From the Research
A comprehensive first obstetrics (OB) visit workup should include a complete medical history, physical examination, laboratory tests, and patient education, with a focus on preventing neural tube defects by prescribing prenatal vitamins containing at least 400 mcg of folic acid, as recommended by the most recent guidelines 1. The medical history should cover previous pregnancies, medical conditions, surgeries, medications, allergies, family history, and social habits including substance use.
- The physical examination should include vital signs, height, weight, BMI calculation, a complete physical exam with special attention to the thyroid, heart, lungs, breasts, abdomen, and pelvic examination.
- Laboratory tests should include a complete blood count, blood type and Rh factor, antibody screen, rubella immunity status, hepatitis B surface antigen, HIV testing, syphilis screening, urine culture, Pap smear if due, gonorrhea and chlamydia screening, and genetic carrier screening as appropriate. Additional tests may include hemoglobin A1C or glucose screening, thyroid function tests, and ultrasound for dating and viability. Patients should be counseled on nutrition, exercise, weight gain goals, avoidance of harmful substances, and warning signs that require immediate medical attention, taking into account the potential risks associated with high-dose folic acid supplementation 1. This comprehensive initial assessment establishes baseline health status, identifies risk factors, and allows for early intervention to optimize maternal and fetal outcomes throughout pregnancy, while also considering the potential risks and benefits of folic acid supplementation 2, 1.