Prenatal visits follow the health of the pregnant patient and the fetus from early pregnancy to birth, usually every 4 weeks until 28 weeks and then more often. Each visit looks for problems early and gives advice that makes pregnancy and birth safer.
Key symptoms
- Common complaints: nausea, fatigue, back pain, heartburn
- Fetal movements, felt from about 18 to 20 weeks
- Bleeding, fluid leak, pain or contractions
- Headache, vision changes or swelling
- Mood, safety at home and substance use
What you find on exam
- Blood pressure and weight at every visit
- Fundal height from 20 weeks, roughly equal to the weeks of pregnancy
- Fetal heart rate with Doppler, normal 110 to 160
- Fetal position late in pregnancy; urine dipstick as needed
Tests
- First visit: blood type and Rh, antibody screen, blood count, HIV, syphilis, hepatitis B and C, rubella
- Dating ultrasound and genetic screening options
- Anatomy ultrasound at 18 to 22 weeks
- Glucose screening at 24 to 28 weeks; Group B Streptococcus swab at 36 to 37 weeks
Treatment basics
- Prenatal vitamin with at least 400 micrograms of folic acid daily
- Vaccines: Tdap, influenza, COVID-19 and RSV in season
- Low-dose aspirin for patients at high risk of preeclampsia
- Advice on nutrition, weight gain, safe activity and avoiding alcohol and smoking
- Rh immune globulin at 28 weeks if Rh negative
Red flags
- Vaginal bleeding or fluid leak
- Less fetal movement
- Severe headache, vision changes or blood pressure 140/90 or higher
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.