Obstetrics Book

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Routine Obstetric Visit

Aka: Routine Obstetric Visit, Routine Obstetric Exam, Prenatal Visit, Prenatal Care, Antepartum Visit, Antenatal Care, Antepartum Care
  1. See Also
    1. Pregnancy Milestones
    2. First Obstetric Visit
    3. Nutrition in Pregnancy
  2. Preparation: Prior to Pregnancy
    1. See Preconception Counseling
  3. Protocol: Schedule of Clinic Visits
    1. Confirmation of intrauterine pregnancy
    2. First Obstetric Visit at 8 weeks gestation
    3. Routine Obstetric Visit
      1. Prenatal Visit every 4 weeks to 28 weeks gestation
      2. Prenatal Visit every 2 weeks to 36 weeks gestation
      3. Prenatal Visit every 1 week until delivery
  4. Symptoms
    1. Pregnancy Induced Hypertension history (after 20 weeks)
      1. Headache
      2. Vision change
      3. Swelling of hands or face
      4. Epigastric Pain
    2. Fetal well being history
      1. Fetal movement ("quickening" at 16-18 weeks)
      2. Fetal Kick Counts (after 36 weeks)
        1. No longer recommended
        2. Results in increased patient anxiety, additional triage visits without improvement in fetal outcomes
    3. Infection history
      1. Dysuria or urgency
      2. Increased or other change in Vaginal Discharge
    4. Vaginal Bleeding history
      1. See First Trimester Bleeding
      2. See Second Trimester Bleeding
      3. See Third Trimester Bleeding
  5. Exam
    1. Blood Pressure
    2. Weight
      1. See Weight Gain in Pregnancy
      2. Obtain patient height at first visit to calculate Body Mass Index
      3. Weight gain >2.3 kg (5 lb) is consistent with edema
    3. Fetal Heart Activity by doptone (after 10-12 weeks)
    4. Fundal height (after 20 weeks)
    5. Abdominal palpation for Fetal Presentation (Leopold maneuvers) starting at 36 weeks
    6. Edema
      1. Face and hand edema (more suggestive of Preeclampsia)
      2. Lower extremity edema (more than 1+ Pitting Edema after 12 hours of bed rest)
        1. Non-specific as present in >80% of pregnancies
  6. Labs: At each visit
    1. Urinalysis for Urine Glucose and Urine Protein
      1. Some guidelines have discontinued routine Urinalysis
      2. Proteinuria has poor Test Sensitivity for detecting early Preeclampsia
      3. Trace Glycosuria has poor Test Specificity for Gestational Diabetes
  7. Labs: At Specific times after initial Prenatal Labs
    1. See Prenatal Labs for other lab testing
    2. Urine Culture at 12 weeks
    3. Aneuploidy and Neural Tube Defect Screening
      1. Requires education starting in first trimester
      2. First trimester screening (Nuchal Translucency, free bHCG, PAPPA) at 9-11 weeks
      3. Second trimester screening (AFP, uE3, HCG, Inhibin) at 15-19 weeks
      4. Amniocentesis for abnormal screening or women over age 35 years
    4. Blood Type and Rh
      1. Indicated for maternal blood type Rh Negative
      2. Performed prior to RhoGAM administration at 28 weeks
    5. Glucose Challenge Test (GCT)
      1. Performed by 26 to 28 weeks
      2. Perform with initial Prenatal Labs if indicated
        1. See Glucose Challenge Test for indications
    6. Hemoglobin or Hematocrit
      1. Perform at 26-28 weeks
      2. Not necessary to repeat later in low risk pregnancy
        1. No Anemia at 26-28 weeks (physiologic nadir)
        2. Uncomplicated pregnancy
          1. No Hemoglobinopathy
          2. No Pregnancy Induced Hypertension
          3. Single gestation pregnancy
        3. Sherard (2001) Obstet Gynecol 98:1038-40 [PubMed]
      3. Treat Iron Deficiency Anemia
        1. Iron Deficiency Anemia increases risk of IUGR, Preterm Labor and Postpartum Depression
        2. Recheck Hemoglobin 4-6 weeks after starting iron replacement
          1. Consider evaluation for malabsorption, blood loss, Thalassemia or other comorbidity if refractory Anemia
    7. Group B Streptococcus routine screening
      1. Culture vagina and Rectum at 36 weeks
    8. Sexually Transmitted Disease screening
      1. Universal screening at First Obstetric Visit
      2. Labs repeated at 28 weeks if at exposure risk
      3. See Prenatal Labs for protocol
  8. Prevention: Vaccinations
    1. See Vaccination in Pregnancy
    2. Influenza Vaccine to all pregnant women (after first trimester)
    3. Hepatitis B Vaccine if non-immune and at risk of exposure
    4. Give Tdap at 27-36 weeks gestation in each pregnancy, regardless of interval (Pertussis protection)
      1. Allows time for maternal Pertussis antibodies to transfer to the baby (passive immunity)
    5. Rh Immune Globulin (RhoGAM) 300 mcg for Rh negative, non-sensitized women
      1. Given at 28 weeks
      2. Given within 72 hours of delivery of an Rh positive infant
      3. Given at times of risk of fetal-maternal transfusion (e.g. Amniocentesis, Abdominal Trauma, Vaginal Bleeding, Miscarriage)
    6. Genital Herpes
      1. Acyclovir 400 mg orally twice daily from 36 weeks until delivery
      2. Indicated in all pregnant women with Genital Herpes history
  9. Management: Education
    1. See First Trimester Education
    2. See Second Trimester Education
    3. See Third Trimester Education
    4. See Nutrition in Pregnancy
  10. References
    1. Zolotor (2014) Am Fam Physician 89(3): 199-208 [PubMed]

