Pregnancy 

Preconception Counselling

• Offer genetic carrier screening and up-to-date cervical screening

• Optimise chronic disease management and ensure rubella and varicella immunity with vaccination pre-pregnancy

• Commence folate supplementation at least one month before conception and advise vitamin D 1000 IU/day if BMI >30

• Advise lifestyle modifications including smoking cessation, alcohol avoidance and regular moderate exercise (150 min/week)

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Folate Supplementation

• Indicated in women with obesity (BMI >30)

• Recommended for women with diabetes

• Essential for those on anticonvulsants (especially valproate, carbamazepine, phenytoin, phenobarbital)

• Necessary for personal or family history of neural tube defects

• Advised in pre-pregnancy folate deficiency due to malabsorption or bariatric surgery

• Indicated in women with a previous pregnancy affected by neural tube defects

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Second Trimester Bleeding

• Differential diagnoses include bloody show of premature labour, cervical insufficiency, placenta praevia and placental abruption

• History should assess unusual vaginal discharge, abdominal pain, uterine contractions, change in fetal movements and amount of blood loss

• Examination should include abdominal assessment of fundal height, uterine tenderness and fetal heart rate evaluation; speculum examination is crucial and transvaginal ultrasound is used to exclude placenta praevia

• Investigations include full blood count, blood group and hold, and fetal fibronectin to predict preterm labour

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Chickenpox Exposure

• If previous chickenpox history is confirmed, no further management is required

• For unvaccinated or uncertain women, check varicella IgG

• If IgG negative and exposure is less than 4 days, administer VZIG with urgent referral to ED

• If exposure is greater than 4 days post-exposure, consider oral aciclovir for post-exposure prophylaxis

• If symptomatic with chickenpox, treat with oral aciclovir noting that risk is highest if infection occurs later in pregnancy; VZIG is not indicated once clinical symptoms are present

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Sensitising Events and Safest SSRIs

• Provide anti-D prophylaxis for Rh-negative women in cases of sensitising events such as miscarriage, termination, ectopic pregnancy, invasive testing and antepartum bleeding

• Sertraline is the preferred SSRI in pregnancy; avoid paroxetine, fluoxetine and citalopram due to higher risk profiles

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Gestational Diabetes Mellitus (GDM)

• Diagnostic criteria vary: RACGP guidelines define fasting BGL ≥5.5 mmol/L and 2-hour BGL ≥8.0 mmol/L, whereas ADIPS uses fasting BGL ≥5.1 mmol/L and 2-hour BGL ≥8.5 mmol/L; pre-existing diabetes is diagnosed with fasting BGL ≥7.0 mmol/L or 2-hour BGL ≥11.1 mmol/L

• Glucose should be monitored four times daily (fasting and 1-hour post meals) with targets of fasting ≤5.0 mmol/L and 1-hour postprandial ≤7.4 mmol/L

• Management involves blood sugar monitoring, dietary modification, physical activity and repeat OGTT 6–12 weeks postpartum

• Early testing with HbA1c or OGTT (12–14 weeks) is recommended for high-risk women and an endocrinology referral is advised for treatment decisions

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GDM and Pre-eclampsia

• Recognise shared risk factors including hypertension, obesity (BMI >30), age over 40, previous pregnancy loss and history of GDM or pre-eclampsia

• For pre-eclampsia prevention, calcium 1 g/day and low-dose aspirin 100 mg/day are recommended for high-risk women

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Antenatal and Routine Pregnancy Assessment

• Routine assessments include screening for perinatal depression (EPDS), domestic violence and urine dipstick for proteinuria

• First-trimester screening (non-invasive prenatal testing or combined first-trimester screening) should be offered after 11 weeks

• Regular monitoring of fetal movements, growth via ultrasound and CTG is essential, particularly in high-risk pregnancies

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Asthma in Pregnancy

• Maintain good asthma control; the risk of exacerbation outweighs the potential risk of medications

• Budesonide (Category A) is preferred and stable patients should not be switched from their current inhaled corticosteroid

• In cases of exacerbation, oral steroids can be used

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Bipolar Disorder in Pregnancy

• Refer to a high-risk antenatal clinic for specialised care

• Ensure regular GP visits to monitor mental health and medication adherence during pregnancy

• Educate about increased risk of relapse postpartum and discuss early warning signs

• Monitor lithium levels frequently with target serum level of 0.6–0.8 mmol/L and adjust dose as maternal fluid volume changes; perform fetal echocardiography if lithium is continued

• Prefer lamotrigine as first-line mood stabiliser and avoid valproate and carbamazepine unless absolutely necessary

• Consider second-generation antipsychotics (eg quetiapine, risperidone) if indicated; advise that sertraline is the preferred SSRI in pregnancy

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General Pregnancy Management High-Yield Points

• Early identification and management of risk factors such as obesity, diabetes and mental health conditions optimise maternal and fetal outcomes

• Preventative strategies include preconception counselling, appropriate supplementation, and lifestyle modification

• Collaborative care involving general practitioners, obstetricians, endocrinologists and mental health professionals is essential

• Regular antenatal follow-up and tailored management plans, including telemedicine options in rural or remote settings, improve care quality and accessibility

• Postpartum follow-up with OGTT is crucial for women with GDM to monitor long-term metabolic risk and guide future pregnancy planning