For each individual, the pregnancy journey is significantly different and your care during this period should reflect this.
It is important to optimise your health and any pre-existing medical conditions that you may have prior to your pregnancy. During your pre-pregnancy consultation, Amanda will take a detailed history of your past medical and obstetric history, along with any pregnancy complications that you may have had. Following this, potential strategies are discussed, with the aim of achieving the best possible pregnancy outcomes.
Regardless of whether your pregnancy is considered to be high-risk or uncomplicated, Amanda is able to look after you from conception to your birth.
Her antenatal care includes performing bedside ultrasounds during every consultation.
Amanda manages complicated vaginal births such as twins and breech deliveries. Every woman has a right to make an informed choice regarding her mode of birth. Amanda is committed to providing you with ample time to discuss your birth preferences throughout your pregnancy and the option of proceeding with a vaginal twin or breech birth if appropriate.
Amanda is able to provide care for pregnancies that are higher risk, including but not limited to:
Amanda is part of a weekend on-call group consisting of Dr. Peter Neil, Assoc. Prof Ryan Hodges, Dr. Annie Kroushev, Dr. Kirsten Palmer and Dr. Danielle Wilkins (Cabrini only).
Please bring with you copies of any investigations that you have already undertaken with your general practitioner.
If you are a Rhesus negative blood group, we will test your antibody levels again at 26–28 weeks gestation alongside your diabetes screening.
Patients who are Rhesus negative should receive Anti-D at approximately 28 and 34 weeks gestation, along with after the birth.
Anti-D should also be given if there are any episodes of bleeding during the pregnancy.
During pregnancy, it is important to test all women for the presence of maternal infections such as HIV, syphilis, rubella and Hepatitis B and C.
These infections can cause complications for both mother and baby.
Extra care and monitoring is required during pregnancy if any of these infections are present.
If anaemia is present, I may undertake further investigations to determine the cause.
Iron deficiency in pregnancy is commonly treated with oral iron supplementation (such as Ferrograd-C or Maltofer). A repeat Full blood count and Ferritin level is undertaken between 26-28 weeks to determine if oral iron supplementation has been effective.
If further treatment is required for iron deficiency, I may discuss with you the need for an iron infusion.
Between 26 and 28 weeks, screening for gestational diabetes in pregnancy is undertaken. This is a 2 hour test which involves fasting from midnight and measuring your body's response to a set amount of glucose.
If diabetes is diagnosed, I will discuss with you optimising your diet and exercise in pregnancy. A referral will also be made to an endocrinologist who specialises in the management of diabetes in pregnancy.
Ultrasounds are used throughout your pregnancy, both formally with an ultrasonographer and during your antenatal appointments at the bedside.
In the first trimester, a dating scan is performed to determine your due date, to establish the number of babies present and the wellbeing of the pregnancy.
Around 12wks, a nuchal translucency ultrasound is performed which measures the thickness of the skin at the back of the neck to assist in determining the risk of genetic abnormalities such as Downs Syndrome. This scan can also look at other structures such as the brain and heart. Even if you have an NIPT, we would still recommend undertaking this scan.
Between 20-22wks, a formal mid-trimester morphology ultrasound is undertaken. This scan looks at the anatomy of the baby in detail, as well as the location of the placenta and the length of your cervix.
As a part of your antenatal visits after 24wks, I will conduct bedside ultrasounds to measure the growth of your baby and how your placenta is functioning.
Occasionally, I will need to order additional formal ultrasounds after 24wks, especially in the context of multiple pregnancies.
Urinary tract infections are more common in pregnancy and not everyone will experience symptoms or become unwell.
It is important to test for the presence of a urinary tract infection in pregnancy, as left untreated, it can increase the risk of preterm birth.
There are 3 main genetic conditions that can be screened for in pregnancy:
If any of these tests come back as high risk, we will discuss about whether we need to proceed with further investigations in order to provide a diagnosis.
Group B Streptococcus (GBS) is a bacteria that occurs as part of the normal vaginal environment in approximately 20% of women.
It does not cause infection in these women, however if it is present during a vaginal birth, there is a 1 in 200 risk of the baby developing a severe infection.
At 36 weeks gestation, I will discuss GBS screening with you and the use of preventative antibiotics in labour if you test positive.
We know that ‘breast is best’ when it comes to feeding in the first six months. However many of us are not adequately prepared for the various challenges that breastfeeding can present, particularily during those fragile first weeks.
I would encourage you to spend some time working through the great resource that is the Australian Breastfeeding Association’s website during your pregnancy. Please discuss any concerns that you have regarding feeding with me during your antenatal appointments.
Pregnancy, birth and the postnatal period is a time in which women are more likely to experience symptoms of depression and anxiety. It is estimated that 1 in 10 women experience these mental health conditions during this period. Thankfully, there has been an improvement in the diagnosis, treatment and acceptance of mental health conditions in the perinatal period.
Below is a list of resources to help educate you regarding your mental health during pregnancy and postnatally, along with the available support services.
I specialise in the management of mental health conditions during pregnancy and I am committed to helping you navigate through the perinatal period with the assistance of a multidisciplinary team.
