Prenatal Care

Prenatal care is the care provided to a woman during the course of the pregnancy. It can be offered as an in-person appointment or as a telemedicine visit.

The first appointment is often labeled the new obstetric visit (NOB visit).

The NOB Visit

At the NOB visit, a detailed history - including medical, surgical, family, obstetrical and gynecologic history and social history- is obtained. The patient`s current medication list is obtained and reviewed. Medication counseling is also performed at this time.

The frequency of visits is outlined:

• Generally every 4 weeks in the first and early second trimester.
• Every 2- 3weeks in the latter part of the 2 and early third trimester and finally.
• Weekly after 36wks as delivery approaches.
• This timing will be adjusted as needed to meet the needs of the woman and the pregnancy.

During the initial visit the pregnancy due date is determined. This may be based on the patient`s first day of the last menstrual period or determined by ultrasound. For patient`s who have irregular periods or whose last menstrual period is uncertain, a first trimester US sometimes referred to as a viability ultrasound, is the most accurate way to determine the due date. It is only in extenuating circumstances that a previously set due date is changed.

Genetic screening and testing and recommended vaccinations in pregnancy may also be discussed at this visit.

During this visit and all subsequent visits, the pregnant patient will have a weight and blood pressure check. Additionally, attempts to visualize or hear the fetal heart tones will be made beginning anywhere from 10-12wks and fundal height checks start at approximately 15weeks. Any concerning findings will prompt additional evaluation.

Obstetric Lab Tests

Any labs and ultrasound imaging previously obtained will be reviewed during this visit. If no labs were ordered, then these will be ordered at this visit.

Routine obstetric labs include blood type, type and screen, rubella, hemoglobin electrophoresis, CBC and urine culture, STD testing including – HIV, hepatitis, syphilis, gonorrhea, chlamydia.

Additional labs may be ordered depending on the patient`s history. These may include a hgb A1c, early glucose test, complete metabolic panel, EKG, 24hr urine protein and creatinine.

Ultrasound in pregnancy

During the course of the pregnancy, the obstetrician or OB clinician will obtain at least one ultrasound. The most important and most popular ultrasound obtained is the anatomy scan. This is usually obtained between 18-22wks of pregnancy. It is a detailed US that evaluates the fetal head, chest, abdomen and extremities. It is during this US that most fetal anomalies are first identified. During this US, the baby`s sex may be revealed.

Additional ultrasounds may be obtained to monitor fetal growth, ,as part of antenatal fetal testing or as a genetic screening tool.

High Risk Pregnancy

Women who have a medical history of obesity, diabetes, high blood pressure, heart disease, depression and anxiety, history of clotting disorders, or other diseases, are considered to be high risk during pregnancy and will thus be monitored more closely. Women who are carrying a pregnancy diagnosed with a fetal anomaly or multiple babies are also generally considered high risk and will usually have a maternal fetal medicine specialist as part of the team caring for them during the pregnancy.

Fetal Testing.

Pregnant patients who are considered high risk or in instances where a patient reports decreased or no fetal movement, fetal testing may be performed to further evaluate the fetus. Ultrasound testing such as biophysicial profile, modified biophysical profile are performed to assess fetal well being and provide some assurance to the mother. A non stress test or contraction stress test is a test where the pregnant woman is hooked up to a monitor and the baby`s heart rhythm recorded over a period of approx. 40minutes. The patterns are evaluated as a measure of fetal well being.

Delivery

During the third trimester, as pregnant women approach their due date, the mode of delivery ie the decision on how the baby will be delivered will be discussed. While the plan is generally for a vaginal delivery, there are circumstances such as multiple previous cesarean sections, previous surgery to the uterus, patient`s restriction, fetal presentation, will call for cesarean delivery. The decision for cesarean is between the patient and the physician and occurs after an in depth conversation that highlights the benefits and risks of the procedure and agreement between the two.

The timing of delivery is also discussed in the third trimester. Generally, the plan is delivery between 39-42weeks. This may change based on the health of the patient and or the fetus.

Postpartum Care

Postpartum care is the care provided to a woman who was recently pregnant. It is provided outside the hospital. It occurs anywhere between a few days of delivery to as far as 12weeks post delivery. The immediate postpartum period is within the first 3wks of delivery and allows for close outpatient follow-up especially for women with a history of elevated blood pressure, history of anxiety, depression or women who had a cesarean delivery.