Precepting checklist

Prenatal Care Precepting Checklist

Every visit

- 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

Initial Visit, “OB 1”

- 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

“OB 2” Visit

- 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)

Gestational Age Specific

- 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)

Counseling

- 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