OSCE station: Preconception counselling By:Nurdalila Sahidan.

Medical Student Uni of Manchester Pre-conception counselling Aim of counselling is: to achieve optimal fetal health and maternal health Major point to discuss for this station: Gather some history and concerns first 1) PMH: ask patient about any chronic diseases and are they in control? eg diabetes, hypothyroidism ( fetal cant make thyroxine until 12 weeks) , PKU ( strict diet for mum) 2) DH:ask about any medications? stop teratogenic medication eg anticonvulsant(carbamazepine, valproate), warfarin, lithium etc might cause abnormality to the baby 3) FH: ask about any diseases that are inherited in the family. Eg thromboembolism.so need to do screening for thrombophilia 4) Identify any risk that might contribute to genetic malformation in baby. Eg both partners are carrier for CF gene or any autosomal recessive or dominant condition. In relevant ethnic population, ask about sickle cell, thalassaemia. Offer test needed eg chorionic sampling 5) SH : ask about home environment? Is it safe for you ( if pregnant) and for baby ( in the future). How about work? just briefly ask unless patient raise concern

Counselling part 6) Encourage patient and partner to prepare actively for pregnancy and be as healthy as possible. Ensure paient is rubella + chickenpox immune 7) Need to stop teratogenic medication as above. And control chronic diseases 8) Offer relevant screening or test if necessary

9) Diet: - advise healthy woman to take 5 portion of fruits and vegetables every day and consuming dairy products to raise stores of vitamins, iron and calcium -Because of the dangers of toxoplasmosis and listeriosis, women should avoid:

Uncooked meat, fish and eggs Unpasteurised milk Soft cheeses Unwashed fruit and vegetables

-If vegetarian-reffer to dietician - take vitamin D: vit D deficiency causing impaired fetal growth -Folic acid- avoid neural tube defect and cleft lip, 0.4mg/d before pregnancy and up to 13 weeks. E Brussels, spinach, sprouts, asparagus,fortified breakfast cereals Should take supplement as well cause diet alone might not enough -avoid liverand vit A ( vit A embryopathy risk) 10) body weight -reuce body weight-diabetes, hypertension etc.healthy is important 11)smoking cause:increase risk of miscarriage, abnormal sperm production, decrease ovulation, preterm labour. IUGR..offer cessation clinic 12)Alcohol -high consumption cause fetal alcohol syndrome ( growth retardation, mental retardation, facial anomalies and behavioural problem). -alcohol cross placenta and effect fetal brain -nice recommend < 1 unit/24 h