Antenatal Prental Care Policies & Guidelines

MARIANO MARCOS MEMORIAL HOSPITAL & MEDICAL CENTER of 16

TITLE: Issue:

Revision:

Document No.:

(Type of Document) Effectivity Date:

MARIANO MARCOS MEMORIAL HOSPITAL & MEDICAL CENTER

Department/ Section:OBSTETRICS AND GYNECOLOGY

Title : Antenatal/Prenatal Care Policies &

Guidelines

Manual : Medical Policy

Category : OPD Services

Section : OB-GYNE Department

Review Responsibility : Protocol Committee

______________________________ ________________________________ _________________________________ Prepared by: Checked by: Approved by:


TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGY Department Chairman

Effective Date : Immediately

Team Members : OB-GYNE Consultants and Residents Trainees, Midwives, Nurses

Physician Order Requirements : Yes

Approving Authority:



TITLE: Issue:

Revision:

Document No.:




Dr. Ma. Lourdes K. Otayza, MD, MHA, CESO V, FPOGS

Chief of Hospital

Introduction:In the Philippines, common causes of maternal mortality are hemorrhage,

hypertension and infections. These are usually preventable causes of maternal mortality and morbidity.

I. Definition:



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGYPrenatal care is a comprehensive antepartum care program that

involves a coordinated approach to medical care and psychosocial support that optimally begins before conception and extend throughout the antepartum period.

The contents of such a comprehensive program sincludes

1. Pre – conceptional care2. Prompt diagnosis of pregnancy3. Initial presentation of pregnancy care4. Follow up prenatal visits



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGYPrenatal care is initiated as soon as pregnancy is diagnosed.

II. Goals of prenatal care:

1. To define the health status of the mother and fetus2. To estimate the gestational age of the fetus.3. To initiate a plan for continuing obstetrical care.

III. Guidelines:

Initial Visit:



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGY1. Each patient is provided her own hospital record wherein a

complete history is taken with emphasis on the menstrual obstetrical and medical history.

2. Laboratory work-ups done which include – CBC, blood typing, urinalysis / culture, Hep BsAg testing, Rubella screening, Papsmear.

3. Complete physical exam done including blood pressure and weight recording.4. Pelvic ultrasonography may requested if necessary.5. Testing for the major blood groups ABO is recommended.6. Routine screening for Siphilis using non – treponemal serologic test VDRL or

RPR.



TITLE: Issue:

Revision:

Document No.:




Subsequent Visit:

The timing of subsequent prenatal visits has been scheduled at intervals of 4 weeks until 28 weeks and then every 2 weeks until 36 weeks and weekly thereafter.

1. Prenatal Surveillance – is to determine the well being of the mother and fetus, the following should be taken in every visit.

Fetal:



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGYFetal Heart Rate

Size / current and rate of changeAmount of Amniotic FluidPresenting part and station (late in pregnancy)

Activity

Maternal:



TITLE: Issue:

Revision:

Document No.:




*Blood pressure measurement – current and extent of change*Weight monitoring – current and amount of change*Mild to moderate exercise – 3 or more times per week*Symptoms – including headache, altered vision, abdominal

pain, nausea, vomiting, vaginal bleeding, vaginal fluid, leakage and dysuria.

*Height in centimeters of uterine fundus from symphysis pubis*Vaginal examination as necessary.

2. Assessment of Gestational Age : Fundic ht. , FHT, Ultrasonography



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGY3. Subsequent Laboratory Test – Universal screening of

pregnant women for gestational diabetes mellitus (GDM), routine screening for Syphilis

4. Immunization for tetanus toxoid : History of tetanus immunization should be taken at the initial visit.

Universal screening of pregnant women for gestational diabetes mellitus (GDM) using the 50-Gram Challenge Test between 24 and 28 weeks’ gestation is recommended. A test value > 140 mg/dl or 7.8 mmol/li for plasma glucose is considered elevated.

All pregnant women should be instructed to perform daily fetal movement counting starting at the third trimester of pregnancy.



TITLE: Issue:

Revision:

Document No.:




The patients’ with the following past medical history are recommended for referral to physician on first visit.

Past OB/GYN History:

- Prior preterm delivery ( <37 weeks)- Intrauterine Fetal demise (IUFD) – 10 weeks with no cardiac activity- Prior cervical / uterine surgery- Prior preterm labor requiring admission ( e.g., early cervical change)- Fetal anatomic abnormality ( e.g., open neural tube defects in prior child or first

degree relative)



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGY- Past complicated pregnancy

Medical History:

- Pre – existing diabetes- Gestational diabetes- HIV

- Chronic hypertension



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGY- Systematic disease that requires ongoing care ( e.g., severe

asthma, lupus, and inflammatory bowel disease)- Current mental illness requiring medical therapy- Cancer

- Seizure disorders- Hematologic disorders- Recurrent urinary tract infections/stones

Psycho – Social :

- Substance use disorders- Eating disorders



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGY- Postpartum depression

Conditions in Current Pregnancy :

- Age ( <16 or >35 years at delivery)- Vaginal bleeding

REFERENCES:

WILLIAMS OBSTETRICS 22ND EDITION by F. Gary Cunningham et al.2005, Mcgraw – Hill Companies, Inc., USA



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGYContemporary Management Options in Obstetrics and Gynecology,

2004 Annual Postgraduate Course, Dept. of OB-GYNE, Philippine General

Hospital, July 12-12,2004.

TETANUS TOXOID SCHEDULE

TT1 – 1st prenatal

TT2 – 4 weeks after TT1



TITLE: Issue:

Revision:

Document No.:



Department/ Section:OBSTETRICS AND GYNECOLOGYTT3 – 6 months after TT2

TT4 – 1 year after TT3 or during next pregnancy

TT5 - 1 year after TT4 or during next pregnancy


Antenatal Prental Care Policies & Guidelines

Documents

Transcript of Antenatal Prental Care Policies & Guidelines