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
| Gestation | Interventions | Education |
| First visit (varies) | Establish accurate dating (FDLMP, cycle length, and US combined) UA Prenatal labs CBCABO/Rh/Ab Rubella titers RPR, HIV, HCV, HBV 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 Wonderfulpregnancy.com Breastfeeding Diet Activity levels Exercise 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 weeks | UA cfDNA offered Screen for risk factors for ASA 81 mg | Review prenatal test results cfDNA screening Carrier screenings |
| 14-16 weeks | Gender by US Recheck TSH/T4 if hypothyroid Schedule anatomy US | |
| 18-20 weeks | Anatomic US Order GDM screen | US results and limitations GDM screening Fetal movement expectations |
| 24-28 weeks | GDM 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 weeks | Tdap (anytime 27-36 weeks) Start weekly antenatal testing at 32 weeks if: Hypertension 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 Breastfeeding Hospital tour Tdap education |
| 36-38 weeks | Confirm 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 weeks | Cervical exam if labor symptoms or if desires induction | Labor precautions |
| >40 weeks | Schedule delivery no later than 41 weeks Antenatal testing if >41 weeks | Postdates education counseling |
| 1-2 weeks postpartum | BP 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 postpartum | Birth control Mood screening GTT if GDM in pregnancy (2 hr 75 g) BP 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