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PRENATAL CARE : INITIAL VISIT

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PRECONCEPTION COUNSELLING

  1. folic acid to prevent NTD ís (0.4 to 1 mg daily in all women, 4 mg if past NTD)
  2. genetic history and risk factors
  3. modify medications, alcohol, smoking
  4. rubella immunity
  5. proper nutrition
  6. use of prenatal vitamin and iron supplementationimage
  7. impact on family and occupation (maternity/paternity leave)
  8. domestic violence  (50% of domestic violence begins in pregnancy) depression / mental health
INITIAL VISIT

generally after 12 weeks

    History

  1. determine GA by dates from the first day of the LMP (if regular periods and sure dates)
  2. if LMP unsure, get a dating ultrasound
  3. determine EDC using the Naegele Rule
first day of LMP + 7 days - 3 months
e.g. LMP = 1 Apr. 1999, EDC = 8 Jan. 2000

modify appropriately for longer or shorter cycles

  4.  obtain obstetric history of all previous pregnancies (GTPAL)

  5.  obtain relevant medical, social, and family history
  6.  counselling
  • drug use, alcohol consumption, smoking
  • breastfeeding
      Physical
  1. complete physical exam
  2. baseline BP (very important for relating subsequent changes)
  3. baseline weight
  4. pelvic exam

  5. Investigations

  1.  blood work

  • CBC, blood group and type, Rh antibodies
  • rubella titre, VDRL, HBsAg routine; HIV serology should be
    offered to all

  2.  urine
  • R&M (Routine and Microscopy), C&S (Urine culture and sensitivity)
    asymptomatic bacteriuria in 5% of pregnant women
  • if untreated 25-30% will get a UTI in pregnancy (increased risk of preterm labour)
   3.  pelvic exam
  • Pap smear (if none within 6 months), culture for GC and Chlamydia

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    PRENATAL CARE : INITIAL VISIT PRENATAL CARE : INITIAL VISIT Reviewed by Radiology Madeeasy on December 27, 2010 Rating: 5
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