- Ideally starts before conception.
- Minimum interval for prenatal visits for women with uncomplicated pregnancies: 4–5 wk until 28 wk of gestation, 2–3 wk from 28–36 wk of gestation, and then weekly until delivery.
- Prenatal visit: Initial visit should include comprehensive history, physical examination, and extensive patient education. Subsequent visits assess maternal and fetal well being, maternal weight gain with review of nutritional intake, fundal height, BP, and urine screening for asymptomatic UTI and proteinuria.
Rhesus type, antibody screen
Screen for antibodies that may result in hemolytic disease of the newborn. Rh- women should receive anti(D)-immune globulin prophylaxis (current recommendations are at 28 wk and at delivery, as well as with any invasive procedure in which maternal–fetal circulation can mix such as amniocentesis or CVS)
Screen for anemia, hemoglobinopathies
Rubella immunity screen
Nonimmune patients should be immunized postpartum (not during pregnancy!)
Treatment of mother and infant may be indicated for positive serologies (see chapter 38)
Immunoprophylaxis at delivery for positive serologies
UA and urine culture
Treatment of asymptomatic bacteria indicated in pregnancy due to increased risk of perinatal morbidity, preterm labor
If not done within 6 months of pregnancy
Chlamydia and gonorrhea endocervical specimen
Repeat testing if initial results are positive, in women <25 yr old, and high-risk women
ACOG recommends universal screening with an “opt-out” strategy
When To Screen
Should be done in first trimester in women with risk factors (obesity, prior history of GDM, prior macrosomic infant)
Repeat STD screening (RPR, HepBsAg, Chlamydia and gonorrhea)
Only women at continued risk and those who acquired a new risk factor during pregnancy
CBC, antibody screening
Early third trimester
Vaginal and rectal swab for GBS
Also in the event of PPROM as outlined below
Not recommended for routine screening
HCV antibody screening
No recommended screening date; done at first prenatal visit
Screen only patients at high risk for disease (IVDU, blood products, liver disease)
Not recommended for routine screening
TSH, free T4
Controversial; ACOG and Endocrine Society recommend testing only for women who are symptomatic, have a personal or family history of disease, or are otherwise at high-risk
Because of the possible adverse impact on neurologic development of undetected hypothyroidism, others recommend universal screening
Pregnant women should be tested in accordance with guidelines established for nonpregnant patients.
Toxoplasmosis IgG and IgM serologies
Routine screening of pregnant women is controversial and often not performed in the US
Test all pregnant women; provide counseling for seronegative women and postpartum varicella vaccine
- First trimester: Routine screening of an unselected population allows for better estimation ...
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