Overview of Prenatal Care Melissa Knabe, CNM Certified Nurse Midwife Department of OBGYN Slides courtesy of Dr. Suzanne Walczak

Goals Understand the importance of prenatal care and general aspects of care Understand barriers to prenatal care Learn how to advocate for your patient

Prenatal Care Ensure uncomplicated pregnancy and healthy mother and newborn Identify those at high risk for common pregnancy complications

Prenatal Care in Wisconsin ~ 72,000 births per year

Prenatal Providers in US

Most Common Pregnancy Related Complications Gestational Diabetes Pre-eclampsia Pre-term labor/delivery Intrauterine Growth Restriction Trauma or violence

Prenatal Care Schedule 1st visit at 6-8 wks Every 4 wks until 24 wks Every 2 wks 26-36 wks Weekly 36 wks until delivery

1st Prenatal Visit Establish gestational age Identify Risk Factors History Physical Exam Labs

Establishing Gestational Age Last menstrual period (LMP) Physical exam Ultrasound

History Previous Pregnancies Gynecologic Problems Medical and Surgical Problems Medications Smoking, Alcohol, Drugs Nutrition Psychosocial information

Routine Initial Labs CBC (Complete Blood Count) Blood Type and Antibody Screen Rubella Titer Hepatitis B Surface Antigen RPR (Syphilis test) HIV Urine Culture Pap smear Chlamydia and Gonorrhea cultures

Optional Labs Hemoglobin electrophoresis Glucose Challenge Test Thyroid Stimulating Hormone Tuberculosis Screen Cystic Fibrosis Genetic screening for high risk groups

Genetic Screening Trisomy 21 Trisomy 18 Neural Tube Defects (Down Syndrome) Trisomy 18 (Edward Syndrome) Neural Tube Defects

Genetic screening 1st trimester 2nd Trimester Nuchal Translucency Blood tests Beta human chorionic gonadotropin (beta-hCG) Pregnancy-associated plasma protein-A (PAPP-A) 2nd Trimester Anatomy ultrasound Alpha Feto Protein (AFP) Estradiol Inhibin A

Diagnostic Genetic Tests Chorionic Villus Sampling Amniocentesis

Routine Monitoring at Each Visit Blood pressure Urinalysis Weight Fetal Heart check Fetal position and movement Questions

Tests Later in Pregnancy Anatomy Ultrasound (20 wks) Screen for Gestational Diabetes (28 wks) Screen for Group B Strep (35 wks) Fetal testing if indicated Non-stress test Biophysical Profile

Important Counseling Preventable Birth Defects Seatbelt use Intimate Partner Violence Labor and Delivery Breastfeeding Contraception Circumcision

Labor and Delivery

Labor “Contractions causing cervical change” <37 weeks = preterm If no spontaneous labor by 41 weeks may induce labor Rupture of membranes may occur before or after onset of labor

Cervical exam eg. “4/80/-1” Dilation (0 to 10cm) Effacement (0 to 100%) Station (-5 to +5) eg. “4/80/-1”

Pain management Environmental and behavioral techniques Parenteral Opiods Epidural

Delivery Normal Spontaneous Vaginal Delivery Operative Delivery Forceps Vacuum Cesarean Section

Post-Partum 2-4 days in hospital 6 weeks until maternal physiology returns to baseline

Barriers to Prenatal Care Cost/Insurance Time Family Responsibilities Education

Advocating for your patient

Advocating for your patient You don’t have to know all the answers! Help her frame questions Help her understand what she can do to minimize identified risks Respect the gift that she gives you of allowing you to participate in her care Be aware of your limitations

Working with Staff Understand you are a guest Introduce yourself and your role Be conscious of the needs of other learners Contact me with any questions/concerns

Resources UpToDate.com What to Expect When Expecting www.whattoexpect.com MoMS Program Coordinator Melissa Knabe, CNM mknabe@mcw.edu Office: 414-805-4785