The maternal passport

The mother’s passport is a very important document that was introduced in Germany in 1961 to document preventive examinations during pregnancy. Every pregnant woman receives this document from her gynecologist after a pregnancy has been diagnosed. The maternity passport should be brought to every pregnancy check-up with the gynecologist as well as to the midwife and the birth, up to the 2nd follow-up examination (6-8 weeks after birth).

In addition, it is advisable to carry the maternity pass with you at all times during pregnancy, as it enables you to react and help more quickly in the event of an emergency and information about the pregnancy, the child and the mother can be accessed quickly. The first page contains the contact details of the gynecologist, the clinic where the delivery is planned and the details of the midwife in charge. The dates of the preventive medical checkups are also noted.

On the 2nd page you will find the results of all laboratory examinations in the form of blood tests (serological examinations) and urine tests. First, the mother’s blood group (A, B, AB or 0) and the rhesus factor (rhesus positive (D positive) or rhesus negative (D negative)) are noted there. The rhesus factor is an important feature on the red blood cells (erythrocytes), which plays an important role during pregnancy.

If the rhesus factor of the mother is positive (D positive) – approx. 85% of all Europeans are rhesus positive carriers of this characteristic – no rhesus incompatibility between mother and child can occur, even if the child is rhesus negative (D negative). However, if the mother possesses the characteristic Rhesus negative (D negative) and the child, due to the inheritance by the father of the child, Rhesus positive (D positive), blood group incompatibility between mother and child during birth can occur.

Before this is not possible due to a blood barrier between the mother’s blood and the child’s blood (placental barrier). Maternal antibodies are formed against the child’s foreign blood. This is usually harmless for the first child.

However, the antibodies formed in the maternal blood can lead to serious complications in the development of the child in the event of a further pregnancy (Morbus haemolyticus neonatorum). As a preventive measure, a rhesus negative mother is administered so-called anti-D antibodies between the 28th and 30th week of pregnancy and up to 72 hours after birth, which prevent the body’s own antibody production. With the help of an antibody addiction test, which is also documented on the 2nd page of the maternal passport, the doctor can find out whether antibody formation has already occurred in the maternal blood and whether there could be a rhesus incompatibility.

If the test is negative, i.e. if no antibody formation has occurred, the test is repeated in the 24th and 27th week of pregnancy. If the test is again negative, there is usually no risk of rhesus incompatibility between mother and child. In addition, a completed vaccination against rubella is recorded on the 2nd page, as well as whether there is sufficient protection against rubella, which is carried out by the doctor using a special test (rubella haemagglutination inhibition test).

This is very important in so far as rubella infection during pregnancy can cause serious damage to the unborn child. If there is no sufficient protection against rubella virus, vaccination during pregnancy cannot be made up for and the only protection against infection is to avoid contact with rubella infected persons. It is therefore very important to ensure adequate vaccination protection even before pregnancy.

On the 3rd page of the maternal passport further possible sources of infection such as an infection with the bacterium Chlamydia trachomatis are recorded in the form of a urine test. The bacterium can lead to eye and pneumonia after birth (postpartum) of the newborn. If the pregnant woman is infected with the bacterium, she must be treated with antibiotics to prevent infection of the child.

In addition, a potential infection with the syphilis (Lues) – pathogen Treponema pallidum- is noted on the 3rd page. This bacterium can be transmitted to the unborn child from the 20th week of pregnancy onwards and must therefore be treated with suitable antibiotics if the mother becomes ill.However, only one test is recorded in the maternal passport and no test result. In addition, the result of a test for hepatitis B infection carried out is recorded on the basis of an antigen test (Hbs antigen) via the mother’s blood.

Infection of the mother with hepatitis B can have life-threatening consequences for the newborn. In case of an existing infection with hepatitis B, the child must be vaccinated against the virus immediately after birth. In addition, the presence of an HIV infection can be determined by the doctor’s advice or the wish of the pregnant woman, and a test for a toxoplasmosis antibody can be performed.

On the 4th page, information on previous pregnancies, such as abortions, miscarriages, or ectopic or ectopic pregnancies (extrauterine pregnancies) are noted. In addition, the course of birth (spontaneous birth, caesarean section (Sectio), vaginal births (sucker/ forceps birth (Forceps)), duration of pregnancy) and possible complications of previous pregnancies are described. This allows a better assessment of possible risk pregnancies.

