See YKHC Prenatal Care Reference for a summary of the details below.
We have a large number of pregnant patients, and many who are high risk. The OB Case Managers are an excellent resource. It is recommended to document any pregnancy problems in the HPI of your prenatal notes. An example:
Pt is a 32 yr old G5P3 AB1 with an EDC of 12/25/17 at 22 weeks gestation with a history of Cholestasis of Pregnancy and Kell Antibodies.
Use the OP PC Prenatal Visit Note for your prenatal visits. There are several auto-texts that can be used when documenting a First Prenatal or routine prenatal visits. These all start with ..ob (case sensitive). The ..ob1stpnhpi is particularly important to include for First Prenatal visits.
The nurse or provider should go through the Ad Hoc form “Perinatal Substance Use Screening” If the screening is positive, please place this in your note and refer to HROB rounds. You should also address the problem and do an SBIRT as time allows.
At the first prenatal visit you will also need to complete the 1st Prenatal Visit ad hoc form and copy the textual rendition of this form to your HPI.
- You should only open one 1st Prenatal Visit ad hoc form for each pregnancy.
- If you need to add or modify information, you should go to the Form Browser, find the 1st Prenatal Visit ad hoc form for the current pregnancy, right click and select Modify.
- see 1st Prenatal Workflow Learning Live for more information
Prenatal Appointment Schedule if Uncomplicated
Q4 week: Appts until 32 weeks
Q2 week: Until be-in-Bethel Date
Q1 week: Appts in Bethel and/or Anchorage
Prenatal Labs/Sono Needed
1st prenatal(If in SRC do labs): CBC, HepBsAg, RPR, CCUA and urine culture, Vitamin D, GC/CT, Rubella, PPD (see PowerPlan). Make appointment for 1st trimester sonogram in Bethel. We want a sonogram as early as possible on everyone.
11-13 weeks: If Advanced Maternal Age, 35 or older, first trimester screening for Down’s. Contact Ann Glasheen for particulars.
15-21 weeks: Do Quad screen
18-24 weeks: Make a 2nd Sonogram appointment in Bethel for Anatomy Screen
24-28 weeks: Prenatal with CBC/GST. If the GST is over 140, will need a 2hr GTT ASAP. Get Quantiferon gold if PPD not done.
36 weeks: Into Bethel (BIB) and/or Anchorage, CBC, GC/CT, and GBS culture
Premature Labor or no prenatal care delivery: Group B Strep (GBS) PCR or Xpert GBS
- Patients in the village with a positive pregnancy test.
- Health Aid contacts RMT.
- RMT provider uses the AMB Prenatal Supplement Power plan to write for cholecalciferol daily, Calcium/vitamin D daily, Ferrous Sulfate daily and prenatal vitamins daily 90 days with 3 refills from the pharmacy in Bethel NOT clinic dispensed.
- The pharmacy will mail the prescription to the patient.
- Patients in the SRC with a positive pregnancy test.
- SRC provider uses the SRC 1st Prenatal PowerPlan to write for cholecalciferol daily, Calcium/vitamin D daily, Ferrous Sulfate daily and prenatal vitamins daily 90 days with 3 refills from the pharmacy in Bethel.
- Patients in Bethel with a positive pregnancy test.
- Provider uses the AMB Prenatal Supplement to write for cholecalciferol daily, Calcium/vitamin D daily, Ferrous Sulfate daily and prenatal vitamins daily 90 days with 3 refills from the pharmacy in Bethel.
|Diagnosis/Indication||Gestational age to begin weekly Testing||Test||Stay in Bethel|
|Intrahepatic Cholestatis of Pregnancy (IHCP)||32 weeks or diagnosis||BPP||32 weeks or diagnosis|
|Gestational Pruritus||Kick Counts||not indicated|
|Pregestational DM||32 weeks||BPP||32 weeks|
|Gestational Diabetes (GDMA2)||32 weeks or diagnosis||BPP||32 weeks or diagnosis|
|Chronic Hypertension in Pregnancy||32 weeks||BPP||32 weeks|
|Pre-ecclampsia (see Gestational Hypertension||diagnosis||BPP||diagnosis|
|Chronic Kidney Disease||32 weeks||BPP||32 weeks|
|Intrauterine Growth Restriction (IUGR)||diagnosis||BPP with dopplers||32 weeks or diagnosis|
|SLE||32 weeks||BPP||32 weeks or diagnosis|
|Fetal Arrhythmia||diagnosis||BPP then kick counts||not indicated|
|Mono/Di twins||32 weeks||per Anchorage||30 weeks to Anchorage|
|Di/DI twins||if indicated||32 weeks to Anchorage|
|Obesity||32 weeks||Kick Counts||not indicated|
|Polyhydramnios||diagnosis||BPP||32 weeks or diagnosis|
|Prior stillbirth||32 weeks||BPP||32 weeks or 1 week before stillbirth|
|Single umbilical artery||Kick Counts||not indicated|