Monday, May 20, 2013

So What Exactly IS "Prenatal Care" Anyway?

Prenatal care consists of a series of visits with a qualified provider of prenatal care (ObGyn, Women's Health Nurse Practitioner or Certified Nurse Midwife) during the course of a pregnancy to insure the optimal health and well-being of mother and child(ren).  In a low-risk pregnancy, we like to see a patient within 8--10 weeks since their last menstrual period.  The first visit includes extensive history-taking, counselling, physical exam, lab tests and education.  After that we see patients monthly until 32 weeks.  Those visits usually consist of a urine specimen, weight, blood pressure, a routine list of questions, a brief exam including a fetal heart rate check and belly measurement, and an opportunity to address any questions or problems that have arisen since the last visit.  At 32--36 wks the visits are 2 wks apart and after 36 wks they occur weekly.  A variety of routine tests are done at the first visit and we offer several optional tests for chromosomal or genetic abnormalities at that time.  At 20 wks a routine anatomic ultrasound study is performed (usually at an outside facility with a high-resolution ultrasound machine), and at 26--28 wks patients under screening for gestational diabetes.  At 35--36 wks we get a routine vaginal culture for group B strep of the vagina and after 36 wks we do weekly cervical checks for fetal position and cervical dilitation and effacement.

With high risk patients or patients who develop certain medical problems during a pregnancy, we sometimes ask them to come in a little more frequently.  Other patients we might have see the maternal fetal specialist (formerly known as "perinatologist") along with us during the pregnancy for a more intensive level of monitoring for a variety of fetal or maternal conditions, including multiple pregnancies, babies with growth or developmental issues, women with a history of preterm labor/delivery, or those with significant problems with blood pressure, diabetes, kidney/heart/endocrine or rheumatologic disease, etc.  Occasionally we also consult specialists in other fields for assistance in managing non-obstetric conditions during the pregnancy, but most minor ailments can be managed by our providers here in the office.  

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