![]() ![]() Maternal height and weight should be measured at the first prenatal visit to determine body mass index, and weight should be measured at all subsequent visits Testing does not reliably detect proteinuria in patients with early preeclampsia trace glycosuria is unreliable for the detection of gestational diabetes Some guidelines recommend routine dipstick urinalysis at each prenatal visit, whereas others no longer recommend it Measurement is subject to inter- and intraobserver error ![]() Measurement of fundal height is recommended at each prenatal visit beginning at 20 weeks and should be plotted for monitoring purposes Pregnant women should be screened for tobacco use, and individualized, pregnancy-tailored counseling should be offered to smokers.Ībdominal palpation (Leopold maneuvers) can be used to assess fetal presentation beginning at 36 weeks' gestation it is less accurate earlier in pregnancyĪlthough most guidelines recommend blood pressure measurement at each prenatal visit, further research is required to determine the optimal frequencyĮdema is defined as greater than 1+ pitting edema after 12 hours of bed rest, or weight gain of 2.3 kg (5 lb) in one weekĮdema occurs in 80% of pregnant women and lacks specificity and sensitivity for diagnosing preeclampsiaĪuscultation for fetal heart rate is recommended at each prenatal visit to confirm a viable fetus, although there is no evidence of other clinical or predictive value Women at risk of preterm birth should be offered intramuscular (preferred) or vaginal progesterone.īreastfeeding should be recommended to pregnant women as the best feeding method for most infants.Ĭounting fetal movement should not be recommended to pregnant women. ![]() Pregnant women should be offered a glucose challenge test to screen for gestational diabetes between 24 and 28 weeks' gestation. Pregnant women should be offered group B streptococcus screening. Pregnant women should be offered inactivated influenza vaccination during influenza season. Pregnant women should be screened for asymptomatic bacteriuria between 11 and 16 weeks' gestation. Women should be screened for rubella immunity during the first prenatal visit. ![]() Pregnant women with iron deficiency anemia should be offered treatment.įolic acid supplementation should be recommended before conception. RhD-negative women carrying an RhD-positive fetus should be given Rh o(D) immune globulin (RhoGam) to decrease the risk of alloimmunization. Physicians should attempt to obtain the most accurate dating of the pregnancy to assist in management of preterm labor and postterm pregnancy. Induction of labor may be considered between 41 and 42 weeks' gestation. Women at risk of preeclampsia should be offered low-dose aspirin prophylaxis, as well as calcium supplementation if dietary calcium intake is low. Screening for diabetes should be offered to all pregnant women between 24 and 28 weeks' gestation. Intramuscular or vaginal progesterone should be considered in women with a history of spontaneous preterm labor, preterm premature rupture of membranes, or shortened cervical length (less than 2.5 cm). If test results are positive or the patient has a history of group B streptococcus bacteriuria during pregnancy, intrapartum antibiotic prophylaxis should be administered to reduce the risk of infection in the infant. Testing for group B streptococcus should be performed between 35 and 37 weeks' gestation. Physicians should recommend that pregnant women receive a vaccination for influenza, be screened for asymptomatic bacteriuria, and be tested for sexually transmitted infections. Specific genetic testing should be based on the family histories of the patient and her partner. Testing for aneuploidy and neural tube defects should be offered to all pregnant women with a discussion of the risks and benefits. Screening and treatment for iron deficiency anemia can reduce the risks of preterm labor, intrauterine growth retardation, and perinatal depression. Administration of Rh o(D) immune globulin markedly decreases the risk of alloimmunization in an RhD-negative woman carrying an RhD-positive fetus. Physicians should recommend folic acid supplementation to all women as early as possible, preferably before conception, to reduce the risk of neural tube defects. Correct dating of the pregnancy is critical to prevent unnecessary inductions and to allow for accurate treatment of preterm labor. Many elements of routine prenatal care are based on tradition and lack a firm evidence base however, some elements are supported by more rigorous studies. ![]()
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