Prenatal visits should begin as early as possible after the diagnosis of pregnancy. The initial visit should include a history, physical examination, advice to the patient, and appropriate tests and procedures (see CMDT Online at AccessMedicine.com for a discussion of routine prenatal care).
The patient's age, ethnic background, and occupation should be obtained. The onset of the last menstrual period and its normality, possible conception dates, bleeding after the last menstruation, medical history, all prior pregnancies (duration, outcome, and complications), and symptoms of present pregnancy should be documented. The patient's nutritional habits should be discussed with her, as well as any use of caffeine, tobacco, alcohol, or drugs (Table 19–1). Whether there is any family history of congenital anomalies and heritable diseases, a personal history of childhood varicella, prior sexually transmitted diseases (STDs), or risk factors for HIV infection should be determined. The woman should be screened for domestic violence. She should also be asked about recent travel to determine the possibility of exposure to the Zika virus.
Height, weight, and blood pressure should be measured, and a general physical examination should be done, including a breast examination. Abdominal and pelvic examination should include the following: (1) estimate of uterine size or measure of fundal height; (2) evaluation of bony pelvis for symmetry and adequacy; (3) evaluation of cervix for structural anatomy, infection, effacement, dilation; and (4) detection of fetal heart tones by Doppler device after 10 weeks.
Prenatal care should begin early and maintain a schedule of regular prenatal visits: 4–28 weeks, every 4 weeks; 28–36 weeks, every 2 weeks; 36 weeks on, weekly.
The patient should be counseled to eat a balanced diet containing the major food groups. See Nutrition in Pregnancy, below.
Prenatal vitamins with 30–60 mg of elemental iron and 0.4 mg of folic acid should be prescribed. Supplements that are not specified for pregnant women should be avoided as they may contain dangerous amounts of certain vitamins.
Caffeine intake should be decreased to 0–1 cup of coffee, tea, or caffeinated cola daily.
The patient should be advised to avoid eating raw or rare meat as well as fish known to contain elevated levels of mercury.
Patients should be encouraged to eat fresh fruits and vegetables (washed before eating).
Only medications prescribed or authorized by the obstetric provider should be taken since certain medications are contraindicated during pregnancy (Table 19–1).
Table 19–1.Common drugs that are teratogenic or fetotoxic.1