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Prenatal Care Routine Full Version 2

Prenatal Care Routine Full Version 2

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Advise the patient of the importance of communication with health care provider as soon as pregnancy is
suspected.
At-risk patients should be assessed and given educational information about risk factors by 16-20 weeks or
anytime thereafter when a risk factor is identifed.
If patients have identifable risk factors, intervene as appropriate in your health care setting. See Annotation
#4, "Risk Profle Screening."

Return to Annotation Table

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Routine Prenatal Care

Algorithm Annotations

Fourteenth Edition/July 2010

Institute for Clinical Systems Improvement

www.icsi.org

24

Is Patient Willing to Change Modifable Risks?

• Provide information about problems caused by specifc behaviors in pregnancy and offer help when
ready to change.
• Offer support, interventions and/or referrals as referred to in the ICSI Preventive Services for Adults

guideline.

• Ask to set a quit or change date, provide educational aids, offer counseling or classes, arrange for follow-
up (at least a phone call) soon after the quit or change date.

Modifable risk factors:

• Family stress

Psychosocial situation – referrals as appropriate, include patient's "support system" in visits and education
Stress/anxiety – educate about and assist with sources of stress such as medical limitations for work,
day care, home help
• Depression
• Domestic violence
• Tobacco use
• Drug and alcohol use – urine testing where indicated
For providers' legal obligations in testing for chemical use during pregnancy, see the 2002 Minnesota
Statutes 626.5561 (Reporting of Prenatal Exposure to Controlled Substances) and 626.5562 (Toxicology
Tests Required). Minnesota statutes may be accessed at http://www.leg.state.mn.us.

• Nutritional concerns
Dietary inadequacy – educate, assist with referral for food supplement program
• Sexually transmitted diseases
• Low preconception BMI/slow prenatal weight gain (see Annotation #5, "Height and Weight/Body Mass
Index [BMI]")

Educate Patient to Monitor Risk Factors

Contractions
Menstrual cramps
Intestinal cramps
Constant backache
Constant pelvic pressure
Vaginal discharge amount and color
Bleeding or spotting
Urinary frequency

(Andersen, 1989 [B]; Nagey, 1985 [R])

Also see Available Resources, "March of Dimes," listed at the end of this guideline.

Home Health Visits/Case Management

Home health visits and case management are additional methods for monitoring patients at risk (Bryce,
1991 [A]).
Return to Annotation Table

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Routine Prenatal Care

Algorithm Annotations

Fourteenth Edition/July 2010

Institute for Clinical Systems Improvement

www.icsi.org

25

Cervical Assessment

Transvaginal sonography of the cervix appears to be an objective and reliable method to assess cervical length
and estimate risk of preterm delivery (Honest, 2003 [R]). Serial measurements may be considered starting
at 16 weeks in high-risk patients (Spong, 2007 [R]). Sonographic cervical length for risk assessment is not
recommended as a routine screening test in low-risk patients. Digital exams should not be eliminated and
can be a useful adjunct to ultrasound fndings (Iams, 1996 [C]; Newman, 2008 [B]).
Cervical sonography is generally performed on a biweekly basis unless clinical conditions suggest more
frequent evaluation (Airoldi, 2005 [B]). A possible beneft of cerclage for patients with prior preterm birth,
current singleton pergnancy and a cervical length of less than 15 mm between 16 and 24 weeks has been
suggested by a recent multicenter randomized trial (Owen, 2009 [A]).
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