Information on antenatal care for pregnant women
Transcript
Title：Information on antenatal care for pregnant women
Programme: Information on antenatal care for pregnant women
Narrator: Hi! Thank you for watching ‘Information for pregnant women attending antenatal visits at the Maternal and Child Health Centres' produced by the Department of Health
Heading: ‘Information for pregnant women attending antenatal visits at the Maternal and Child Health Centres' produced by the Department of Health
Narrator: In this session, we will provide information about antenatal checkup procedures at MCHCs, points to note during checkups, application for sick leave certificate, health talks, warning signs during pregnancy, and the prevention of infectious diseases.
Heading: Shared-care programme by MCHCs and hospitals
Narrator: To ensure you are receiving proper care, the Department of Obstetrics & Gynaecology of the HA hospitals and the Maternal and Child Health Centres of the Department of Health join hands to provide antenatal checkups and health care services throughout your pregnancy and during delivery. MCHCs offer free checkups for Hong Kong residents. Generally, pregnant women will receive follow-up care at a MCHC after having been assessed at the Department of Obstetrics and Gynaecology of an HA hospital or the MCHC. For high-risk cases like those who have twin pregnancy, diabetes or other obstetric complications, will receive follow-up care at the hospital. While receiving antenatal care at MCHC, pregnant women may also be transferred back to the hospital for follow-up care if necessary.
Heading: Antenatal checkup procedure
Heading: First antenatal checkup
Narrator: If you have not registered your pregnancy at the Department of Obstetrics & Gynaecology of an HA hospital, you will have your first checkup scheduled during the 10th - 14th week of pregnancy. At your first checkup, the nurse will obtain your personal information, such as your health status and that of your family as well as your obstetric history. This information help us better comprehend your health status so that we can arrange the best appropriate care for you promptly.
The nurse will also assess the health status of you and your foetus, measure your body height and body weight, test your urine sample and measure your blood pressure.
The doctor will then perform a physical examination which includes examination of the heart, lungs and abdomen. A gynaecological examination will also be performed if necessary. If you are at 12 weeks of pregnancy or more, the doctor will also check the foetal heartbeat.
Heading: Blood Test
Narrator: A blood sample will be taken at your first antenatal checkup. A blood test includes blood type, Rhesus factor, haemoglobin level, mean cell volume, rubella antibodies, hepatitis B antigens, syphilis and HIV antibodies. For more information, you may also refer to the 'Antenatal Blood Investigations' information leaflet. If you already have undergone a checkup and have a blood sample taken at the Department of Obstetrics & Gynaecology of an HA hospital, you won't need another blood sample test or see the doctor at the MCHC.
Heading: Number of subsequent follow-ups
Narrator: Under normal circumstances, subsequent follow-ups are carried out once every 4 to 6 weeks before the 28th week of pregnancy; once every 2 to 4 weeks for pregnancies at 28 to 36 weeks; and once every 1 to 2 weeks for pregnancies after 36 weeks. The Department of Obstetrics & Gynaecology of an HA hospital or the MCHC may make other appropriate arrangements base on individual health conditions.
Heading: Subsequent follow-ups
Narrator: At each checkup, health care professionals will assess your health status, including weight gain, blood pressure, urine test for glucose or sugar and protein. The nurse or midwife will also examine your uterus and monitor the foetal heartbeat. For pregnancies at 32 weeks or after, the foetal position will also be examined.
If necessary, you will be arranged to see the doctor. If physical examination is normal, the antenatal checkup procedure is completed. Finally, the nurse will arrange the next follow-up for you. Don't forget your follow-up card before you leave.
Heading: Subsequent follow-up memo
Narrator: Make sure to visit the MCHC on schedule with your follow-up card and the urine sample. If you have been given the antenatal record, bring that along as well.
Heading: Request for a certificate
Narrator: The Employment Ordinance stipulates that absence from work for antenatal checkups shall be a sickness day. You may apply for either a certificate of attendance or a sick leave certificate from the doctor, whichever is appropriate. Please note that a certificate of attendance may not be accepted by some employers as a proof for a sick leave. Some employers only accept sick leave certificates. Therefore, you need to check with your employer about their policy beforehand. An administrative fee will be charged for requesting certificate of attendance or a sick leave certificate subsequently on days other than on the day you receive the service. If your company requires a certificate for the expected date of delivery, please inform the nurse during the antenatal visits.
