Prenatal Care in Family Practice PDF

DR. KELLI STEPHENSON, D N P, C N M , F N P PRENATAL CARE IN FAMILY PRACTICE  FETUS / WOMEN INFANT FAMILY Well-being Improved Promote outcomes developmen t...

DR. KELLI STEPHENSON, D N P, C N M , F N P PRENATAL CARE IN FAMILY PRACTICE  FETUS / WOMEN INFANT FAMILY Well-being Improved Promote outcomes developmen t GOALS OF Reduce mortality Reduce; PTB; IGR; Reduce unintended PRENATAL FTT pregnancy Reduce Healthily Reduce CARE risks in the future growth & neglect, developmen violence t Promote Reduce parenting abuse, skills neglect, violence Visit Gestational Age First Before 12 weeks Second 16 weeks Third 20 weeks Fourth 24 weeks Fith 28 weeks VISIT Sixth 30 weeks SCHEDULE Seventh 32 weeks Eighth 34 weeks Ninth 36 weeks Tenth & beyond Weekly until birth  Nulligravida (never pregnant), THE G’S & P’S primigravida (first-time -gravida Pregnancy Case Study: pregnant), multigravida (many Mary presents to you for a pregnancies new OB appointment; her ) chart indicates G4P2012. What does this mean? Nullipara (no live births), -para Live birth multipara (many live births) INITIAL VISIT HEALTH PHYSICAL LAB WORK GENETIC EDUCATION HISTORY EXAM SCREENING HEALTH HISTORY Jordan text pg 91 table 6.4 Accurate dating Complete pregnancy history Complete conception history  Naegels rule EDD Pregnancy is approximately 280 days Subtract 3 months and add 1 week to the first day of LMP 90% of women will deliver by 41 weeks using this method Pregnancy wheels -> based on standard 28-day cycle EMR -> typically based on Naegels rule If unknown LMP or history is unknown: order dating ultrasound bHCGs -> not accurate Due MONTH, not date  PHYSICAL EXAM Pregnancy -> systemic -> initial head to toe Pre-pregnancy weight Height/weight -> BMI -> consider referral at 40 Vital signs (blood pressure, pulse, respirations, temperature) Pelvic exam -> enlarged uterus, collect pap, collect STI Doppler FHT -> 10-12 weeks SIGNS OF PREGNANCY Category Defining Characteristic Signs and Symptoms Presumptive Changes the woman notices Amenorrhea; breast changes; N/V; Subjective fatigue; urinary frequency Suggestive but not diagnostic Probable Observed by healthcare worker Uterine enlargement; Objective vaginal/cervical changes; Suggest by not diagnostic palpation of fetus; pregnancy tests Positive Directly involving fetus Ultrasound; FHT; fetal movement Absolute proof by examiner Diagnostic  LAB WORK Jordan text page 94 table 6.5 GENETIC SCREENING Shared decision making Voluntary Screening -> not diagnostic NIPT Non-invasive perinatal testing Fraction of fetal blood Genetic & carrier EDUCATION Preventative care -> immunizations; oral health; mental health; IPV Health promotion -> nutrition; substance use; exercise; working SUBSEQUENT VISITS 16 WEEKS Review height; fetal movement Education Health history Weight gain Labs Referrals as needed Ultrasounds Seatbelt use Genetic screening Changes in pregnancy Order Fetal movement 20-week ultrasound for fetal Exercise anatomy Danger signs Exam Weight; blood pressure; urine dip (if applicable); FHT; fundal 20 WEEKS Review Health history Ultrasound Order Additional labs and/or ultrasounds as needed Exam Weight; blood pressure; urine dip (if applicable); FHT; fundal height; fetal movement Education: Common discomforts; fetal growth & development  Review 24 WEEKS Health history Ultrasounds or labs Order Any labs or ultrasounds Exam Weight; blood pressure; urine dip (if applicable); FHT; fundal height fetal movement Education Upcoming testing Common discomforts Weight gain PTL  Review 28 WEEKS Health history Ultrasounds or labs since last visit Order 1-hour OGTT and CBC (or H/H) Exam Weight; blood pressure; urine dip (if applicable); FHT; fundal height; fetal movement Education Physiological changes in the 3rd trimester S/S of PTL Common discomforts 2-week visits 30 WEEKS Review Health history Diagnostic testing and/or US Exam Weight; blood pressure; urine dip (if applicable); FHT; fundal height; fetal movement Education PP BCM Tdap around 32 weeks Next visit 2 weeks  Review 32 WEEKS Health history Diagnostic testing and/or US Exam Weight; blood pressure; urine dip (if applicable); FHT; fundal height; fetal movement Tdap Education f/u PP BCM PTL precautions Daily fetal movement Pain management 34 WEEKS Review Health history Diagnostic testing and/or US Exam Weight; blood pressure; urine dip (if applicable); FHT; fundal height; fetal movement Education: GBS swab @36 weeks PTL BH ctx Tour CB classes 36 WEEKS Review Health history Diagnostic testing and/or US Exam Weight; blood pressure; urine dip (if applicable); FHT; fundal height; fetal movement GBS swab Education Labor Pain management BCM GBS GBS = Group B Strep infection Test around 36 w Positive -> antibiotics during labor Negative -> no treatment Other reasons to treat GBS disease in prior infant GBS in urine at ANY point in pregnancy -> do not recheck with a swab @36w delivery by 42 weeks REFERENCES HOLLIER, A. D. (2018). CLINICAL GUIDELINES IN PRIMARY CARE (3RD ED.). ADVANCED PRACTICE EDUCATION ASSOCIATES, INC. JORDAN, R. G., ENGSTROM, J., MARFELL, J., & FARLEY, C. L. (2018). PRENATAL AND POSTNATAL CARE (2ND ED.). WILEY-BLACKWELL.