Overview
This lecture covers the management, screening, and key considerations of pregnancy in the primary care setting.
Initial Pregnancy Assessment
- Confirm pregnancy using urine or serum hCG tests.
- Determine estimated due date (EDD) based on last menstrual period (LMP) or ultrasound.
- Document relevant medical, surgical, and obstetric history.
Routine Prenatal Care
- Schedule regular visits: every 4 weeks (until 28 weeks), every 2 weeks (28-36 weeks), weekly (36+ weeks).
- Monitor maternal weight, blood pressure, and fetal heart tones at each visit.
- Assess for gestational diabetes between 24-28 weeks with glucose tolerance testing.
- Screen for anemia and blood type early in pregnancy and repeat as indicated.
Key Screenings and Labs
- Screen for rubella, hepatitis B, syphilis, HIV, and urine culture at first visit.
- Perform genetic screening and carrier testing based on patient risk factors and preferences.
- Offer Group B Strep screening at 35-37 weeks.
Counseling and Education
- Advise on prenatal vitamins with folic acid to prevent neural tube defects.
- Educate about lifestyle modifications: avoid tobacco, alcohol, and certain medications.
- Discuss warning signs (bleeding, severe abdominal pain, decreased fetal movement).
Common Issues in Pregnancy
- Manage nausea/vomiting with dietary changes and safe medications if needed.
- Address urinary tract infections promptly due to increased risk of complications.
- Monitor for preeclampsia signs: headache, vision changes, elevated blood pressure, proteinuria.
Key Terms & Definitions
- hCG (human chorionic gonadotropin) — hormone detected in pregnancy tests.
- EDD (Estimated Due Date) — expected date of delivery calculated from LMP or ultrasound.
- Gestational Diabetes — high blood sugar first detected during pregnancy.
Action Items / Next Steps
- Review patient history and confirm pregnancy with hCG testing.
- Schedule initial and follow-up prenatal visits according to guidelines.
- Order recommended labs and screenings at the appropriate gestational ages.
- Advise patient to start prenatal vitamins and provide educational materials.