Clinical Practice Guideline for
Routine Prenatal and Postpartum Care
Early prenatal care with ongoing risk assessment helps to ensure appropriate care for all patients,
to ensure good use of available resources, and to improve the outcome of pregnancies. Outcome
data suggests that babies born to mothers who do not receive prenatal care are 3 times more
likely to be of low birth weight, and 5 times more likely to die, compared with babies born to
mothers who receive prenatal care.
All patients should be evaluated within the first trimester of pregnancy by an obstetrician, nurse
midwife, family practitioner or other primary care practitioner providing perinatal services. This
initial encounter’s documentation should include: date prenatal care was initiated, date of LMP
and EDD.
Prenatal Care Guideline
Visit #1
6-12
weeks
Screening Maneuvers
Counseling & Education
 Risk Profiles: family history
& genetic risks
 Current Medications
 Height & Weight to calculate
BMI to determine weight
gain guidelines.
 OB History & Physical Exam
 Hemoglobin
 Urine
 Rubella Status
 ABO/Rh/Ab
 RPR or VDRL
 Hepatitis B
 Chlamydia/
Gonorrhea/Syphilis screening
(women at high risk or in
high prevalence areas should
be rescreened in the 3rd
trimester)
 Blood Pressure
 Fetal heart tones
 HIV testing discussion
 Domestic Abuse Screening
 Psychosocial Screening
 Integrated Screen
 Chorionic Villus sampling
 Lifestyle & Promotion of
healthy behaviors including:
-Dental care
-Wearing seat belts
-Continued exercise
-Avoiding substance &
hazardous-chemical exposure
-Minimal use of hot tubs or
saunas
-Sexual activity
-Smoking cessation
-Working
-Air travel
 Nutrition including:
-Prevention of Listeriosis
-Caffeine Intake limited to
< 200mg per day
 Weight gain
 Warning signs
 Course of Care
 Fetal growth
 Breast-feeding
 Body mechanics
 Review lab results
 Occupational hazards
 Risk Assessment including:
-Female Genital Mutilation
(FMG)
-Prior C-Section
(*if desired, coverage by
insurance will vary, check with
patient’s insurance)
 MaterniT21 Test (test for
pregnant women considered to
have a high risk of a child with
Trisomy 21. Coverage by
Immunization &
Chemoprophylaxis
 Nutritional supplements
(daily prenatal vitamin
containing Folate 400mcg
per day; ideally women
should start 12 weeks prior to
conception; women who
have had prior complicated
pregnancies with fetal neural
tube defects will require
higher doses of Folate at 4mg
per day.)
 Offer Inactivated Influenza
vaccine anytime during
pregnancy if necessary
during the Influenza season
October through May.
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Screening Maneuvers
Counseling & Education
Immunization &
Chemoprophylaxis
insurance will vary, check with
patient’s insurance)
 Genetic screening for cystic
fibrosis & muscular atrophy
 Further testing based on
physician discretion
Visit #2
16-18
weeks
 Weight
 Blood Pressure
 Fetal heart tones
 Fetal activity
 Integrated Screen
 Quad Screen
 Fundal height
 Urine albumin & glucose
 HgA1c for high risk
gestational diabetes
 Genetic amniocentesis (*if
 Second trimester growth
 Quickening
 Lifestyle
 Physiology of pregnancy
desired, coverage by insurance
will vary, check with patient’s
insurance)
 MaterniT21 Test (test for
pregnant women considered to
have a high risk of a child with
Trisomy 21. Coverage by
insurance will vary, check with
patient’s insurance)
Visit #3
20
weeks
Visit
#4
24
weeks
Visit #5
28
weeks
Visit #6
31
weeks
 Weight
 Blood Pressure
 Fetal heart tones
 Fundal height
 Fetal activity
 Urine albumin & glucose
 OB Ultrasound (optional)
 Weight
 Blood Pressure
 Fetal heart tones
 Fundal height
 Fetal activity
 Urine albumin & glucose
 Psychosocial Screening
 Preterm labor risk
 Weight
 Blood Pressure
 Fetal heart tones
 Fundal height
 Hemoglobin
 Gestational diabetes
screening
 Urine albumin & glucose
 Fetal activity
 Weight
 Blood Pressure
 Fetal heart tones
 Fundal height
 Preterm labor signs
 Childbirth Classes
 Family issues
 Length of stay
 Newborn care provider
Tdap ideally between 27 and
36 weeks of gestation.
