Summary of "Family Medicine: Prenatal Care | Lecturio"
Summary of Family Medicine: Prenatal Care | Lecturio
This video provides a comprehensive overview of routine prenatal care for average-risk pregnant women, emphasizing timing, procedures, screenings, lifestyle advice, and common patient questions.
Main Ideas and Concepts
Initial Prenatal Visit (around 8 weeks gestation)
- Initiate folic acid supplementation (recommended minimum 400 micrograms, often 1 mg daily).
- Perform the following tests:
- HIV testing
- Hepatitis B surface antigen testing
- Rubella immunity screening
- Do not measure fundal height yet (starts at 20 weeks).
- Complete pelvic exam.
- Check body weight and blood pressure.
Routine Prenatal Visit Schedule (for average-risk patients)
- Monthly visits until 28 weeks.
- Biweekly visits from 28 to 36 weeks.
- Weekly visits from 36 weeks until delivery.
- More frequent visits for high-risk pregnancies (e.g., diabetes, twins).
Clinical Monitoring During Pregnancy
- Fetal heart tones detectable by Doppler at 10–12 weeks.
- Fundal height measurement begins at 20 weeks.
- Fetal lie assessed at 36 weeks.
- Routine urinalysis at every visit is no longer favored due to poor sensitivity for gestational diabetes and preeclampsia.
- Cervical cancer screening only if due based on usual intervals, not routinely during pregnancy.
Laboratory Testing at Initial Visit
- Complete blood count (CBC)
- HIV test
- Hepatitis B surface antigen
- Blood type and Rh factor
- Rubella immunity
- Syphilis test
- Gonorrhea and chlamydia testing
- Urinalysis (initially)
Dietary Recommendations
- Most artificial sweeteners are safe except saccharine.
- Moderate caffeine intake (1–2 cups coffee/day) is acceptable.
- Avoid unpasteurized foods and deli meats due to Listeria risk.
- Fish consumption limited to 12 ounces per week; avoid high-mercury fish (swordfish, shark) and raw fish.
- Caloric increase during pregnancy is modest (~300–400 calories/day).
- Excessive weight gain can lead to gestational diabetes and hypertension.
Weight Gain Guidelines
- Normal weight: 11–15 kg (25–35 lbs).
- Overweight: lower gain recommended.
- Obese: 5–9 kg (11–20 lbs).
Common Patient Questions and Advice
- Air travel is safe up to 36 weeks, but risk of thrombosis on long flights should be considered.
- Exercise is encouraged (moderate, ~30 minutes most days).
- Avoid hair treatments, hot tubs, and saunas especially in the first trimester.
- Acetaminophen is the safest pain medication.
- Nausea/vomiting in first trimester managed with vitamin B6 and dietary adjustments (e.g., crackers on waking).
Ultrasonography
- Indicated if dates are unclear.
- Routine ultrasound at 18–20 weeks for fetal anatomy survey and aneuploidy screening.
- Routine ultrasounds reduce missed multiple gestations and post-dates pregnancy but benefits vary.
Screening for Aneuploidy
- Combined first and second trimester screening includes labs, ultrasound, and maternal factors.
- Positive screens may lead to amniocentesis or chorionic villus sampling.
- Amniocentesis carries a small risk (~0.5%) of miscarriage.
- Cell-free fetal DNA testing from maternal blood is accurate but costly.
Other Routine Screenings
- One-hour glucose tolerance test at 24–28 weeks for gestational diabetes.
- Early screening for obese women or those with prior gestational diabetes.
- Group B streptococcus screening at 35–37 weeks with IV antibiotics during labor if positive.
- Repeat urinalysis for bacteriuria between 11–16 weeks.
Vaccinations
- Influenza vaccine recommended during pregnancy (can delay until 2nd or 3rd trimester if concerned about first trimester risks).
- Tdap vaccine between 27–36 weeks gestation.
- Rubella vaccine contraindicated during pregnancy; administer postpartum if needed.
Detailed Methodology / Instructions for Prenatal Care
At Initial Visit (~8 weeks)
- Take complete history and perform pelvic exam.
- Order labs:
- CBC
- HIV
- Hepatitis B surface antigen
- Blood type and Rh factor
- Rubella immunity
- Syphilis
- Gonorrhea and chlamydia
- Start folic acid supplementation (1 mg daily).
- Measure weight and blood pressure.
- Counsel on diet, exercise, and lifestyle.
Subsequent Visits
(Details not provided in the summary)
Category
Educational
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