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Health Care Guideline Routine Prenatal Care How to cite this document: Akkerman D, Cleland L, Croft G, Eskuchen K, Heim C, Levine A, Setterlund L, Stark C, Vickers J, Westby E. Institute for Clinical Systems Improvement. Routine Prenatal Care. http://bit.ly.Prenatal0712. Updated July 2012. Copies of this ICSI Health Care Guideline may be distributed by any organization to the organization’s employees but, except as provided below, may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc. If the organization is a legally constituted medical group, the ICSI Health Care Guideline may be used by the medical group in any of the following ways: • copies may be provided to anyone involved in the medical group’s process for developing and implementing clinical guidelines; • the ICSI Health Care Guideline may be adopted or adapted for use within the medical group only, provided that ICSI receives appropriate attribution on all written or electronic documents and • copies may be provided to patients and the clinicians who manage their care, if the ICSI Health Care Guideline is incorporated into the medical group’s clinical guideline program. All other copyright rights in this ICSI Health Care Guideline are reserved by the Institute for Clinical Systems Improvement. The Institute for Clinical Systems Improvement assumes no liability for any adap- tations or revisions or modifications made to this ICSI Health Care Guideline. www.icsi.org Copyright © Year by Institute for Clinical Systems Improvement I annotation. corresponding table indicatesalinked inbluethis Text S I NSTITUTE YSTEMS Fifteenth Edition CS July 2012 I MPROVEMENT FOR C LINICAL Routine Prenatal Care Routine Prenatal Guideline: Health Care ** * [Bracketed] itemsrefertohigh-risk groupsonly. Numbers refertospecificannotations. Copyright ©2012 byInstituteforClinical SystemsImprovement 3 Should alsoincludeallsubjectslisted forthepreconceptionvisitifnoneoccurred. Visit to deferred be to 1 Visit under listed tests laboratory and physical and history the for acceptable is It 2 withtheagreementofbothpatient andtheclinician. Preconception Visit 1 Visit 2 Visit 3 Visit 4 Event 1 Visit 2 6-8 weeks ** 10-12 weeks 16-18 weeks 22 weeks Screening Risk profiles 4 Risk profiles 4 Weight 5 Weight 5 Weight 5 Maneuvers Height and weight/BMI 5 GC/Chlamydia 4 Blood pressure 6 Blood pressure 6 Blood pressure 6 Blood pressure 6 Height and weight/BMI 5 Fetal aneuploidy Depression 11 Fetal heart tones 28 24 History and physical 7 Blood pressure 6 screening Fetal aneuploidy Fundal height 30 28 Cervical cancer screening 2 History and physical 7* Fetal heart tones screening 24 Cervical assessment 31 Rubella/rubeola 8 Rubella 8 Fetal heart tones 28 Varicella 9 Varicella 9 OB Ultrasound 29 Domestic violence 10 Domestic violence 10 (optional) Depression 11 Depression 11 Fundal height 30 CBC 16 Cervical assessment 31 ABO/Rh/Ab 17 Syphilis 18 Urine culture 19 HIV 20 [Blood lead screening 21] Viral hepatitis 26 Counseling Preterm labor 12 Preterm labor 12 Preterm labor Preterm labor Preterm labor education12 education12 education12 Substance use 2 [VBAC 22] Education Prenatal and lifestyle Prenatal and lifestyle Prenatal and lifestyle Nutrition and weight 2 Prenatal and lifestyle Intervention 23 education 23 education 23 education 23 Domestic violence 10 education • Fetal growth • Follow-up of • Follow-up of List of medications, herbal • Physical activity • Nutrition • Review labs from modifiable risk modifiable risk supplements, vitamins 13 factors factors • Follow-up of modifiable visit 1 Accurate recording of • • risk factors • Breastfeeding Physiology of Classes menstrual dates 14 pregnancy • • Nausea and vomiting • Nausea and Family issues • Second-trimester • • Warning signs vomiting Length of stay • growth • • Course of care Physiology of Gestational pregnancy • Quickening diabetes • Physiology of pregnancy • Follow-up of Preterm labor 32 Discuss fetal aneuploidy mellitus (GDM) modifiable risk prevention 31 Preterm labor screening 24 factors prevention 31 www.icsi.org 27 27 Immunization Tetanus booster Tetanus booster [Progesterone 31] [RhoGam 17] & Rubella/MMR 8 Nutritional supplements 25 Chemoprophylaxis [Varicella/VZIG 9] Influenza 27 Hepatitis B vaccine 26 [Varicella/VZIG 9] Folic acid supplement 15 Pertussis 27 1 Institute forClinical SystemsImprovement Annotation [Bracketed] itemsrefertohigh-risk groupsonly. Numbers refertospecificannotations. Visit 5 Visit 6 Visit 7 Visit 8-11 Visit Post-Partum Event 28 weeks 32 weeks 36 weeks 38-41 weeks 4-6 weeks Screening Preterm labor risk 4 Weight 5 Weight 5 Weight 5 Cervical cancer screening 2 Maneuvers Weight 5 Blood pressure 6 Blood pressure 6 Blood pressure 6 [GC/Chlamydia 4] Blood pressure 6 Fetal heart tones 28 Fetal heart tones 28 Fetal heart