RECOMMENDED CARE AT VTSIT RESOURCES TO GIVEl f LNMP unknown, order an "urgent" f irst trimester U/S for datinglf 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) free for women 40 and over at BC women'sr Private options available for screening at various locations. Selum Integrated Prenatal Screen Part I available for women of all

Prenatal BiochemistryLaboratory Requisit ionPrivate Clinics

Routine PN ultrasound - for fetal detail ( if placenta , ' low lying',, need to repear

' Repeat cBC and screen for gestational diabetes (50 gm) plus repeat canadianBlood Services (CBS) iab work

. lf screen positive do full glucose tolerance test

. Referral to Obstetrician if previrtus c-section (to book C/S or VBAC

BreastfeedingPamphlets

28 WEEKS a

o

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t inq Fetal Movements

Rhogam shot if Rh negative (300 micrograms)Start q2 week prenatal visitsAdminister Edinburgh Postnatal Depression Scale

r Fetal Movement CountPamphlet

. Perinatal DepressionSupport lnformation

. Commence NSTs for insulin dependant or insulin required pregnanciestwice/week

35 - 37 WEEKS | . Vaginallanal swab for group B strepo Start weekly prenatal visits: Sgld original copy of Prenatal Historv Record to Labor & Deliverv LGH

41 WEEKS . U/S for f luid level. lmmediate induction indicated if AFI < 5 cm and DVp < 2. Begin twice weekly NSTs at local hospitalr Review Fetal Movement Counts. Review accuracy of EDC

' Discuss and book induction at 41 + 3 weeks

Minimum baby visits to physician at ' l , 3 and 6 weeks postpartumcommunity Health Nurse wil l contact patient within 24 hours after discharoelf mastitis present; treat with appropriate antibiotics for 7-.,| 0 days

I

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a Avoid codeine in the breastfeedino mother

. Mastitis Tx Protocols

' Coroners Report(Codeine)

1,3n{*$ver "',-);,..l;,,r:i l; i j,; I!"t*8EtfXl!,_,r( ira tLeil rrt)e..d ;itti q le ) t

VISIT

FROM6-sWEEKSOI{WARDS

12 WEEKS

15 - 20 WEEKS

18 - 20 WEEKS

21 WEEKS

24 - 28 WEEKS

32-36 WEEKS

Community & Family Health FlogramPerinatal & Paediatric Services

$tt$ PRENATAL cARE TIMELINE ff'$

OFFICIAL 1St PRENATAL VISIT - START PRENATAL RECORD

' Complete physical. PAP. Cervical swabs for Chlamydia and N. Gonorrhea. HlV, Hep B, syphil is, rubella antibody titre (CDC lab requisit ion). Blood type (CBS lab requisit ion)o CBC. Urinalysis, c&s for asymptomatic bacteruria (if positive, rlsk of preterm labour -

treat as per C&S). NOTE: Lab wil l only do if ordering physician clearlywrites "screen for asymptomatic bacteruria"

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Cornplete TWEAK ScoreStart monthlv prenatal visits

. Serum Integrated Screen Part 2

. Quad l,/ laternal Serum Screen if SIPS Part 1 not done

ATTENTION: once U/s report is back and blood work recorded on prenatalhistory. 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 society of obstetricians and Gynecologists of canada current quidelines)

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Baby's Best ChancePrenatal ClassSchedule

POSTPARTUM

G:\G BCU PS\PerinalaLPeds\Forms\,perinatat\prenatal Care Timeline .doc