Heading: Antenatal checkup (Warm reminder)
Heading: Measurement of body weight and blood pressure
Narrator: Let's talk about the key points on measuring body weight and blood pressure.
A pregnant woman's body weight reflects both the health status of the mother and the foetus and therefore body weight is required to be measured at every checkup. To ensure accuracy, you are advised to wear similar clothing in terms of thickness and number of pieces at every visit. In cold weather, take off your coat before having your body weight measured. Your blood pressure will also be measured at every visit. Wear wide sleeves clothing so that you can roll up your sleeves for an accurate blood pressure measurement.
Heading: Purpose of a urine test
Narrator: Antenatal checkup also includes a urine test. By checking for glucose and protein in the urine, health problems such as diabetes or pre-eclampsia, during pregnancy, can be identified promptly. This enables an arrangement of early follow up and management.
Heading: Collection of urine sample – Container
Narrator: To collect a urine sample, you need a clean bottle. A wide-mouth bottle is the best choice because you can urinate directly into the bottle. If you use a bottle with a small opening, you may urinate into a disposable paper cup and then pour the urine into the bottle. The bottle cap should be tightly closed to prevent leakage.
Heading: Urine collection – time
Narrator: A urine sample should be collected in the early morning. Fully release the first early morning urine immediately after getting out of bed, then drink some water and collect a sample of the second urine before you have a breakfast.
Heading: Collection of urine sample - The importance of cleaning the genitals
Narrator: Have you ever heard of proteinuria? Proteinuria is the presence of protein in the urine. A number of factors will cause proteinuria. Improper urine sample collection is the most common cause. For example, a urine sample contaminated with vaginal secretions reduces the accuracy of the test result, and this will make the health care professionals unable to accurately assess your health status. As a urinary tract infection and pre-eclampsia may also cause proteinuria, it is important that you cleanse your genitals thoroughly before collecting the urine sample. Let's watch the demonstration of cleaning of genitals.
Heading: Collection of urine sample – Steps
Backdrop: A nurse demonstrates how to cleanse the genitals, using a model
Narrator: Clean your vulva with a wet cotton wool pad or tissue paper to remove any vaginal discharge. Wipe from front to rear. Each wipe should be done with a new wet cotton wool pad or tissue paper.
Narrator: When collecting the urine sample, omit the first and last part of your urine flow, try to catch the mid-stream urine and keep in a container. This helps minimise the likelihood of proteinuria in the test result because of presence of vaginal secretions in the urine sample.
Heading: Gestational diabetes mellitus
Narrator: Perhaps you may ask whether the presence of glucose in urine indicates gestational diabetes mellitus. In fact, it is normal that a pregnant woman's urine contains a small amount of glucose due to hormonal changes during pregnancy. In this case, the doctor may require a blood sample for an accurate diagnosis.
Generally, pregnant women with high-risk factors for gestational diabetes mellitus will need a blood glucose test. Risk factors include history of diabetes in first degree relatives, aged 35 or over, overweight or history of gestational diabetes mellitus, or having given birth to a baby of 4 kg or above. These pregnant women will have a higher chance of gestational diabetes mellitus. The health care professionals will decide when a pregnant woman should undergo such a test.
Pregnant women diagnosed with gestational diabetes mellitus are required to adhere to appropriate dietary control. Some of them may also need medications. Serious health problems such as hypertension or preterm labour may result if appropriate treatment is not received promptly.Heading: Warning signs during pregnancy
Heading: Early gestation
Narrator: Perhaps you would like to know how to deal with warning signs during pregnancy. Vaginal bleeding or lower abdominal pain in early pregnancy may be an early sign of an abortion, which is also known as threatened abortion. Miscarriages, ectopic pregnancies and molar pregnancies, however, have similar symptoms. Be careful if you have these symptoms and seek medical advice promptly.
