At each visit, weight, blood pressure, fundal height, fetal heart rate are measured, and a urine specimen is obtained and tested for protein and glucose. Review any concerns the patient may have about pregnancy, health, and nutrition.
6-12 Weeks
- Confirm uterine size and growth by pelvic examination.
- Document fetal heart tones (audible at 10–12 weeks of gestation by Doppler).
- First trimester screening and a discussion of choices of aneuploidy screening should be discussed at this time.
- Chorionic villus sampling is performed during this period (11–13 weeks).
16-20 Weeks
- The "quad screen" and amniocentesis are performed as indicated and requested by the patient during this time.
- Fetal ultrasound examination to determine pregnancy dating and evaluate fetal anatomy is also done.
- An earlier examination provides the most accurate dating, and a later examination demonstrates fetal anatomy in greatest detail. The best compromise is at 18–20 weeks of gestation.
20-24 Weeks
- Instruct patient about symptoms and signs of preterm labor and rupture of membranes.
- Consider cervical length measurement by ultrasound after 18 weeks with history of prior preterm delivery (> 2.5 cm is normal).
24 Weeks to Delivery
- Ultrasound examination is performed as indicated.
- Typically, fetal size and growth are evaluated when fundal height is 3 cm less than or more than expected for gestational age.
- In multiple pregnancies, ultrasound should be performed every 4–6 weeks to evaluate for discordant growth.
24-28 Weeks
- Screening for gestational diabetes is performed using a 50-g glucose load (Glucola) and a 1-hour post-Glucola blood glucose determination.
- Abnormal values ( 140 mg/dL) should be followed up with a 3-hour glucose tolerance test.
28 Weeks
- If initial antibody screen is negative, repeat antibody testing for Rh-negative patients is performed, but the result is not required before Rho(D) immune globulin is administered.
28-32 Weeks
- Repeat the complete blood count to evaluate for anemia of pregnancy.
- Screening for syphilis and possibly HIV is also frequently performed at this time.
28 Weeks to Delivery
- Determine fetal position and presentation.
- Question the patient at each visit for symptoms or signs of preterm labor or rupture of membranes.
- Assess maternal perception of fetal movement at each visit.
- Antepartum fetal testing is performed as medically indicated.
36 Weeks to Delivery
- Repeat syphilis and HIV testing, cervical cultures for N. gonorrhoeae and Chlamydia trachomatis should be performed in at-risk patients.
- Discuss with the patient the indicators of onset of labor, admission to hospital, management of labor and delivery, and options for analgesia and anesthesia.
- Weekly cervical examinations are not necessary unless indicated to assess a specific clinical situation.
- Elective delivery (whether by induction or cesarean section) prior to 39 weeks of gestation requires confirmation of fetal lung maturity.
41 Weeks
- Examine the cervix to determine the probability of successful induction of labor.
- Based on this, induction of labor is undertaken if the cervix is favorable (generally, cervix 2 cm dilated 50% effaced, vertex at –1 station, soft cervix, and midposition); if unfavorable, antepartum fetal testing is begun.
- Induction is performed at 42 weeks gestation regardless of the cervical examination findings.