Prenatal Care Precepting Checklist
- Review weight, blood pressure
- Review fetal heart tones, fundal height (> 12 weeks)
- Review problem list
- Review dating criteria
- Review prenatal labs
- Recheck STDs if appropriate
- Appropriate counseling
- Appropriate coding
- Height and weight (BMI), establish weight gain goals (record in counseling section)
o BMI <18.5: 28-40 pounds
o BMI 18.5-24.9: 25-35 pounds
o BMI 25-29.9: 15-25 pounds
o BMI >29.9: 11-20 pounds
- Record LMP and establish EDD
o Document LMP (Sure LMP?)
o Document if on contraception
o Document regular periods
- Record brief OB history
o Delivery date, type of delivery, living, complications
- Order Prenatal Panel, Type & Screen, HIV, and Urine culture
- Order Varicella (part of prenatal panel) IF patient without history of chicken pox or has not received 2
doses of varicella vaccine
- Order early 1 hr GTT or A1c (if appropriate)
- Order appropriate genetic testing (cystic fibrosis, sickle cell, etc.)
- Order Prenatal Vitamins
- Order Dating Ultrasound (done at Bruner, 8-12 weeks)
- Appropriate counseling
- OB Packet given
- Documentation of full PE in prenatal exam section
- History Taken
o Medical/Surgical
o Family/Genetic/Social
o Detailed OB History
- Gonorrhea and Chlamydia
- Pap smear (if indicated)
- 11-13 Weeks
o Combined Test, Down Syndrome (elective, MFM Referral for Harmony screen and counseling)
- 15-18 Weeks
o Quad Screen (elective)
- 18-20 Weeks
o Anatomy U/S (done at the Seton Clinic)
- 24-28 Weeks
o 1 Hour GTT, Hgb/Hct
o TOLAC or C/S counseling visit with Harper, McMullen, or OB Fellow (if indicated)
- 28 Weeks
o Type and Screen, Rhogam (if indicated)
o Tdap (recommended at 27-36 weeks gestation)
- 35-36 Weeks
o U/S for vertex presentation
o GBS (if collected after 35 weeks is valid for remainder of pregnancy)
- 39-40 Weeks
o Cervical exam (if indicated)
- 41 Weeks
o Fetal Monitoring (if not induced by 41 weeks)
- Every Visit
o Weight gain
o Diet/Exercise
o Smoking/drug/EtOH use
o Prenatal care timeline
- Initial Visit
o Prenatal testing, including ultrasound
o Childbirth classes, hospital tours
o Breastfeeding
o Domestic violence
o Influenza vaccine
o Toxoplasmosis precautions
o Sexual activity
o Family Medical leave
o 1 st trimester screen (Down syndrome, if appropriate)
- 12-20 Weeks
o Quad Screen
- 20-28 Weeks
o Signs and symptoms of PTL
o Signs and symptoms of preeclampsia
o GDM, glucose tolerance test
o Tdap vaccine
- 28-36 Weeks
o Signs and symptoms of labor
o Signs and symptoms of preeclampsia
o GBS testing
o Delivery planning, hospital tour
o Traveling
- 36-42 Weeks
o Signs and symptoms of labor
o Signs and symptoms of preeclampsia
o Delivery planning (birth plan), hospital tour
o Anesthesia/Analgesia
o Contraception
o Newborn care and education
o Newborn PCP
o Breastfeeding
o Circumcision
o Postpartum Depression