NAGERCOIL OB-SOCIETY

Antenatal Checklist

Antenatal Care

Preventive 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 test

Diagnosis (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 gains

Defensive medicine

Institutional pressures

Patient 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 Board

Dr 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.