Maternity and Reproductive Health

Maternity and reproductive health covers contraception, pregnancy management in primary care, and postnatal care. Contraception questions are among the most commonly tested items in the AKT.

Contraception options and their effectiveness. Long-acting reversible contraceptives (LARCs) are the most effective: copper IUD (non-hormonal, lasts 5-10 years), levonorgestrel IUS (Mirena lasts 5 years, also treats menorrhagia), subdermal implant (Nexplanon, lasts 3 years), and depot injection (Depo-Provera, every 12-13 weeks). The combined oral contraceptive is contraindicated in women with migraine with aura (due to stroke risk), BMI over 35, age over 35 who smoke, and uncontrolled hypertension. The UKMEC criteria (categories 1-4) guide safe prescribing: Category 1 (no restriction), 2 (advantages outweigh risks), 3 (risks outweigh advantages), 4 (unacceptable risk).

Emergency contraception: levonorgestrel (up to 72 hours), ulipristal acetate (up to 120 hours), or copper IUD (up to 120 hours, most effective option). The copper IUD is the most effective emergency contraception and should be offered to all women presenting within the time window.

Antenatal care in primary care involves booking before 10 weeks, arranging dating scan at 11-14 weeks, combined screening for Down's/Edwards'/Patau's syndromes, anomaly scan at 18-20 weeks, and routine blood tests (FBC, blood group, antibodies, hepatitis B, HIV, syphilis, rubella immunity). Gestational diabetes screening (OGTT at 24-28 weeks) is offered to women with risk factors: BMI above 30, previous GDM, family history of diabetes, or ethnicity with high diabetes prevalence.

Prescribing in pregnancy: folic acid 400mcg daily before conception until 12 weeks (5mg if high risk: previous neural tube defect, on antiepileptics, BMI over 30, diabetes). Vitamin D 10mcg daily throughout pregnancy. Drugs to avoid: ACE inhibitors, statins, warfarin (first trimester teratogenicity), retinoids, methotrexate, and sodium valproate.

Postnatal mental health: the Edinburgh Postnatal Depression Scale (EPDS) screens for depression. Postnatal depression affects 10-15% of women. Baby blues (first 2 weeks, self-limiting) must be distinguished from postnatal depression (persistent low mood, anhedonia, guilt) and puerperal psychosis (rare, onset within 2 weeks, psychiatric emergency requiring urgent referral).