Recommended Orders for 18-Week Pregnancy in the 2nd Trimester
At 18 weeks of pregnancy, the recommended orders should include a detailed anatomy ultrasound, screening for gestational diabetes, assessment of fetal growth, and appropriate laboratory tests to monitor maternal health.
Core Recommended Orders
Ultrasound Assessment
- Detailed anatomy scan (if not already completed)
- Comprehensive evaluation of fetal anatomy
- Assessment of placental location and appearance
- Measurement of amniotic fluid volume
- Cervical length assessment to screen for preterm birth risk 1
Laboratory Tests
- Complete blood count to assess for anemia
- Urinalysis to screen for proteinuria and infection
- Blood type and antibody screen (if not done in first trimester)
- Glucose screening test (24-28 weeks, but can be ordered now if high-risk)
- Thyroid-stimulating hormone levels if clinically indicated 1
Maternal Assessment
- Blood pressure measurement with appropriate cuff size
- Weight measurement to track appropriate gestational weight gain
- Fundal height measurement
- Assessment for edema or other signs of preeclampsia 1
Specialized Orders Based on Risk Factors
For Patients with Suspected Fetal Growth Restriction
- Serial umbilical artery Doppler assessment if fetal growth restriction is suspected
- Weekly umbilical artery Doppler evaluation for severe fetal growth restriction (estimated fetal weight less than 3rd percentile) 1
- Consider weekly cardiotocography testing if fetal growth restriction is identified 1
For Patients with Obesity
- Early screening for gestational diabetes (if not already completed)
- Consider growth scan at 28-32 weeks to aid in detection of late-onset fetal growth restriction
- Appropriate BP cuff size for accurate measurements 1
For Patients with Previous Complications
- More frequent monitoring if history of previous adverse pregnancy outcomes
- Consider additional fetal surveillance based on specific risk factors 1
Nutritional and Supplementation Orders
- Continue prenatal vitamins with folic acid
- Standard dose: 0.4-1.0 mg folic acid for low-risk women
- Higher dose: 4.0 mg folic acid for high-risk women (history of neural tube defects) 2
- Vitamin D supplementation if deficient
- Calcium supplementation if indicated 1
Patient Education and Counseling
- Nutrition counseling for appropriate weight gain during pregnancy
- Physical activity recommendations (30 minutes of moderate exercise for at least 5 days/week)
- Discussion of warning signs requiring immediate medical attention:
- Vaginal bleeding
- Decreased fetal movement
- Severe headache
- Visual disturbances
- Abdominal pain 1
Follow-up Planning
- Schedule next prenatal visit in 4 weeks (standard for second trimester)
- Schedule glucose screening test for 24-28 weeks if not done earlier
- Plan for additional growth scans if indicated by risk factors
- Consider anesthesia consultation if BMI >35 1
Special Considerations
- For patients with previous preterm birth or cervical insufficiency, consider cervical length monitoring
- For multiple gestations, more frequent monitoring and specialized care is required
- For patients with chronic medical conditions, coordinate care with relevant specialists 1
Remember that second-trimester vaginal bleeding is associated with increased risk of preterm delivery and adverse outcomes, requiring prompt evaluation and possibly additional monitoring 3.