tones 28 Height and weight/BMI 5 Table Depression 11 Fundal height 30 Fundal height 30 Fundal height 30 Blood pressure 6 Fetal heart tones 28 Cervix exam 34 Cervix exam as indicated 34 History and physical 7 Fundal height 30 Confirm fetal position 35 Domestic violence 10 Gestational diabetes mellitus Culture for group B Depression 11 (GDM) 32 streptococcus 36 Gestational diabetes Domestic abuse 10 mellitus (GDM) 32 [Rh antibody status 17] [Hepatitis B Ag 26] [GC/Chlamydia 4] Counseling Psychosocial risk factors 4 Preterm labor Prenatal & lifestyle Prenatal & lifestyle Contraception 12 23 23 Education Preterm labor education12 education education education Discussion of postpartum Prenatal & lifestyle • Follow-up of • Follow-up of depression Prenatal & lifestyle education 23 Intervention education 23 modifiable risk factors modifiable risk factors Breastfeeding concerns • Follow-up modifiable risk • • Postpartum care • Postpartum and support factors Follow-up of modifiable risk • Management of late vaccinations • Work factors pregnancy symptoms • Infant CPR • Physiology of pregnancy • Travel • Contraception • Post-term management • Preregistration • Contraception • When to call provider Labor & delivery update • Fetal growth • • Sexuality Discussion of Breastfeeding Preterm labor prevention 31 • Pediatric care postpartum depression Awareness of fetal movement 33 • Episiotomy Labor & delivery issues Warning signs/pregnancy- induced hypertension [VBAC 22] Preterm labor prevention 31 Immunization [ABO/Rh/Ab 17] Tetanus/pertussis 27 & [RhoGAM 17] Chemoprophylaxis [Hepatitis B Ag 26] Fifteenth Edition/July2012 Routine Prenatal Care Routine Prenatal annotation. corresponding table indicatesalinked inbluethis Text www.icsi.org 2 Routine Prenatal Care Fifteenth Edition/July 2012 Topical Index Component Related Page # ABO/Rh/Ab ............................................................................................................................................................................................28 Aneuploidy Screening ............................................................................................................................................................................36 Bariatric Surgery .....................................................................................................................................................................................21 Blood Lead Screening ............................................................................................................................................................................30 Blood Pressure ........................................................................................................................................................................................21 Breastfeeding ..........................................................................................................................................................................................34 Complete Blood Count (CBC) ...............................................................................................................................................................27 Cervical Cancer Screening (Pap Test) ....................................................................................................................................................10 Cervix Exam ...........................................................................................................................................................................................49 Cervical Assessment for Preterm Delivery .............................................................................................................................................46 Depression ..............................................................................................................................................................................................24 Domestic Violence ..................................................................................................................................................................................23 Fetal Heart Tones ....................................................................................................................................................................................45 Fetal Movement ......................................................................................................................................................................................49 Fetal Position ..........................................................................................................................................................................................50
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