 Work
 Physiology of pregnancy
 Pre-registration
 Fetal growth
 Awareness of fetal
movement - kick count
 Preterm labor symptoms
 Birthing options
 Baby feeding
 Rhogam (if indicated)
 Influenza (optional)
 Travel
 Sexuality
 Pediatric care
 Circumcision
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Screening Maneuvers
 Urine albumin & glucose
 Edema
 Fetal activity & position
Counseling & Education
Immunization &
Chemoprophylaxis
 Episiotomy
 Labor & Delivery issues
 Warning signs
 Weight
 Blood Pressure
Visit #7  Fetal heart tones
 Fundal height
 Urine albumin & glucose
34
 Edema
weeks
 Fetal activity & position
 Weight
 Postpartum care
 Blood Pressure
 Management of late
 Fetal heart tones
pregnancy symptoms
 Fundal height
 Contraception
Visit #8  Confirm fetal position
 Labor signs & symptoms
 Urine albumin & glucose
 When to call Dr
36
 Edema
weeks
 Fetal activity
 GBS (Group B Strep)
Screening
 Psychosocial Screening
 Weight
 Post-term management
 Blood Pressure
 Labor & delivery update
Visits
 Fetal heart tones
 Labor signs & symptoms
#9-13
 Fundal height
 When to call Dr.
 Check cervix (if indicated)
 Importance of postpartum
37-41
 Urine albumin & glucose
follow-up exam
weeks
 Edema
 Fetal activity & position
1. Patients who seek prenatal care after the first trimester will require completion of the items listed under visit #1
at the time of the first visit.
2. High risk pregnancies are managed per physician discretion.
Postpartum Care Guideline
Screening Maneuvers
Postpartum
 Weight
 Blood Pressure
 Breast Exam
 Abdominal Exam
 Pelvic Exam
 Physical, Social, & Psychological wellbeing including:
-Lack of sleep
-Fatigue
-Pain
-Breastfeeding difficulties
-Stress
-New onset or exacerbation of mental health
disorders
-Lack of sexual desire
Counseling & Education
 Postpartum Depression
 Birth Control
 Breastfeeding (if applicable)
 Pelvic Floor Muscle Exercises (Kegel’s)
 Women with pregnancies complicated by
preterm birth, gestational diabetes, or
hypertensive disorders of pregnancy should
be counseled that these disorders are
associated with a higher lifetime risk of
maternal cardiometabolic disease.
 Women with chronic medical conditions
such as hypertensive disorders, obesity,
diabetes, thyroid disorders, renal disease,
mood disorders, and substance use disorders
should be counseled about the importance
of timely follow up with the OB-GYN or
PCP for ongoing coordination of care.
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 For a woman who has experienced a
miscarriage, stillbirth, or neonatal death, it
is essential to ensure follow up with an OBGYN. Key elements include:
-Emotional support and bereavement
counseling
-Referral if appropriate to counselors and
support groups
-Review of any lab and pathology studies
related to the loss of the infant
-Counseling regarding recurrent risk and
future pregnancy planning
All patients should have a postpartum evaluation on or between 21 days and 56 days after delivery. C-section
patients should return to the office for staple removal as indicated by the practitioner, and should return to the
office between 21 days and 56 days after delivery for a postpartum evaluation.
-Urinary incontinence
References
Routine Prenatal Care. Epocrates with Citations from Institute of Medicine, CDC, and American
College of Obstetricians and Gynecologists (ACOG), March 3rd, 2020
Optimizing Postpartum Care. American College of Obstetricians and Gynecologists (ACOG),
May, 2018
Guidelines for Perinatal Care. American Academy of Pediatrics [and] the American College of
Obstetricians and Gynecologists, Sixth Edition, October 2007.
National Committee for Quality Assurance, HEDIS 2013 Technical Specifications for Health
Plans, Volume 2, Pages 253-263, October, 2012.
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