From the Guidelines
For an OB patient in clinic, you need to provide comprehensive prenatal care that includes regular check-ups, appropriate screenings, and patient education, prioritizing the patient's reproductive life plan and risk assessment as outlined in the most recent guidelines 1. To achieve this, begin by obtaining a thorough medical history, including previous pregnancies, medical conditions, medications, allergies, and family history.
- Perform a physical examination including vital signs, weight, fundal height measurement, fetal heart rate assessment, and evaluation for edema or other concerning signs.
- Order appropriate laboratory tests based on gestational age, including initial blood work (CBC, blood type, Rh status, rubella immunity, hepatitis B, HIV, syphilis screening), urine analysis, and glucose screening between 24-28 weeks.
- Schedule ultrasounds at appropriate intervals, typically at 8-12 weeks for dating, 18-22 weeks for anatomy scan, and as needed for specific concerns.
- Provide prenatal vitamins containing 400-800 mcg of folic acid daily throughout pregnancy.
- Counsel patients on nutrition, exercise, weight gain goals (typically 25-35 pounds for normal BMI), and warning signs that require immediate attention such as vaginal bleeding, decreased fetal movement, severe headache, visual changes, or contractions.
- Discuss birth plans, pain management options, and postpartum care including breastfeeding support and contraception plans, taking into account the patient's risk factors and medical history as outlined in 1. This comprehensive approach ensures optimal maternal and fetal health monitoring while preparing the patient for delivery and postpartum recovery, and is supported by the most recent guidelines from the American Journal of Obstetrics and Gynecology 1.
From the Research
Assessment and Care for OB Patients in Clinic
- The importance of early identification and management of high-risk obstetric patients is emphasized in various studies 2.
- High-risk patients who need special attention include those with airway problems, cardiorespiratory disease, and rare genetic conditions.
- Anaesthetic options for labour analgesia as well as anaesthesia for operative delivery should be discussed in detail with the patient if a delivery management plan is to be constructed 2.
Triage and Acuity Scales
- Triage in healthcare is sorting patients by acuity to prioritize them for full evaluation, and standardizing this process can improve patient flow and quality of care 3.
- The American College of Obstetricians and Gynecologists recommends that pregnant women be triaged based on acuity, rather than time of arrival.
- Obstetric triage acuity scales can serve as templates for use at the facility level and have been shown to result in timelier initial assessment and decreased wait times 3.
Folic Acid Supplementation
- Studies suggest that the use of folic acid may lower the risk of hypertensive disorders in pregnant women 4, 5.
- The odds of developing gestational hypertension and preeclampsia were significantly reduced as the duration of folic acid-containing supplement use increased 4.
- Folic acid supplementation during pregnancy could significantly reduce the risk of preeclampsia, particularly when taken as part of a multivitamin 5.