Table of contents:

1. Pregnancy card - information
2. Pregnancy card - when is the birth?
3. Pregnancy card - what does it look like?
4. Pregnancy card - diabetes in pregnancy
5. Pregnancy card - GBS testing and antenatal care

The pregnancy card is increasingly taking on different forms. In Poland, it is usually a cardboard sheet that is about 44 cm long and 17 cm wide, folded four times. It can also be an A4 or A6 notebook containing all the original laboratory results and Medical US tests.

On the first page of the "classic" card you will find the personal details of the patient and the obstetrics-gynaecology clinic/office or the doctor carrying out the pregnancy.

Pregnancy card - information

Personal data include:

• patient's name,
• PESEL,
• date of birth,
• address,
• telephone number,
• place of work,
• the patient's occupation with an assessment of possible harm to the course of pregnancy,
• the normal development of the foetus.

A very important piece of information is the date of the first day of the last menstrual period, on the basis of which the date of the expected date of delivery is calculated using the Naegele rule.

Pregnancy card - when is the birth?

Naegele's rule - is a way of calculating the due date. Add 7 days to the OM date, subtract 3 months and add a year (this applies to a 28 day cycle when ovulation occurs on the 14th day of the cycle), if your cycles are shorter or longer subtract or add the appropriate number of days.

OM - 10.01.2016 10+7 days = 17 17.01.2016 - 3 months = 17.10.2015 + year = 17.10.2016

If the patient does not remember the exact date of the first day of the OM, the due date is calculated based on the Medical US examination of the first trimester of pregnancy. By measuring the CRL (crown-rump length) - the fetal parietal dimension - the Medical US apparatus calculates the expected date of delivery. Regardless of which delivery dates are estimated in subsequent Medical US examinations, the final TP always remains constant, calculated on the basis of the Medical US from the first trimester.

Pregnancy card - what does it look like? photo.panthermedia

On the front of the pregnancy card you will also find the patient's blood group and the blood group of the baby's father. Please note that these data are for reference only; it is advisable to enclose the original blood group result of the pregnant woman issued by the Blood Donor Centre with the pregnancy card. Only such a result is evidence authorising possible blood treatment.

Pregnancy card - what does it look like?

Inside, the pregnancy card is divided into three areas:

The first area - on the left-hand side - concerns the obstetric history. Here, data on the number of pregnancies, the number of deliveries and miscarriages are included. Below this, in chronological order, should be entered:

• the dates of completion and the week in which the pregnancy ended e.g. May 2011 GCFN at 40tc GSW 3960g/56cm/10 Apgar points,
• method of pregnancy termination - GCFN or caesarean section,
• any complications of pregnancy - e.g. gestational/pre-pregnancy diabetes, gestational/chronic hypertension, hypothyroidism,
• information about chronic diseases, medications taken, past operations.

A description of the first obstetric examination, which should be performed by the 10th week of pregnancy, should appear below.

The data of the first examination include - date of examination performed, week of pregnancy, patient's weight, patient's height, BMI (Body Mass Index), RR (blood pressure), possible occurrence of oedema or varicose veins.

The gynaecological examination assesses the appearance of the vulva, vagina, cervical disc, vaginal discharge. A two-handed examination assesses the uterus, the adnexa.

At the first visit it is also advisable to examine the breasts.

The second area is divided into numbered columns and boxes. Each column refers to one visit of the pregnant woman to the obstetrician.
Here the following information will be included: date of examination, week of pregnancy, size of the uterus, height of the fundus, patient's weight, additional symptoms such as the appearance of oedema or varices, current RR, fetal heart rate, appearance of the cervix, its length, consistency, dilation.
During the visit, the results of laboratory tests previously ordered are entered: usually a blood count and a general urine test. Below this, the doctor records recommendations for taking medication, performing additional laboratory tests or imaging - Medical US.