Heading: Mid- and late-pregnancy
Narrator: If you have vaginal bleeding during mid- or late pregnancy, that is, after the 24th week of pregnancy, it is referred as antepartum bleeding. It may be due to placenta praevia, accidental bleeding or other non-placental problems. If bleeding occur in areas connecting the placenta and the uterus, this may harm the foetus due to insufficient oxygen supply leading to reduced blood flow to the placenta. Seek medical advice promptly if bleeding occurs.
Pre-eclampsia can occur during the mid- or late pregnancy period. Protein in the urine and high blood pressure may be detected during the checkups. Severe headaches, swelling of the feet or blurred vision may also occur. As pre-eclampsia can seriously affect the health of both the mother and the baby, you should seek medical advice promptly if you develop any of these symptoms.
Generally, first time mothers may feel the baby move during the 20th week. A baby's movements may start at around the 18th week for those who are pregnant for the second time or more. Movements happen more often as the baby grows. After 28 weeks, if you feel that the baby's movement decreases significantly, seek medical advice promptly.
Heading: Signs of labour contractions
Narrator: What are labour contractions? Signs of labour contractions include labour pains, vaginal bleeding and ruptured membranes.
Labour pain refers to persistent abdominal pains that become more regular, stronger in intensity and increasingly at shorter intervals. Vaginal bleeding refers to blood-stained fluids coming out of the vagina
Water breaks means amniotic fluid leaks from the amnion which surrounds the baby. Fluid may come out of the vagina gradually, in a large amount or scantily. When the amnion is ruptured, the bacteria can enter the uterus and cause an infection to the baby. If a large amount of amniotic fluid is leaking there is possibility of umbilical cord compression by the foetal head. In this case, it is life threatening to the baby. If this happens, the pregnant woman should immediately sit or lie down still and stay calm. She should be sent to the hospital promptly in an ambulance.
Heading: Management on pregnancy warning signs and labour contractions?
Narrator: In conclusion, if you have come across any warning signs during pregnancy, please go to the A & E Department or see an Obstetrician promptly. Do not go to a MCHC because they don't have the appropriate facilities to handle such emergencies. Never wait until the next visit to the MCHC because it will cause a delay for treatment. If it is close to the expected date of delivery, go directly to the admission ward or labour ward if you have any signs of labour contractions.
Heading: What pregnant women should do to prevent infectious diseases
Narrator: Pregnant women should protect themselves against infectious diseases such as rubella, chickenpox and the fifth disease. These diseases are highly infectious and are transmitted by droplets from an infected person or through direct contact with an infected person's secretions. A mother who was infected with these diseases during pregnancy will have adverse impact on the foetal health. For example, congenital abnormalities such as deafness, blindness or mental retardation will result. In the worst scenario, this may lead to foetal death. In fact, almost all women develop lifelong immunity after the infection or vaccination in the childhood. So, please relax!
The symptoms of these infectious diseases are usually mild and alike. Patients usually present with mild fever, fatigue and rashes. If you have influenza, a cold or generalised discomfort, please visit a general out-patient clinic or consult your family doctor. Never take medications without a doctor's advice.
Heading: Prevention of infectious diseases
Narrator: Prevention is better than cure. It is important to maintain personal hygiene. Wash your hands frequently, cover your mouth and nose with tissue paper when sneezing or coughing. Dispose tissue paper soiled with secretions from the mouth and nose properly in a lidded rubbish bin. Keep your home clean with good ventilation. Avoid going to crowded or poorly ventilated public places. This helps reduce the chance of infection.
A balanced diet and adequate physical activities are also important. All these things will enhance your immunity.
Heading: History of contact with suspected or confirmed infected persons
Narrator: If you have a history of contact with an infected person or if you have symptoms like fever, fatigue or rashes, please visit a general out-patient clinic, the private doctor's clinic or the A & E department. To prevent cross infection to other pregnant women, do not visit MCHC. If you have queries, please call the MCHC or the Department of Obstetrics & Gynaecology of the hospital so that appropriate arrangement can be made prior to the consultation.
Heading: Enquiries
Narrator: If you have queries, please feel free to enquire the MCHC or with other health care professionals
Heading: Other information
For more health information, please call the 24-Hour Information Hotline at 2112 9900, or visit the website at www.fhs.gov.hk of Family Health Service of the Department of Health.