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Feature Article

General practice shared care in pregnancy

Marc JNC Keirse

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Abstract

Antenatal care needs have evolved recently with aneuploidy screening, routine Rh (D) prophylaxis and conclusive evidence about gestational diabetes. Other elements, including effective communication and assessment of fetal growth and hypertension, remain challenging.

Key Points

  • Maternity care does not start with a positive pregnancy test, nor does it end with birth.
  • Shared care is only meaningful if it valorises both the continuum and the specific needs of pregnancy.
  • Inaccuracy in determining gestational age impedes appropriate care throughout pregnancy.
  • Careful documentation of all findings on a record held by the woman is the key to efficient communication that involves the woman too.
  • Aneuploidy screening should only be undertaken when there is an agreed strategy for diagnosis and management.
  • Timely detection of inadequate fetal growth and hypertensive disorders is the main challenge in the second half of pregnancy.

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