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Recommendations
for Preventive Care for Normal or Low-Risk Pregnancies
DISCLAIMER:
Coverage of preventive services varies under PPO and indemnity plans. Members
covered under these policies need to refer to their Certificate of Coverage
or contact a customer service representative for information regarding covered
services.
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Screening
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Testing
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Exam
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Counseling
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1st Prenatal Visit
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- Medical history
and medications
- Genetic and
OB history
- Environmental
exposures
- Physical
activity
- Tobacco,
alcohol and substance use
- Risk factors
for IUGR and low birth weight
- STD history,
including genital herpes
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CBC
Cervical cytology
(as needed)
ABO/Rh typing,
Rh(D) and other antibody screen
RPR/VDRL, offer
HIV screen, other STD screening based on risk assessment
Hepatitis B
surface antigen
Urine testing
to detect asymptomatic bacteruria
Rubella antibodies
if lacking evidence of immunity
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Blood pressure
Weight
General physical
exam
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Nutrition
Tobacco use
Alcohol and
drug use
HIV
Safety belts
Exercise
Diagnostic
testing
Expected course
of pregnancy
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Follow-up Visits
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- Remain alert
for signs of physical abuse
- Remain alert
for poor pregnancy weight gain
- EDD confirmation
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Offer triple
test for women with access to counseling and follow-up services,
skilled high resolution ultrasound and amniocentesis capabilities
and reliable laboratories. Optimal timing is 15 to 18 weeks
Screening for
gestational diabetes at 24-28 weeks
Ultrasound
if size-date discrepancy or EDD uncertain
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Blood pressure
Weight
Urinalysis
for bacteriuria, glucose and protein
Fundal height
Fetal heart
tones
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Nutrition
Exercise
Safety belts
Assessment
of fetal movement
Pre-term labor
Discuss any
upcoming tests
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Prior to Delivery and Intrapartum
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- Consider
rectal and vaginal swab for Group B Strep (GBS) culture at 35-37
weeks for women who do not already have risk factors indicating
the need for intrapartum antibiotic prophylaxis (i.e. prior history
of newborn with GBS, symptomatic or asymptomatic GBS bacteriuria).
- Intrapartum
chemoprophylaxis should also be given if 35-37 week GBS culture
is positive or if GBS culture results are unknown and any of the
following: <37 wks gestation, membrane rupture ³ 18 hours
or temperature ³ 38.0° C.
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Breast feeding
Delivery options
for women with a history of a prior C-section
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Key Clinical Considerations Regarding Medical Therapies
During Pregnancy
- Antenatal corticosteroid
therapy administered to women in preterm labor is highly effective in
reducing mortality and disability in preterm infants.
- Treatment of bacterial
vaginosis with the appropriate combination of antibiotics reduces the
rate of preterm birth.
- Drug, alcohol and
tobacco cessation during pregnancy reduces the risk of preterm birth.
- The following practices
have not been determined to be effective in preventing
premature births:
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Bed rest
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Home uterine
activity monitoring
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Iron supplementation
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Most labor-inhibiting
drugs/agents
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IV hydration
for premature labor
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Risk scoring
systems
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References:
Guide
to Clinical Preventive Services, 2nd ed. Baltimore (MD) Williams
& Wilkins; 1996
"Key Findings of the Final Report of the Low Birthweight Patient
Outcomes Research Team (LBW PORT)", AHCPR, August 1998
MMWR, 45(RR-7);1-24, May 31, 1996
Guidelines for Perinatal Care, 4th Edition, American Academy
of Pediatrics and the American College of Obestrics/Gynecology, 1997
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