In addition, the date of birth, weight and sex of previously born children are documented on page 4. The 5th page describes medical information (anamnesis) and findings of the first preventive examination. This includes, for example, family illnesses with special attention to diabetes mellitus, high blood pressure (hypertension), malformations, genetic and psychological diseases, own previous illnesses, allergies, taking medication, the social and professional situation as well as previous pregnancies (number of pregnancies (gravida) or births (number of births (para), premature births, delivery complications).

The gynaecologist may classify the pregnancy as a high-risk pregnancy after a medical consultation (anamnesis). Furthermore, the advice given to the pregnant woman regarding a balanced diet, stimulants, medication, sports, profession, travel, birth preparation courses and pregnancy exercises as well as possible risks during pregnancy are documented. Information about a possible HIV test and dental health as well as a successful early cancer detection examination are also noted.

The 6th page contains on the one hand information about particularities in the course of the pregnancy (e.g. medication, diseases of the mother, special pregnancy diseases, abnormalities in the amniotic fluid and bleeding), and on the other hand the date of the expected delivery. In order to calculate the exact date, the date of the last menstrual bleeding, the safe date of conception, the date of pregnancy and the week of pregnancy at that time play an important role. The approximate date of delivery can then possibly be more precisely determined and adjusted during pregnancy.

The calculation is made according to the so-called Naegele rule in the following way: Date of delivery (ET) = First day of the last period + 7 days – 3 months + 1 yearPages 7 and 8 contain the so-called gravidogram. These are pregnancy records which give the midwife and the doctor a good overview of the course of pregnancy. This table contains all the results of the preventive medical checkups.

These are the respective SSW (week of pregnancy), the position of the upper edge of the uterus (fundus position), the position of the child (i.e. pelvic end position (BEL), skull position (SL) or transverse position (QL)), the fetal heart sounds (recorded by ultrasound (US) or CTG (cardiotocography)), the child’s movement, Water retention (edema) or varicose veins (varicosis) in the woman, the current weight of the pregnant woman, the blood pressure values, the concentration of the carrier molecule for oxygen (Hb), urine tests (for protein, sugar, blood, nitrite) and the result of the vaginal examination (vaginal examination). In addition, entries about possible complications, height and weight of the child as well as medication are also possible. On the 9th page, treatment methods and medications for possible illnesses can be documented, as well as an overview of any inpatient hospital stays during pregnancy.

In addition, the fetal heart action and uterine activity, which are determined by cardiotocography (CTG) every 2 weeks from the 28th week of pregnancy, are recorded.The findings of ultrasound examinations during pregnancy (3 preventive appointments: 1) 9-12th week of pregnancy, 2) 19-22nd week of pregnancy, 3) 29-32nd week of pregnancy) constitute the main content of pages 10 and 11. Ultrasound (sonography) can show fetal growth patterns, as well as organ systems or organ malformations, the amount of amniotic fluid, the size of the child (head, trunk, legs), heart activity, and the movement and position of the child. If complications or abnormalities such as malformations, premature labor, bleeding or cervical shortening (cervical insufficiency) are suspected, additional conditions (indications) for further ultrasound check-ups can be recorded on this page.

On the 13th page, the growth of the child is documented on the basis of a curve. The crown-rump length (SSL), the head diameter from temple to temple (BPD) and the abdominal diameter from rib to rib (ATD) are entered. A comparison between the growth values of the child and the age-dependent normal curve as well as the course over time are observed.

Further ultrasound examinations in the case of abnormal (pathological) abnormalities can also be described on page 14 as on page 12. On page 15, the final examination (epicrisis) after the birth of the child is documented. This page is divided into 3 sections.

The first section contains information about the pregnancy, the performed check-ups and the social situation of the woman. Second, the birth is recorded including date of birth, SSW, sex of the child, position of the child, size of the child and head circumference as well as possible abnormalities and the PH value of the umbilical artery after birth. In addition, the birth form and the APGAR score, which represents the initial examination of the child (A= respiration, P= pulse/heart rate, G = basic tone (muscle tone), A= appearance (skin/skin color), R= reflexes) immediately after birth, after 5 and 10 minutes, is described.

In part 3, the health of the woman in the puerperium is noted. The last page of the maternal passport contains the findings of the 2nd postnatal examination of the woman 6-8 weeks after delivery.