prenatal testing cheat sheet
- 1. Routine Prenatal Visits Preconception Counseling: • Start PNV 400 mcg* (prenatal vitamins) now! • Look over med list • Prior pregnancy history, FHx • Hereditary diseases (Sickle cell, Thalassemia, CF) • Modifiable risk factors for preterm labor, gHTN/PreE, GDM • Work-related exposure to infectious agents or chemicals • Modifiable risk factors for contracting infectious diseases • History of physical, emotional, or sexual abuse • Alcohol, tobacco, Substance use – discuss use and cessation • HPV, Rubella, Varicella vaccines in past First Prenatal visit: • Counseling: nutrition, morning sickness, breastfeeding, weight, exercise • LMP, 1st tri dating u/s (most accurate between 10w-13w6d) • Bloodwork: CBC, Blood Type and Rh status (Type & Screen), RPR, Rubella IgG, Varicella IgG, HBsAg, HIV • Hemoglobinopathies if indicated, TSH if indicated, CF if indicated • UA and urine culture (treat even if asymptomatic UTI) • Urine drug screen (depending on population being treated) • Pap smear (if not up to date, and pt is >21), GCCT • 1 hour early OGTT 11-13 weeks: • 1st trimester screening if desired (NT, B-hCG, PAPP-A) • FHT’s heard w/ Doppler by week 12 for sure • Start ASA 81 if applicable for pre-E prevention @ 13w 14-28 wks q4 week visits • 15-22 weeks: Quad screen if desired (MS-AFP, B-hCG, Estriol, Inhibin A) • 2nd trimester ultrasound (anatomy scan) @18-22 weeks unless you are only having 1 U/S total in your pregnancy, then optimal time would be 18w-20w6d. This evaluates fetal anatomy & presentation, AFI, cardiac activity, placental position, fetal biometry, and fetal number. • 16 weeks: vaginal progesterone as indicated from hx, TVUS @20w for others • 20 weeks: Begin measuring fundal height at each visit • Counseling: preterm labor, contraception, baby doctor 28-32 weeks q2 week visits • 28 weeks - 1 hr OGTT, CBC, RPR, GCCT, Rhogam, if needed • TDaP (for patient, partner, family members) • Discuss contraception options • Sign consent for Tubal Ligation & make copies for patient (consent only good x 6 mo.) • 30-32 weeks growth scan for smoking, THC, steroids (asthma), f/u scan 32+ weeks • OB consult as indicated • Start 2x/week NSTs as applicable • 36 weeks GCCT, GBS testing (with sensitivities if needed) • 36+ begin weekly visits, weekly Leopold maneuvers • Counseling: preterm/term labor, preE, fetal movement counts, analgesia, post-term, induction, C/S, newborn care/circ, postpartum depression, breastpump paperwork, FMLA paperwork, crib/carseat planning, breastfeeding, return to work • 41 weeks: NST, AFI Anytime: • Flu vaccine in season (for patient, partner, family members) • Tobacco use, drug use, alcohol use • Intimate partner violence screening • Food security, living situation, support system Postpartum visit: • Edinburgh Postnatal Depression Scale (EPDS) • The 9 B’s of the Post-Partum visit: Baby, Breast or Bottle feeding, Blues, Bleeding, Bladder, Bowels, Birth control, Banging • Review last PAP smear • Discuss Kegel exercises • Discuss return to work, pumping, newborn caregiver • Contraception counseling • Follow ups for GDM, GHTN • Vaccinations postpartum as indicated Pre-Pregnancy BMI Total Wt. Gain Recommended <18.5 28-40 lbs 18.5-24.9 25-35 lbs 25.0-29.9 15-25 lbs >30 11-20 lbs