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RMHP Perinatal Care Guideline

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RMHP Perinatal Care Guideline Perinatal Care Guideline Gestational Assessments Routine Lab/Diagnostic Routine Patient Education High Risk Lab/ High Risk Counseling Age Procedures Diagnostic Procedure Up to 12 Weeks Screen for Preterm labor (PTL) risk Complete Blood Count or Premature labor signs and symptoms Chorionic villi sampling Domestic Violence factorsat first visit HCT/HGB Appropriate weight gain based on BMI (CVS)if indicated Remain alert for signs Screen for sexually transmitted disease Urinalysis with culture and E x e r c i s e Ultrasound (US) Chronic Hypertension Calculate BMI and set weight gain goals follow up with test for cure if N u t r i t i o n Offer Cystic fibrosis screen Early and frequent visits for pregnancy positive Smoking Cessation - referral to CO Quit Offer nuchal translucency Advise about the adverse effects of smoking and alcohol and drug Assess fundal height measurements, Blood Group & Rh Type Toxoplasmosis measurements and abuse FHT’s, weight, and blood pressure biochemical markers to Antibody screen Communicable diseases Nutritional counseling regarding diet and salt intake Assess for gestational diabetes mellitus detect Down syndrome and Syphilis screen Sexual activity Obesity (GDM) risk factors and screen if high other genetic disorders Cervical Cytology Breastfeeding Importance of optimal weight gain and exercise risk Other genetic testing Hepatitis B Seat belt use during pregnancy Dietician consult as needed Assess oral health and refer for dental Rubella Antibodies Dental hygiene, flossing and seeing their dentist for dental Nutritional Counseling care if needed Chlamydia and gonorrhea cleaning at least once during their pregnancy Referral if underweight, overweight, or GDM Ask about tobacco use, document screen Stressful or prolonged work hours Genetic Counseling teaching, and refer to CO Quit Line Testing for HIV with consent Substance abuse – counsel and offer referrals to appropriate drug Offered if >35 years of age Screen for substance abuse GDM screen if high risk per treatment program if identified Cystic Fibrosis Offer screening for cystic fibrosis to all protocol Domestic violence Offer counseling and referral HIV patients Genetic disorders screen HIV risks and prevention Infection Assess mental health and psychological based on family history Discuss risks and prevention strategies needs Flu vaccine* Positive mental health history Facilitate appointment with mental health specialist Continued risk assessment for PTL Ultrasound 12-28 Weeks Offer screening tests for Referral for childbirth/parenthood education course Tobacco and Substance Abuse Offer anatomic survey ultrasound to be Re-testing for sexually aneuploidy Breastfeeding Discuss risk of continuing tobacco, alcohol, or illicit drugs transmitted disease completed at 18•20 weeks Ultrasound Appropriate weight gain Preterm Labor Hepatitis B, if indicated Ask about tobacco use, Urinalysis for albumin and Interpretation of routine lab results Perform cervical exams as needed and aggressive tocolysis if PTL is GDM screen document teaching and refer to CO glucose at each visit Smoking Cessation - referral to CO Quit identified to allow time for antenatal steroids administration Quit Line Repeat antibody test for un- PTL – identifying and managing signs and symptoms Consider maternal cell-free Consider weekly 17P injections if meets high risk criteria Re-screen for substance abuse sensitized Rh neg pts (28 Substance abuse-counsel, provide interventions and/or referrals for DNA testing or Teaching to include dangers of delivering early and benefits of early Follow up on mental health and or wks) tobacco, alcohol or illicit drug use Amniocentesis if >35 years detection of PTL psychological needs Screening for GDM Domestic violence – acknowledge abuse, make a safety old or abnormal quad screen, Asthma Flu vaccine* assessment, assist with development of safety plan and provide family history offetal Education regarding limiting adverse environment exposure during appropriate referrals, documentation, and continued support abnormalities Tdap with every pregnancy at pregnancy Educate Tdap vaccine needed for family members caring for baby 27 - 36 weeks (May be given Discuss asthma triggers to reduce symptoms as early as 20 weeks) Review personal best records on peak flow meter Domestic Violence Remain alert for signs Positive mental health assessment Facilitate appointment with mental health specialist *All pregnant women should be offered the influenza vaccine during the influenza season. Influenza vaccine is considered safe at any stage of pregnancy. Brochures for this topic and other resources are available through RMHP OB Case Manager. To request material or assistance, please contact an OB Case Manager at 970-263-5564 or 1-800-843-0719. Gestational Asssessments Routine Lab/Diagnostic Routine Patient Education High Risk Lab/ High Risk Counseling Age Procedures Diagnostic Procedure 28-36 Weeks Assessment for PTL Repeat HCT/HGB Nutrition Testing