Routine Prenatal Care

Question 1

What are the typical routine labs obtained at the first OB visit?

Answer 1

Hgb, platelets, type and screen, Rubella IgG, RPR, HIV, Hep B surface antigen, urine culture, gonorrhea/chlamydia.

+/- Hepatitis C, urine drug screen, hgb electrophoresis, 1hr GCT or A1c, pap smear, baseline AST, ALT, Cr, UPC depending on risk factors.

Question 2

What is carrier screening and what is aneuploidy screening? When are they offered?

Answer 2

Carrier screening= maternal and paternal screening for inherited diseases, often autosomal recessive diseases for which the parent is a silent carrier. Offered to patient as part of preconception counseling, those with family history of genetic diseases, all patients. (CF, Spinal muscular atrophy, Fragile X, Tay-Sachs, hemoglobinopathies)

Aneuploidy screening: screening for fetal aneuploidy during current pregnancy. Offered to all patients, regardless of risk.

• 1st trimester screen: maternal serum + fetal ultrasound between 10-13w6d
• Quad screen: maternal serum between 15-22 weeks
• Cell free DNA: 10 weeks - term

Question 3

What essential care is performed at 3rd trimester visit?

Answer 3

• GCT (if not already performed)
• Repeat CBC, RPR, Type and Screen
• Rhogam if Rh negative
• Tdap
• Repeat HIV if STI in pregnancy or otherwise high risk

Question 4

At what gestational age is GBS collected? What if the patient is allergic to penicillin?

Answer 4

All pregnant women should undergo antepartum screening for GBS at 36 0/7–37 6/7 weeks of gestation, unless intrapartum antibiotic prophylaxis for GBS is indicated because of GBS bacteriuria during the pregnancy or because of a history of a previous GBS-infected newborn.

For women with a high risk of anaphylaxis, clindamycin is the recommended alternative to penicillin only if the GBS isolate is known to be susceptible to clindamycin. SUSCEPTIBILITIES MUST BE PERFORMED. Alternatively, penicillin allergy testing, if available, is safe during pregnancy and can be beneficial for all women who report a penicillin allergy, particularly those that are suggestive of being IgE mediated, or of unknown severity, or both

Question 5

A G1P0 is now 42w0d during a pregnancy with no complications. She desires expectant management. What do you recommend?

Answer 5

Cervical exam, stripping of membranes, and IOL due to increased risk for IUFD. If she declines IOL, recommend twice weekly NST with amniotic fluid assessment.

Question 6

What are the typical weight gain recommendations for each BMI range?

Answer 6

BMI <18.5 –>28-40 lbs
BMI 19-25 –>25-35 lbs
BMI 26-30 –>15-15 lbs
BMI >30 –>11-20 lbs