OB visits: 

1st visit → monthly until 28-32 weeks → 2x a month until 36-38 weeks → weekly until 41→ induction

Every visit includes: 

BP, maternal weight, heart tones, UA if mom is ever hypertensive

At some point during visits: flu vaccine (if in season), depression screening at least once prenatally and once postnatally, screen for intimate partner violence

First visit (varies)Establish accurate dating (FDLMP, cycle length, and US combined)
Prenatal labs 
Rubella titers
Gonorrhea/Chlamydia testing
Urine drug screen
Pap smear (if due)
Screen for DM if risk factors (weak evidence)
Thyroid labs if high risk or symptoms
TB screening if risk factors
Screen for history of varicella vax or chickenpox
Screen for family history of genetic diseases
Screen for prior pregnancy complications
Cardiac exam
Screening for smoking/EtOH/substance abuse
Screening for depression/anxiety
Screen for prior VTEs
Final EDC
Activity levels
Course of care
Expected weight gain
Specific issues related to hx
Safe medications
CMV precautions
Smoking cessation counseling
Substance use counseling
EtOH use counseling
10-12 weeksUA
cfDNA offered
Screen for risk factors for ASA 81 mg
Review prenatal test results
cfDNA screening
Carrier screenings
14-16 weeksGender by US
Recheck TSH/T4 if hypothyroid
Schedule anatomy US
18-20 weeksAnatomic US
Order GDM screen
US results and limitations
GDM screening
Fetal movement expectations
24-28 weeksGDM screen (start with 1hr 50g glucose)
RhoGAM at 28 weeks if Rh Negative
CBC repeat for patients at high risk for anemia
Federal tubal papers if Medicaid and desires sterilization at delivery or after
RhoGAM education (if relevant)
GDM screening education
Childbirth classes
30-34 weeksTdap (anytime 27-36 weeks)
Start weekly antenatal testing at 32 weeks if: 
Preeclampsia (twice weekly)
Preexisting DM or GDM requiring insulin
Previous unexplained fetal demise
Antiphospholipid antibody syndrome or SLE
Growth restriction
Sickle cell disease
Renal disease
Oligo/polyhydramniosCertain other high risk conditionsDiscuss starting antiviral if history of HSV
Preterm labor precautions
Hospital tour
Tdap education
36-38 weeksConfirm cephalic fetal presentation
ECV encouraged if not by 37 weeks (RhoGAM prior to)
GBS screen
+/- Repeat HIV screen if high risk  Repeat growth US if obese
Schedule Cesarean at 39 weeks if indicated
Labor precautions/birth plans
GBS education
37-40 weeksCervical exam if labor symptoms or if desires inductionLabor precautions
>40 weeksSchedule delivery no later than 41 weeks
Antenatal testing if >41 weeks
Postdates education counseling
1-2 weeks postpartumBP check
Screening for breastfeeding problems
Mood screening
Incision check (if Cesarean delivery)
Intimate partner violence screening 
Birth control counseling
Breastfeeding education
Activity recommendations
6 weeks postpartumBirth control
Mood screening
GTT if GDM in pregnancy (2 hr 75 g)
CheckPap smear if due or abnormal in pregnancy
Exam if 3rd/4th degree laceration
Birth control expectations/counseling
Interval for next pregnancy
Release for activities/work

Common Prenatal Medications: 

  • Prenatal vitamin
    • 400 mcg folate normally vs. 4,000 mcg for those with prior NTD affected pregnancies or on antiseizure medications
  • Iron (ONLY if previous dx of iron deficiency)
  • ASA after 12 weeks if risk factors for preeclampsia:
    • Prior preeclampsia
    • Chronic HTN
    • Multifetal gestation
    • T1D or T2D
    • Renal disease
    • Autoimmune conditions (SLE, antiphospholipid antibody syndrome)
  • Nausea: Vitamin B6, doxylamine (Unisom SleepTabs), Reglan, Zofran
  • Constipation: MiraLAX
  • GERD: PPI or H2 blocker