for sexually transmitted Tobacco and Substance Abuse Inappropriate weight gain disease, prn Perform US for poorly controlled GDM Prophylactic administration of Discuss risks of continued use of tobacco, alcohol, and illicit drugs and inadequate fetal growth Rho (D) immunoglobulin (28 Seat belts Repeat hemoglobin or Chronic Hypertension or PIH Meaning of test results Screen when appropriate and treat if wks) hematocrit (32 wks) Explain non stress test or BPP frequency and results indicated for reproductive tract infections Urinalysis for albumin and Review signs of PIH/preeclampsia NST Review signs of PIH and when to report changes Biophysical profile (BPP) Assess for PIH glucose at each visit Smoking cessation counseling Premature Labor Follow up on mental health and or Group B Strep screen Counsel and provide interventions and/or referrals for alcohol and psychological needs Check for UTI and/or vaginal infections as indicated Flu vaccine* illicit drug use US cervix as needed to check for cervical change Teach daily fetal movement assessments as a means of antepartum Tdap with every pregnancy at Tocolysis as needed fetal surveillance 27 - 36 weeks (May be given Antenatal steroid administered if delivery is imminent as early as 20 weeks) Recommend that elective deliveries not be performed before 39 weeks gestation to minimize prematurity-related prenatal Domestic Violence Obesity complications Increased surveillance for gestational hypertension/preeclampsia Review signs and symptoms to report: vaginal bleeding, pelvic pain, fever, nausea, swelling, fatigue, fetal movements Review signs and symptoms of preeclampsia Maintain tight glucose control in women with GDM or diabetes Positive mental health assessment Facilitate appointment with mental health specialist Continued risk assessment Urinalysis for albumin and NST After 36 Review onset of labor, bleeding, membrane rupture Tobacco and Substance Abuse Assess for PIH glucose at each visit BPP Weeks Analgesic/anesthetic options Discuss risks of tobacco, alcohol, and illicit drug use Flu vaccine* Follow up on mental health and or Fetal movement counts reinforced Domestic Violence psychological needs Smoking cessation counseling Remain alert for signs Assess readiness for infant Chronic Hypertension or PIH Pediatric care choice Review signs of PIH and have patient report changes of symptoms Recommend that elective deliveries not be performed before 39 NSTs or BPP weeks gestation to minimize prematurity-related prenatal Positive mental health assessment complications Facilitate appointment with mental health specialist Continued antepartum assessment NST testing, evaluation of Fetal movement counts reviewed NST 2 times per week After 41 Tobacco and Substance Abuse Follow up on mental health and or amniotic fluid volume, BPP Discuss possible induction Weekly BPP Weeks Discuss risks of tobacco, alcohol, and illicit drug use psychological needs Positive mental health assessment Facilitate appointment with mental health specialist Nutrition Tobacco and Substance Abuse Postpartum Interval history Pap smear, as indicated Screening for DM in all women Discuss risks of tobacco, alcohol, and illicit drug use As indicated by patient’s Exercise/physical activity who had GDM Care 4-6 Weight, blood pressure Breast care weeks after Examination of breasts history and status at exam Hygiene delivery (21-56 Abdomen and pelvis to include evaluation days) of episiotomy repair and uterine involution Emotional changes Evaluation of parent/family/newborn Sexual activity and methods of birth control adaptation and bonding Evaluate postpartum depression *All pregnant women should be offered the influenza vaccine during the influenza season. Influenza vaccine is considered safe at any stage of pregnancy. References: Note: Collaborative, C. C. (2013, September 30). HealthTeamWorks. Retrieved from Pregnancy-Related Depressive Symptoms Guidance: www.healthteamworks.org Clinical Guidelines adopted by RMHP are based on clinical evidence at the time of publication. New Environment, D. o. (2009, March). HealthTeamWorks. Retrieved November 5, 2013, from Gestational Diabetes Addendum 2009: http://www.healthteamworks.org information, evidence and practice standards may be available; therefore, always use best clinical HealthTeamWorks. (2011, Jan 3). Depression in Adults: Diagnosis & Treatment Guideline. Retrieved from HealthTeamWorks: http://www.healthteamworks.org judgment in their interpretation. Improving Pregnancy Outcomes. (2013). Retrieved from RMHP: http://www.rmhp.org/members/for-your-health/stay-healthy/pregnancy Newborn, A. C., Practice, A. C., Riley, L. E., & Stark, A. R. (2012). Guidelines for Perinatal Care 7th Edition. Elk Grove Village, IL: American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Prevention, D. o. (2013, August 28). Tdap for Pregnant Women: Information for Providers. Retrieved from CDC: http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm Approved 12/5/2018 Queenan, J. T. (2007). High-Risk Pregnancy. Washington: American College of Obstetricians and Gynecologist. .
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