NAGERCOIL OB-SOCIETY
Antenatal Checklist
Antenatal CarePreventive medicine in
pregnancy
Clinical examination Investigations Counselling
Antenatal Care
Investigations in Pregnancy
Rifle vs Shotgun approach
Rifle – hit bull’s eyeSpecific test based onClinical judgmentDiagnostic accuracyPredictive value
Shotgun – spray shotsMany testsDiagnostic accuracy + /-Predictive value + /-May not hit the bull’s
eye!!
A test should be done only if the result is likely to make a difference to the management
What is a ‘necessary’ test?
Any test the results of which are not likely to be make a difference in the appropriate management of the patient
What is an ‘unnecessary’ test?
Questions to ask before ordering a test
Why is the test being ordered?What are the consequences of not ordering the test?How good is the test? How are the test results interpreted?How will the test results influence patient
management and outcome?
Reasons for ordering a testDiagnosis (eg, Pregnancy / no pregnancy)
Screening (eg, for Down’s syndrome)
Monitoring (eg, serial ultrasound scan)
Research (to understand the pathophysiology of
a particular disease process)
Reasons for unnecessarily ordering a test
Financial gainsDefensive medicineInstitutional pressuresPatient demands
The flip side….
Generates anxiety
Involves time, cost
Risks & complications exist
Results may be shocking!
Leads to unnecessary/inappropriate interventions
Pre test CounselingWhat test?
Why is it done?
How is it done?
What is the likely expense?
What are the risks & likely outcomes?
What is the plan of management?
What are the fall outs if it is not done?
Investigations in Pregnancy
Which and when???
Developed by Abbott National Advisory Board
for Duphaston
Members of the Advisory BoardDr Ameet Patki, Chairman, MumbaiDr Mala Arora, DelhiDr Ritu Joshi, JaipurDr Bhasker Pal, KolkataDr Parul Kotdawala, AhmedabadDr Susheela Rani, BangaloreDr Suchitra Pandit, MumbaiDr Anita Singh, Patna
Investigations in Antenatal Care
MandatoryPreferable
Mandatory
These tests are mandatory in the provision of standard antenatal care
Preferable
These tests have been shown to be of clinical value, but are not into evidence based recommendations as of now
ANC was released in FOGSI Varanasi, Jan 27th 2012
Acknowledgements
A special thanks to – Dr Susheela Rani, Bangalore and Dr Bhasker Pal, Kolkata for providing material for this presentation.
