RECOMMENDED CAREAT VTSIT RESOURCES TO GIVE lf LNMP unknown, order an "urgent" first trimester U/S for dating lf ultrasound not available on the Norlh Shore, consider options in VCH Prenatal Screening . All Rh negative patients require Rhogam for pv bleeding Early Pregnancy Loss 1O _ 13 WEEKS . Nuchal rranslucency Test (optional) freefor women 40 and overat BC women's r Private options available for screening at various locations . Selum Integrated Prenatal Screen Part I available for womenof all Prenatal Biochemistry Laboratory Requisition Private Clinics Routine PN ultrasound - for fetal detail (if placenta ,'low lying',, needto repear ' Repeat cBC and screen for gestational diabetes (50 gm) plus repeat canadian Blood Services (CBS) iab work . lf screen positive do fullglucose tolerance test . Referral to Obstetrician if previrtus c-section (to bookC/S or VBAC Breastfeeding Pamphlets 28 WEEKS a o a t inq Fetal Movements Rhogam shot if Rh negative (300micrograms) Start q2 week prenatal visits Administer Edinburgh Postnatal Depression Scale r Fetal Movement Count Pamphlet . Perinatal Depression Support lnformation . Commence NSTs for insulin dependant or insulin required pregnancies twice/week 35 - 37 WEEKS | . Vaginallanal swabfor groupB strep o Start weeklyprenatal visits : Sgld original copy of Prenatal Historv Record to Labor & Deliverv LGH 41 WEEKS . U/S for fluidlevel. lmmediate induction indicated if AFI < 5 cm and DVp < 2 . Begin twiceweekly NSTsat local hospital r Review Fetal Movement Counts . Review accuracy of EDC ' Discuss and book induction at 41 + 3 weeks Minimum babyvisits to physician at 'l , 3 and 6 weeks postpartum community Health Nurse willcontact patient within 24 hoursafter discharoe lf mastitis present; treat with appropriate antibiotics for 7-.,| 0 days I a o a Avoidcodeine in the breastfeedino mother . Mastitis Tx Protocols ' Coroners Report (Codeine) 1,3n{*$ver "',-); ,..l;,,r:i l;i j,; I!"t*8EtfX l!,_,r( ira tLeil rrt)e..d ;itti q le ) t VISIT FROM6-sWEEKS OI{WARDS 12 WEEKS 15- 20 WEEKS 18 - 20 WEEKS 21 WEEKS 24 - 28 WEEKS 32-36 WEEKS Community& FamilyHealthFlogram Perinatal & Paediatric Services $tt$ PRENATAL cARE TIMELINE ff'$ OFFICIAL 1St PRENATAL VISIT - START PRENATAL RECORD ' Complete physical . PAP . Cervical swabsfor Chlamydia and N. Gonorrhea . HlV, Hep B, syphilis, rubella antibody titre(CDClab requisition) . Blood type (CBSlab requisition) o CBC . Urinalysis, c&s for asymptomatic bacteruria (if positive, rlskof preterm labour - treatas per C&S). NOTE: Lab will only do if ordering physician clearly writes "screen for asymptomatic bacteruria" a a Cornplete TWEAKScore Startmonthlv prenatal visits . SerumIntegrated Screen Part2 . Quad l,/laternal Serum Screen if SIPSPart 1 not done ATTENTION:once U/s report is back and blood work recorded on prenatal history . Fax copy of completed prenatal history to Labour & Delivery at LGH {604-9g3- 6045) . Give patient if travel olans Standard of Care determined by LGH perinatat Carc C (As per societyof obstetricians and Gynecologists of canada current quidelines) a o Baby's BestChance Prenatal Class Schedule POSTPARTUM G:\G BCU PS\PerinalaLPeds\Forms\,perinatat\prenatal CareTimeline .doc