Summary of the practice guideline 'Pregnancy and puerperium' from the Dutch College of General Practitioners
Wiersma, T.J.; Daemers, D.O.; Oldenziel, J.H.; Flikweert, S.; Assendelft, W.J.
Nederlands Tijdschrift Voor Geneeskunde 148(2): 65-72
2004
ISSN/ISBN: 0028-2162 PMID: 14753127 Document Number: 582560
During the first trimester of pregnancy, obstetric care concentrates particularly on assessment of gestational age (by history taking or if menstrual history is unclear, ultrasonography) and on the assessment of obstetric or medical risk factors necessitating a referral for specialist care. Tracing hereditary conditions in relatives is important as this is a reason for antenatal screening for congenital abnormalities. In comparison to the previous guideline, blood testing in the first trimester has been extended to include screening for irregular erythrocyte antibodies and the possibility of screening for HIV. Pregnant women with a history of thyroid problems may also be tested for serum concentrations of thyroid stimulating hormone (TSH), free T4 and, on indication, the TSH-receptor antibody levels. Since haemodilution is physiologically normal during the second half of pregnancy, at a gestational age of 18 weeks and above, only a haemoglobin-level of 6.5 mmol/l or less justifies the diagnosis of anaemia, and should treatment be commenced. If a newborn does not show any abnormalities immediately after delivery, the physical examination now routinely carried out at a few days post-partum rarely produces any additional findings and can safely be omitted.