OB Visits

00-12 WGA

Prenatal visit: _ y/o G-TPAL at _ WGA by _ with [current complications] presents for prenatal visit. [Previous complications].

• LMP date:

• Lab work

  • Urine (2 labs): Urine pregnancy (beta-hCG qualitative), urine culture

  • Bloodwork (3 labs): CBC, blood type, Rh antibody screen

  • Infectious disease screen (6 labs)

    • Viruses with associated immunizations (3 labs): Rubella antibodies, varicella IgG, Hepatitis B surface Ag

    • STIs (3 labs): Gonorrhea/Chlamydia NAAT, RPR/Reflex FTA-ABS, HIV 4th Generation EIA

• Additional testing

  • No Pap within 3 years or no Pap/co-testing within 5 years: Perform Pap

  • Pt counseled about genetic (aneuploidy) testing

• Ultrasound at 8-12 WGA shows [] WGA fetus per [gestational sac, crown rump length]

• Treatment

  • Administer seasonal influenza vaccine

  • Start prenatal vitamin

  • Treat nausea due to pregnancy

• F/u every 4 weeks until 28 WGA

12-20 WGA

Prenatal visit: _ y/o G-TPAL at _ WGA with [current complications] presents for prenatal visit. [Previous complications].

• > 14 WGA; fetal heart tones _ by Doppler

• Refer for anatomy scan to be performed at 18-20 WGA

• Prophylaxis per risk factors

  • H/o preeclampsia: Aspirin 81 mg from 12 to 39 WGA

  • H/o spontaneous preterm birth with no maternal h/o HTN, seizure disorder and no known fetal anomaly: Weekly hydroxyprogesterone caproate supplementation (Makena) from 16 to 36+6 WGA

• Provided with birthing class pamphlet

• F/u every 4 weeks until 28 WGA

20-28 WGA

Prenatal visit: _ y/o G-TPAL at _ WGA with [current complications] presents for prenatal visit. [Previous complications]. Fundal height consistent with dates.

• Fetal heart tones _ by doppler

• 24 WGA: Repeat CBC and perform 1 hour glucose tolerance test (GTT)

• 28 WGA:

  • Administer TDaP

  • Maternal blood type Rh negative:

    • Repeat antibody screen

    • Administer anti-D immune globulin (RhoGAM) 300 mcg IM after antibody screen is drawn

• Prophylaxis

  • H/o preeclampsia: Continue aspirin 81 mg from 12 to 39 WGA

  • H/o preterm birth: Continue Makena from 16 to 36+6 WGA

• Delivery and postpartum

  • Pt desires TOLAC: Refer for OB consult

  • Counseled about postpartum birth control

• F/u every 4 weeks until 28 WGA

28-36 WGA

Prenatal visit: _ y/o G-TPAL at _ WGA with [current complications] presents for prenatal visit. [Previous complications]. Fundal height consistent with dates.

• Fetal heart tones _ by doppler

• 28 WGA:

  • Administer TDaP

  • Maternal blood type Rh negative:

    • Repeat Rh antibody screen

    • Administer anti-D immune globulin (RhoGAM) 300 mcg IM after Rh antibody screen is drawn

• 36 WGA: Perform GBS swab, repeat HIV test. Repeat G/C if risk factors present.

• Prophylaxis

  • H/o preeclampsia: Continue aspirin 81 mg from 12 to 39 WGA

  • H/o preterm birth: Continue Makena from 16 to 36+6 WGA

• Delivery and postpartum

  • Discussed s/sx of labor and plans for delivery

  • Counseled about postpartum birth control

• F/u every 2 weeks until 36 WGA

36-42 WGA

Prenatal visit: _ y/o G-TPAL at _ WGA with [current complications] presents for prenatal visit. [Previous complications]. Fundal height consistent with dates.

• Fetal heart tones _ by doppler

• Fetus vertex by U/S

• 36 WGA: Perform GBS swab and repeat G/C if risk factors present

• Prophylaxis

  • H/o preeclampsia: Continue aspirin 81 mg from 12 to 39 WGA

  • H/o preterm birth: Continue Makena from 16 to 36+6 WGA

• Delivery and postpartum

  • Discussed s/sx of labor and plans for delivery

  • 40 WGA: Schedule IOL for 41 WGA

  • Counseled about postpartum birth control

• F/u every week until delivery