The third area contained in the middle of the pregnancy card is the serological tests. On this page, the results of the individual tests will be entered, along with the date of performance:

• Syphilis,
• HBV,
• HCV,
• HIV,
• Toxoplasmosis,
• Cytomegalovirus,
• Rubella virus - Rubella,
• Anti-Rh antibodies ( Coombs test), IAT - indirect Coombs test.

Other tests included in the pregnancy chart:

• Cervical cytology - should be performed in the first trimester of pregnancy unless clinical conditions do not allow it: spotting, bleeding, threatened miscarriage, vaginal infection.
• Fasting glucose level - indicated measurement in early pregnancy. Patients at increased risk should be ordered to have a 75g OGTT already in the first trimester of pregnancy.
• Glucose load test 75g ( TOG 75g/ OGTT ) - is performed between the 24th and 28th week of pregnancy.

Conditions for performing the test:

• fasting,
• 8-14 hours after your last meal,
• for at least 3 days without carbohydrate restriction,
• 75g of glucose dissolved in 250-300ml and drunk within 5 min,
• during the test the patient should be seated, not take any food and not smoke,
• blood for the test should be taken on an empty stomach, one hour and 2 hours after drinking the glucose solution,
• the test should not be carried out during or within 72 hours after short-term steroid therapy and during intravenous betamimetics therapy.

Pregnancy card - diabetes in pregnancy

Diabetes in pregnancy is diagnosed when any result on the TOG is abnormal.

A normal TOG result of 75g is:

• fasting <92mg/%
• after 1 hour <180mg%
• after 2 hours < 153mg%

Once diabetes is diagnosed in pregnancy, a diabetic diet should be initiated and the profile of blood glucose levels during the diet should be assessed. If blood glucose levels are too high despite the diet, this requires the inclusion of insulin.

Pregnancy card - what does it look like? fot.panthermedia

Pregnancy card - GBS testing and perinatal prophylaxis

GBS culture - Gram-positive β-haemolytic streptococcus - Streptococcus agalactiae

Indicated vaginal and rectal swab collection for GBS between 35.-37 weeks of pregnancy.

GBS is present in the vagina or rectum in approximately 30% of women. Colonisation can be transient, chronic or persistent. Carriage is asymptomatic and can lead to intrauterine infection by the ascending route during pregnancy.

In the late 20th century in the USA, perinatal β-haemolytic streptococcal infection was the most common cause of early sepsis and neonatal death. Neonatal GBS infection may appear at 1 week of life as early neonatal septicaemia, the late form will occur after 1 week of life . The clinical picture varies from pneumonia, meningitis through purulent arthritis to osteomyelitis.

Perinatal antibiotic prophylaxis is recommended u:

• gBS-positive patients,
• in patients with unknown culture results,
• gBS negative patients with a positive history of streptococcal infection in a previous child,
• gBS negative patients with positive urine culture for streptococcus,

The usual treatment is intravenous ampicillin, possibly cefazolin, clindamycin or erythromycin.

1. It is not recommended to eradicate the carrier during pregnancy. After discontinuation of the drug, colonisation rapidly recurs.
2. Colonisation of the newborn without perinatal prophylaxis is around 50%.
3. If less than 1 hour has passed between the first antibiotic dose and delivery, 40% will be colonised.
4. Birth between 2 and 4 hours after antibiotic administration - 3% of newborns are colonised.
5. Birth after 4 hours of antibiotic administration - only 1% of newborns will be colonised.

Brief descriptions of Medical US tests performed during pregnancy will be included on the back of the pregnancy card. Three Medical US tests are recommended, one in each trimester of pregnancy.

Further sections are devoted to possible medical consultations during pregnancy - dental, internal medicine.

In summary, in the pregnancy card we will find the most relevant information concerning the pregnant woman and the foetus. It is recommended that the original blood group test result, the result of the vaginal culture for streptococcus and a list of the medicines taken be kept permanently attached to the pregnancy card.

The pregnant woman should always carry her pregnancy card with her.