Routine questions

• Cramping, bleeding, fluid leakage
• Fetal heart tones (US < 12 wks, Doppler > 12 wks)
• > 16 wks: fetal movement
• > 20 wks: measure fundal height

Initial visit

• PMH, PSH, FH, SH, Meds, Allergies
• Personal or FH of DVT/PE/stroke (@ early age)
• FH of developmental delay/birth defect; type
• FH of multiple miscarriages, bleeding, or clotting disorders
• Gyn hx
• Age at menarche
• Menses regular (Y/N), cycle length
• Any abnormal paps? When? +/- colpo/laser/LEEP/conization?
• STIs?
• Gyn surgeries?
• OB hx
• G[] P[ , , , ]
• Miscarriages (Y/N), number, at what gestational age
• Date of LMP? Was LMP normal in timing/duration?
• Vaccinations and dates (Tdap, MMR, Flu)
• Screened for CF, SC, Thalassemia, Ashkenazi panel?
• Labs
• Rh(D) type, antibody screen
• Hgb/Hct, MCV
• HIV< VDRL/RPR, HBsAg
• Rubella, varicella immunity
• Pap (if screening indicated)
• Chlamydia PCR
• UCx
• Dipstick for urine protein

• 18-20 wks - fetal survey - date scheduled?
• 24-28 wks 
• Gestational diabetes mellitus (GDM) screening (glucose measured 1 hr after 50 g glucose challenge)
• If positive (≥ 140 mg/dL), confirm diagnosis with 100-g 3-hour glucose tolerance test (positive if ≥ 2 abnormal values) 

• Blood glucose	Carpenter & Coustan	NDDG
  Fasting	≥ 95	≥ 105
  1 hr	≥ 180	≥ 190
  2 hr	≥ 155	≥ 165
  3 hr	≥ 140	≥ 145

• Goal: fasting ≤ 95 mg/dL, 1 hr ≤ 140 or 2 hr ≤ 120. Poor control a/w increased risk for pre-eclampsia, macrosomia/shoulder dystocia, neonatal hypoglycemia 
• 1st-line treatment: Dietary modifications
• 2nd-line treatment (if not meeting goals): Medications (insulin, metformin, glyburide OK in pregnancy)
• CBC to screen for anemia/need for iron supplementation
• Rh (+/-)
• If negative, antibody screening and Rhogam
• 32-34 wks
• Contraceptive counseling
• Review labor signs, make sure signed up for classes, know where triage is located, how to call after hours exchange
• 36-37 wks
• GBS screening
• CBC/HIV
• Scan for presentation