Antenatal Checklist

NAGERCOIL OB-SOCIETY

Antenatal Care

Preventive medicine in pregnancy

Antenatal Care

   Clinical examination Investigations Counselling

Investigations in Pregnancy

Rifle vs Shotgun approach

Rifle – hit bull’s eye  Specific test based on    Clinical judgment Diagnostic accuracy Predictive value Shotgun – spray shots  Many tests    Diagnostic accuracy + / Predictive value + / May not hit the bull’s eye!!

What is a ‘necessary’ test?

A test should be done only if the result is likely to make a difference to the management

What is an ‘unnecessary’ test?

Any test the results of which are not likely to be make a difference in the appropriate management of the patient

Questions to ask before ordering a test  Why is the test being ordered?

 What are the consequences of not ordering the test?

 How good is the test?  How are the test results interpreted?

 How will the test results influence patient management and outcome?

Reasons for ordering a test  Diagnosis

(eg, Pregnancy / no pregnancy)

 Screening

(eg, for Down’s syndrome)

 Monitoring

(eg, serial ultrasound scan)

 Research

(to understand the pathophysiology of a particular disease process)

Reasons for unnecessarily ordering a test  Financial gains  Defensive medicine  Institutional pressures  Patient demands

The flip side….

     Generates anxiety Involves time, cost Risks & complications exist Results may be shocking!

Leads to unnecessary/inappropriate interventions

Pre test Counseling

 What test?

 Why is it done?

 How is it done?

 What is the likely expense?

 What are the risks & likely outcomes?

 What is the plan of management?

 What are the fall outs if it is not done?

Investigations in Pregnancy Which and when???

Developed by Abbott National Advisory Board for Duphaston

Members of the Advisory Board  Dr Ameet Patki, Chairman, Mumbai   Dr Mala Arora, Delhi Dr Ritu Joshi, Jaipur     Dr Bhasker Pal, Kolkata Dr Parul Kotdawala, Ahmedabad Dr Susheela Rani, Bangalore Dr Suchitra Pandit, Mumbai  Dr Anita Singh, Patna

Investigations in Antenatal Care

  Mandatory Preferable

Mandatory

 These tests are mandatory in the provision of standard antenatal care

Preferable

 These tests have been shown to be of clinical value, but are not into evidence based recommendations as of now

ANC was released in FOGSI Varanasi, Jan 27 th 2012

Acknowledgements A special thanks to – Dr Susheela Rani, Bangalore and Dr Bhasker Pal, Kolkata for providing material for this presentation.