advent of obstetric ultrasound brought with it a dramatic revolution in the antenatal care and screening for fetal anomalies. This has allowed early pregnancy viability and accurate dating of pregnancies. Improved technologies with ultrasound have given rise to fetal anomaly screening. (3 marks)
During the early 1950s, there was a move towards hospital confinement from home confinement. Home deliveries are now an infrequent event with a countrywide average of about 2 per cent. (2 marks)
As new technology became available to monitor and induce labour in the late 1960s and early 1970s, the rate of induction of labour increased. Consumer groups such as the National Childbirth Trust began to question the efficacy of many interventions. (2 marks)
New standards in maternity care continue to be set, with government reports such as Changing Childbirth (1993) and Maternity Matters (2009) laying out targets and standards for childbirth in the UK. (1 mark)
3 Outline the physiological changes that occur in response to pregnancy in the cardiovascular system, the cervix and the respiratory system.
