Prenatal Care Basics

Question 1

Important tests/tx for 0-12 wks preatal visit

Answer 1

• one visit every 4 weeks
• First prenatal visit:
  
  • prenatal profile labs (blood type/antibodies, CBC, rubella status, HIV, hepatitis B, syphilis screen)
  • Pap (if indicated)
  • GC/CT, urine culture
  • Rx for prenatal vitamins
  • early glucola if risk factors
• Every visit – gestational age, weight, blood pressure, update labs
• Flu shot as early in pregnancy as possible during flu season
• If unsure dating, may need dating ultrasound

Question 2

Important tests/tx for 13-24 wks prenatal visit

Answer 2

• one visit every four weeks (more frequently if high risk or diabetic)
• Genetic Screening: MSAFP/Quad Screen @ 15-22 weeks;
  
  • if covered by insurance, may qualify for sequential screen – blood draw and U/S @ 10 – 14 weeks
  • second blood draw @ 15 – 22 weeks
  • Materni21 or cell free DNA testing if history indicated
• Anatomy ultrasound @ 18-22 weeks
• Fetal movement @ 18-20 weeks
• Every visit – gestational age, weight, blood pressure, urine dip (DG), update labs, refill PNV if needed

Question 3

Important tests/tx for 25-40 wks prenatal visit

Answer 3

• one visit every 4 weeks until 32 weeks, q2wk visits 32-36 weeks, weekly visits 36-40 weeks (may be more frequent if high risk &/or diabetic)
• Glucola, CBC @ 24-28 weeks
• Tdap > 27 weeks, indicated in every pregnancy
• RhoGam @ 28 weeks for Rh negative patients
• CBC @ 28 weeks: repeat HCT or reticulocyte count at 34 weeks to eval response to therapy if on iron
• Start once to twice weekly NSTs/weekly AFI if indication (DM, HTN, IUGR, etc.) Breastfeeding info @ 36 weeks if indicated
• GBS culture @ 35-37 weeks; if PCN allergy add sensitivity
• Fetal kick counts BID @ 37 weeks

Question 4

Important tests/tx for 40+ weeks prenatal visit

Answer 4

• one visit q week, or more frequently if desired by MD/NP/CNM
• NST’s 2x weekly start 40 5/7, with 1x AFI
• Fetal kick counts BID
• Each visit – gestational age, weight, blood pressure, urine dip, update labs.
• Refill PNV if needed
• Schedule IOL between 40 3/7 - 41 0/7
• Schedule IOL @ 37 weeks for GHTN, 38weeks for CHTN, and 39 weeks for wellcontrolled A2GDM. 36 to 37 weeks for previa. 37 weeks for h/o myomectomy

Question 5

Calculate Estimated Date of Delivery

Answer 5

pregnancy = 280 days, 9 months or 10 lunar months from LMP

Nagele’s rule: 1st day of LMP + 7 days + 1 year - 3 months
-if cycle not 28 days adjust +7 days

Question 6

First Prenatal Visit: History

Answer 6

• Calculate gestational age
• History of present pregnancy
• History of all previous pregnancies:
  
  • -GTPAL, year, sex, weight, gestation age, mode of delivery, length of labour, complications with pregnancy or delivery
• Gynecological and Past Medical History
• Medications/OTC/Herbal
• Family History: ethnicity, genetic disease, birth defects, multiple gestation
• Social History: current situation, smoking, ETOH, drugs, violence/abuse

Question 7

Symphysis Fundal Height

Answer 7

12 weeks: at pubic symphysis
20 weeks: umbilicus
27 weeks: sternum

SFH should be within 2cm of GA between 20 and 37 weeks

Question 8

Types of prenatal testing for aneuploidy + timing, adv./disadv.

Answer 8

• first-trimester combined test = PAPP, B-hCG, nuchal transluceny
  
  • 9-13 weeks
• second-trimester quad screen = a-fetoprotein, B-hCG, inhibin A, estriol
  
  • 15-20 weeks
• chorionic villouis sampling ==> karyotype/dx
  
  • 10-13 weeks
• amniocentesis ==> karyotype/dx
  
  • 15-20 weeks
• second trimester US ==> fetal anatomy
  
  • 15-20 weeks
• cell-free fetal DNA
  
  • >10 weeks