Prenatal Care
General Information
Please note that the prenatal care documents (including the DFMCH guide) are meant as guides only - we encourage you to work with your site lead and clinic cohort to adjust these to what works for your patients and clinical location
Of note all OB telehealth visits should be billed as Global OB, and NOT as one of the 9944- codes
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UW MFM antenatal guidance for COVID+ pregnant patients
The UW OB guidance about outpatient care of pregnant patients during this pandemic is here
Joint Statement on Patient Centered Pregnancy Care during COVID
AAFP COVID-19 Maternity Care module
ACOG Practice Advisory on COVID-19
Please explore the California Quality Care Collaborative page on COVID-19, it is truly excellent
CDC guide on caring for pregnant women
DFMCH presentation on OB care during COVID by Ally Couture, DO from 4/30/20
National perinatal association website including very useful links for families
Society for Maternal Fetal Medicine Guidance and Preliminary MFM guidance on COVID
Wisconsin Association for Perinatal Care website and link to watch webinar on COVID-19 and prenatal care in the rural setting
Patient Information Documents regarding changes in care routines
What to Expect Prenatal Care (English) What to Expect Hospital Care (English)
What to Expect Prenatal Care (Spanish) What to Expect Hospital Care (Spanish)
What to Expect Prenatal Care (Chinese) What to Expect Hospital Care (Chinese)
What to Expect Prenatal Care (Hmong) What to Expect Hospital Care (Hmong)
Hospital Specific information
Meriter Hospital
Hospital updates (including visitor policy) Please note only one support person allowed but doulas/midwives are considered part of the care team and thus not considered the one support person). Visitor information patient handout for L&D/pp/newborn and "Beginning of Life" visitor process
Tubal sterilizations have resumed as of 4/24/20
Waterbirths have resumed as of 5/11/20 as long as patient screens negative for COVID
All patients requiring induction need pre-procedure COVID testing. The protocol is the same as any other patient requiring COVID testing with Quartz, done at John Wall Drive. Place the order in UW Epic and the patient calls 608-720-5111 to set up an appointment time for testing. . The results will show in UPH Meriter Epic once Care Everywhere is queried
Information regarding elective induction cancellation
Please relay the following information to the patient when discussing or scheduling an elective induction:
Every effort will be made by L&D to bring you in for your elective induction.
Due to the potential effects of COVID-19 on the workforce and patients, your elective induction may need to be cancelled.
The Labor and Delivery charge nurse will call you and your OB or on call OB provider.
You will be asked to call the clinic and follow up with your OB provider to address rescheduling the induction, discuss prenatal care needs and develop a new delivery plan.
St Mary's Hospital
Hospital updates (including visitor policy) Please note only one support person allowed, this would include doula/midwife if preferred ie if they chose a doula their partner wouldn't be allowed
St Mary's patient handout - please give prenatally
Please make patients aware that NO is no longer an option for pain management
All patients requiring induction need pre-procedure COVID testing (72 hours in advance). For our patients we can do this two ways (Document for details ):
1) We can order a test in our UW system as described under Meriter information. to be done at our testing sites per the usual protocol. Results will be available in CareEverywhere for review upon IOL admission at St. Mary's.
2.) They can be tested at any of SSM's multiple pre-Op COVID testing locations (any site that has a lab EXCEPT SMH itself). To do this, we would need to log into the SSM EHR, open a telephone encounter, and place the "Pre-Op COVID lab" order. You must ensure that the "Expected Date" is 3 days prior to the scheduled IOL date. The patient does not have to schedule a lab appointment. On the specified day, they can go to any of the lab sites (listed on the document's last page) and inform them of their need for a pre-procedure COVID test. Results will then be available in the SMH chart, viewable in UW through CareEverywhere.
UW DFMCH Adapted Prenatal Visit Schedule
Schedule develop in consultation with guidance from UW OB, Dean OB, USCF, and ACOG (Examples of other prenatal schedule modifications from ACOG). The goal is to minimize patients coming into clinic and is tailored to low risk patients as discussed in the document.
In thinking about how to schedule these visits we should strive for HIGH phone visit continuity particularly given we will have low (though as much as possible) face to face visit continuity and generally no labor and delivery continuity.
Examples of how this schedule was operationalized at Belleville Clinic and "NorthWing" Clinic
UPDATE 5/15/20 We will no longer be doing vital signs at the 20 week or other ultrasound appointments outisde of our clinics. We recommend the addition of a face to face prenatal care visit between 18-22 weeks to facilitate vital signs and an additional point of contact.
UPDATE 3/23/21 This schedule is not being applied consistently at clinics. It is likely appropriate for patients to now receive the bulk of their care in person however this schedule will remain accessible as needed in the future and to consider how virtual visits can be incorporated into OB care
If you need help getting the OB navigator/linking the telemed visit with the pregnancy episode of care please see this document from Katie Greenfield on making it work!
UW DFMCH Adapted Prenatal Visit Schedule for COVID.pdfBlood pressure monitoring considerations
What UW OB is doing:
If patient has a BP cuff, recommend daily BP checks and a call to the clinic nurse with this value or enter into mychart bp monitoring (see details of entering this order in the adapted prenatal care guide above)
If patient does not have a BP cuff but is willing to purchase one, we recommend the Omron brand (New Omron 3 Series Upper Arm Blood Pressure Monitor (model BP7100) - $32 dollars on Amazon - now available but shipping is out at least a week. Patient should check BP at home and call the clinic with this value
Postpartum: If patient does not have a cuff and cannot purchase one, coordinate a follow up blood pressure check at baby’s newborn visit
Postpartum: If none of these options are possible, the patient should call the clinic in 3-5 days about scheduling a nurse visit for BP check per our usual recommendation.
Please note that there are often no telehealth bp cuffs left for discharge given expedited discharges after delivery. If a patient's bp is borderline or if there are previous issues with htn disease in previous pregnancies think about getting a cuff early for the patient rather than waiting for post partum follow up
Registries for COVID+ patients
Univeristy of California San Fransisco PRIORITY registry for COVID+ pregnant patients
From the AAP section on Neonatal Perinatal Medicine (website/info here) -- Registry Link