What topics should be covered at a 34-week prenatal visit?

From the Guidelines

At a 34-week prenatal visit, healthcare providers should assess both maternal and fetal wellbeing, including measurement of vital signs, fundal height, fetal position, heart rate, and movement, as well as evaluate for pregnancy complications such as preeclampsia, gestational diabetes, and intrauterine growth restriction, and discuss signs of preterm labor, birth plans, and postpartum care, as recommended by the most recent guidelines 1. The visit should include:

• Measurement of vital signs (blood pressure, weight, urine analysis)
• Fundal height measurement
• Assessment of fetal position, heart rate, and movement
• Discussion of signs of preterm labor
• Review of birth plan
• Addressing questions about labor, delivery, or postpartum care
• Laboratory tests, such as Group B Streptococcus (GBS) screening, which is usually performed between 35-37 weeks to determine if antibiotics will be needed during labor
• Evaluation for pregnancy complications, such as preeclampsia, gestational diabetes, and intrauterine growth restriction, with monitoring for developing preeclampsia using urinalysis at each visit, along with clinical assessment and blood tests (Hb, platelet count, liver transaminases, uric acid, and creatinine) at 28 and 34 weeks as a minimum, as recommended by the International Society for the Study of Hypertension in Pregnancy 1
• Assessment of fetal well-being with ultrasound from 26 weeks’ gestation and thereafter at 2 to 4 weekly intervals if fetal biometry is normal and more frequently in the presence of suspected fetal growth restriction, as recommended by the International Society for the Study of Hypertension in Pregnancy 1
• Discussion of pediatrician selection, infant feeding plans, and postpartum contraception options
• Administration of Rho(D) immune globulin (RhoGAM) for women with Rh-negative blood type who are not sensitized, if not done already These assessments are crucial as you enter the final weeks of pregnancy when complications are more likely to develop and preparations for delivery become more urgent, and should be guided by the most recent and highest quality evidence, such as the 2021 guidelines from the Society for Maternal-Fetal Medicine 1.

From the Research

34 Week Prenatal Visit

At 34 weeks of pregnancy, the following topics may be covered during the prenatal visit:

• Discussion of the birth plan and any concerns or questions the patient may have
• Review of the patient's medical history and any complications that may have arisen during the pregnancy
• Measurement of the patient's blood pressure and weight
• Measurement of the fetal heart rate and assessment of fetal movement
• Discussion of breastfeeding and newborn care
• Review of any necessary vaccinations or medications, such as tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccines 2
• Screening for group B streptococcus (GBS) is typically performed between 36 and 37 weeks of pregnancy, but may be discussed at the 34 week visit in preparation for the screening 3, 4, 2, 5

Laboratory Tests

The following laboratory tests may be performed or discussed at the 34 week prenatal visit:

• Blood tests to check for anemia or other conditions
• Urine tests to check for protein or blood in the urine
• Screening for GBS, which is typically performed between 36 and 37 weeks of pregnancy 4, 2, 5
• Discussion of any previous test results, such as glucose screening or ultrasound results

Education and Preparation

The 34 week prenatal visit is also an opportunity to educate the patient on:

• Signs of labor and when to go to the hospital
• Breastfeeding and newborn care
• Postpartum recovery and self-care
• Any necessary preparations for the birth, such as packing a hospital bag or installing a car seat 6, 2