Schedule of Prenatal Care

Meadows Maternity and Family Practice

First Visit:

  • Review History, Lab and Ultrasounds (if available)…if done but no copy on chart then request the results from either the referring GP(see space available on the AN note for request of info), the lab, or the radiology clinic (put a sticky on the front of the chart)
  • If no lab &/or Ultrasound then give pt approp forms
  • Confirm Pregnancy due dates
  • Review relevant issues (PN Vits, Lifestyle issues)
  • Review Screening options (if seeing pt prior to deadline for screening tests)
  • Nuchal translucency/First Trimester Screen (11-14 wks)
  • Maternal Serum triple screen (15-16.5 wks)
  • Amnio
  • NIPT
  • Discuss how clinic works
  • Shared practice
  • Shared call group with Rockyview Maternity (but all female MDs)
  • Will see mom and baby for 6 wks post partum
  • Discuss routine F/U visits
  • q 4/52 until 28 GA wks
  • q2/52 until 36 GA wks
  • q1/52 until delivery
  • Send AN Note back to GP (if pt doesn’t have a regular GP then we advise them to find one during the pregnancy as they will need someone to follow baby for regular newborn exams)
  • Add pts name to the OB Patient list
  • If prior C-section – get copy of OR report for C-section, VBAC handout for pt ect.

12 wks:

  • Complete exam if not previously done by GP (pap, GC/Chlamydia)
  • Document recent lab or nuchal transluceny/FTS results

18-20 wks:

  • Review U/S (placenta/anatomy/dates)
  • Document in chart U/S data (i.e. placental location & if f/u u/s required)
  • If Trail of Labor or wants repeat c-section, refer to OB for consultation

24 wks:

  • Lab req for CBC, GDS, Ferritin, and TSH (if hypothyroid)
  • If RH(-) then also do ABO, RH & AB screen (Canadian Blood Services F/U lab form)
  • Review cord blood donations (HO in drawer in each room or if private donation then in maim filling cabinet in office)
  • Tell pt if they don’t hear from us, then assume all is well

28 wks:

  • Update prenatal record with recent lab and ultrasound
  • If Rh (-), give Rhogam at 28 wks (not earlier)
  • Rhogam – must get informed consent for receiving a blood product. Make sure all the pt info is documented on the Rhogam forms and give patient the blood product card
  • Fill out Hospital Pre-registration form and fax it to RGH WSU
  • Fax copy of prenatal record to the RGH WSU

30-32 wks:

  • Fetal movement chart
  • Advise pt that if concerns regarding pregnancy/labour/ect. they should call for advise at 943-3191 with their questions…this will get them through to a nurse at the LINK line.

35+ wks:

  • Vag/rectal swab for GBS
  • Do pv exam if not sure they are vertex (if not sure do u/s for position at 36+ wks)
  • If Breech then refer to WSU @ RVG for OB consult re: the ECV. Pt must be at least 37 weeks for ECV. After the OB does the consult, they will either book the pt for the ECV or rpt c/s.

36+ wks:

  • Put copies of prenatal record on the desk in the central pod area to be taken to Women’s Specialty unit
  • If Trial of Labor, also photocopy OB letter and OR Report and staple it to the PN records
  • if you know you are on call the next day…then please take them in with you)

38-39 wks:

GDM and on Insulin:

  • Book induction between 38 – 39 wks
  • Ensure recent BPP if booking cervidil (within 48 hrs)
  • Advise pt that if insulin requirements drop suddenly then they need to contact our office ASAP.

38 – 39 wks:

Advanced Maternal Age:

  • Do BPP at 38 and 39 weeks
  • Offer the patient induction between 39 and 40wks
  • If pt needs cervidil, make sure there is a BPP within the last 48hrs

40 wks:

  • VE to determine favorability of cervix
  • Discuss induction with pt (we usually book induction from 41wk to 41w4d). We do BPPs at approx 41wks and 41w3d. Need BPP done at least 48 hours prior to induction with cervidil.
  • HO for induction in file box in each room
  • To book induction, fill the induction form and fax it + PN record + recent U/S to WSU at RGH
  • We try to have them delivered by 41 5/7

Paper work to complete in Hospital:

  • Delivery record
  • Baby registration (PNOB)
  • Summary sheet for mom…white sheet filled under “legal” in the chart (we usually do this at the time of delivery and then fax it to the office 252-1765)
  • Summary sheet for baby is done at the time of discharge (i.e. “normal newborn male, uncomplicated pp course, f/u office in 4-5 days”)
  • Newborn exam form (at the time of delivery, complete initial exam area and name of GP at bottom of form)
  • If you are discharging the babe then complete discharge exam area on form and fill in follow up plans (i.e. f/u in office in 3-4 days, x-ray hips at 3 mo if indicated ect)

Post Partum:

Immediate PP period:

  • Breast feeding and decreased milk supply – Rx with Motilium 20mg QID (can go up to 40mg QID if needed). Make sure patient pumps QID, in addition to breastfeeding, for the first few days. Warn patient of potential headache and diarrhea as SE of meds.
  • We see babies in the office until they are back up to birth weight. Should be gaining between 20-30g/day
  • Make sure mom books 6 week post partum check up
  • Sacral Dimple Guidelines in office info book
  • Post partum depression – there are handouts in the bottom drawer of the filing cabinet. Can refer to our Behavioral Health consultant.

6 Week post partum:

  • Paps can by done by GP at 6 months post partum
  • BCP – Rx Micronor 28 (handouts are in file box in each room)
  • If ordering any labs, ensure GPs name is on the lab requisition and have pt f/u with GP for results
  • If pt wants an IUD then they can attend Dr. Michele Moss’s information seminar (she will review the different kinds of IUD’s, give them a Rx and book them an appt at the office to insert it).
  • Mirena handouts in each room. Also give pt handout on Dr. Moss’s information seminar. Pt can get dates from office staff up front.