Prenatal care (C0033052)

Definition (CHV) health care service provided before child delivery to prevent complications
Definition (CHV) health care service provided before child delivery to prevent complications
Definition (CHV) health care service provided before child delivery to prevent complications
Definition (CCC) Actions performed to support the gestation period of the formation of an offspring/child (being with child)
Definition (MEDLINEPLUS)

Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Prenatal care can help keep you and your baby healthy. It lets your health care provider spot health problems early. Early treatment can cure many problems and prevent others.

Your doctor or midwife will give you a schedule for your prenatal visits. If you are over 35 years old or your pregnancy is high risk because of health problems like diabetes or high blood pressure, your doctor or midwife will probably want to see you more often. You can also expect to see your health care provider more often as your due date gets closer.

Dept. of Health and Human Services Office on Women's Health

Definition (MSH) Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality.
Definition (PSY) Medical, health, and educational services provided or obtained during pregnancy. Includes maternal health behavior affecting prenatal development.
Definition (CSP) care provided the pregnant woman in order to prevent pregnancy complications, and decrease the incidence of maternal and prenatal morbidity and mortality.
Definition (NIC) Monitoring and management of patient during pregnancy to prevent complications of pregnancy and promote a healthy outcome for both mother and infant
Concepts Health Care Activity (T058)
MSH D011295
SnomedCT 424525001, 146789000, 268571001, 169559003, 243786000, 18114009
CPT 59426, 59425
LNC LA10429-1
English Prenatal Care, Care, Prenatal, Prenatal care, Maternity care, Antenatal care (regime/therapy), Antenatal care, Pregnancy care, rnrx pregnancy care (treatment), rnrx pregnancy care, prenatal care, antenatal care, antepartum care, rnox perform pregnancy care, rnox perform pregnancy care (treatment), Pregnancy Care, Antepartum care, Antenatal care - A/N, Ante-natal care, Antenatal care - AN, Prenatal, Antepartum care of mother, Antenatal care (procedure)
Japanese 妊婦管理, ニンプカンリ
Swedish Prenatal vård
Spanish atención prenatal (régimen/tratamiento), atención del embarazo, atención prenatal, asistencia prenatal, higiene del embarazo, asistencia prenatal (régimen/tratamiento), asistencia prenatal (procedimiento), Cuidado prenatal, Atención Prenatal
Czech prenatální péče, Prenatální péče
Finnish Prenataalinen hoito
Russian PRENATAL'NYI PERIOD, UKHOD, ПРЕНАТАЛЬНЫЙ ПЕРИОД, УХОД
French Prise en charge prénatale, Soins prénatals, Prise en charge anténatale, Soin prénatal
Croatian PRENATALNA SKRB
Polish Opieka przedporodowa
Hungarian Prenatalis gondozás
Norwegian Prenatal pleie, Prenatal helsehjelp
Portuguese Assistência Pré-Natal, Pré-Natal, Cuidados pré-natais, Cuidado Pré-Natal
Dutch prenatale zorg, Zorg, prenatale
German Schwangerenvorsorge, Schwangerenbetreuung
Italian Assistenza prenatale
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Prenatal visit (regime/therapy) (C1827763)

Concepts Health Care Activity (T058)
SnomedCT 424619006
English Prenatal visit, Prenatal visit (regime/therapy)
Spanish visita prenatal (régimen/tratamiento), visita prenatal
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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