Transcript Prenatal Checklist

Every Prenatal Visit
 Physical exam and counseling on prenatal topics pertinent
to current gestational age of pregnancy
 Urinalysis OB (usually ordered by our nurses and done
before you see the patient in the room)
 Vital signs, height and weight
 Doppler for fetal heart tones starting after week 10
 Fundal height measurement after 20 weeks
 Fetal lie by Leopold maneuvers after 36 weeks (you can also
do transabdominal US to confirm vertex positioning)
 Pelvic exam for cervical change and station after 36 weeks
Initial prenatal visit
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Urine pregnancy test to confirm pregnancy
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Pap smear only if age >21 and not current
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GC/Chlamydia genprobe (if positive treat with Rocephin & Zithromax
respectively)
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Wet prep only if they complain of discharge (if trich positive treat with
Flagyl)
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Pelvic exam
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Dating based on LMP (Naegle’s rule)
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LMP (1st day) + 1 year – 3 months + 7 days
LMP- 07/24/2014, EDD- 05/01/2015
Refer immediately for OB ultrasound to confirm gestational age (earlier the
US, the more accurate the dates)
Initial prenatal visit
 Prescribe prenatal vitamins, can also recommend
prenatal/ OB gummy vitamin if patient does not
tolerate regular prenatal vitamins
 Influenza vaccination (can be given in any trimester)
 Genetic screen/ Risk assessment
 If high risk OB recommend referral to fetal-maternal
medicine, Dr. Rodts-Palenik
 Order OB panel labs
OB Panel Labs
 CBC, CMP
 Urinalysis, Urine culture, UPT (treat asymptomatic
bacteriuria in pregnancy)
 RPR (treat with Penicillin G Benthazine)
 HIV (antiretroviral therapy)
 Rubella IgG (if non-immune, vaccinate after delivery)
 Hepatitis B surface antigen (treatment is active and passive
immunization of infant after delivery)
 Antibody screen
 ABO/Rh (if Rh- neg will need rhogam)
At 16-20 weeks
 Maternal quad screen (16 weeks)
 If abnormal, patient may want further testing
(amniocentesis)
 Refer for OB ultrasound to assess fetal anatomy (20
weeks)
 Perform transabdominal US in our clinic to determine
fetal gender (Dr. Elkins is the best at this) (20 weeks)
At 24-28 weeks
 Gestational diabetes screen (O’Sullivan)- 1 hour GTT
 If CBS >140, recommend 3 hour GTT
 3 hr GTT 1 hr<180, 2hr <155, 3hr <140
 Administer RhoGam if Rh negative patient (28 weeks)
 Repeat H&H to evaluate for anemia
 STI testing if increased risk
 Refer to OBGYN for BTL if requested by patient (they must
sign consent forms several weeks in advance)
 Tdap vaccination (28-32 weeks)
At 35-37 weeks
 Group B strep
 If positive must treat with intrapartum antibiotic
prophylaxis (PCN)
 Fax records to L&D
 Give patient pager number or cell number if you so
choose
 Counsel on labor & delivery preparation, where to go,
who to call, signs of labor etc.
At 40-42 weeks
 Induction of labor not recommened before 40 weeks
 If you and your patient choose induction, you must
speak with Dr. Madden ahead of time and reserve a
room in L&D (they usually need 1-2 days notice)
 L&D (318) 769-7030
 Clinic visits recommened every 4 weeks from intial
visit to 28 weeks gestation
 From 28-36 weeks recommend routine prenatal visits
every 2 weeks
 After 36 weeks recommend routine prenatal visits
weekly
 These are approximate and will change if patient is
high risk OB
Pregnancy Complications
 Hypertension
 Safe medications inlude: Methyldopa (Aldomet),
Nifedipine (Procardia) and Labetalol (Trandate)
 Gestational diabetes
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Oral agents not recommened
Initial trial of diet control
Have patients bring sugar logs to each visit
Use NPH (BID) and Novolog (TID with meals)
Review Questions
 Using Naegele’s rule calculate the estimated due date:
LMP – December 2nd, 2013
Answer
EDD= September 9th, 2014
BONUS QUESTION
 Who’s due date is September 9th, 2014??
Answer
 Christian and Michelle Sonnier 