Columbus County Health Department Policy and Procedure
Maternal Health Laboratory and Testing
Policy Title:
Maternal Laboratory Testing
Program Area:
Maternity
Policy Identifier:
(optional)
Approval Date:
Effective Date:
4/15/09
Revision
Date(s):
Approved by:
Kim Smith RN, BSN, MSHCA, Health Director
Approved by:
Hilda Memory RN, BS, MSHA, Director of Nursing
2/24/2005
3/13/2006, 4/15/2010, 1/12/2015
Lisa Stevens Nurse-Midwife
Purpose:
Assess basic body chemistries that may have a direct bearing on pregnancy and
pregnancy outcomes.
Definitions:
Prevision for lab tests to access current health status, potential health problems, and
maintenance of pregnancy.
Responsibilities:
Nurse Practitioners, Enhanced Role Public Health Nurse
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Columbus County Health Department Policy and Procedure
Maternal Health Laboratory and Testing
Procedures:
Laboratory Tests (DHHS 4010)
A.
To be done at times listed below:
1.
Pregnancy test (done prior to admission to clinic).
2.
Serology (Syphilis Screening) on initial visit and at 28-30 weeks.
3.
CBC on the initial visit and then Hemoglobin and/or Hematocrit q (every)
month and PRN (as needed) until delivery.
4.
Blood grouping, RH type and antibody screening at initial visit.
5.
If Rh negative, order Rh antibody screen at 28 weeks and give Rhogam 9 (D
Immune Globulin) if indicated.
6.
Rubella titer if immunity or vaccine not documented in record.
7.
Varicella Titer if immunity or vaccine not documented in record.
8.
Urine dipstick for sugar and protein each visit, a urine culture on initial visit
(and as needed). Treat positive findings per UTI guidelines.
9.
Culture for gonorrhea on initial visit and at 35-37 weeks gestation. If
positive, treatment is given and culture is repeated in 3 weeks.
10.
Wet mount as needed per patient’s signs and symptoms.
11.
1 hour glucose test at 26-28 weeks gestation. If positive follow-up with 3
hour GTT. If positive follow Diabetes Screening Guidelines.
12.
Herpes culture when lesions present.
13.
Hepatitis B screening test on initial visit.
14.
AFP (Alpha Feto Protein) at 15-19 weeks gestation.
15.
Chlamydia test on initial visit and repeat at 35-37 weeks gestation. If
positive, treatment is given and culture is repeated in 3 weeks.
16.
Sickle Cell test (Hgb Electrophoresis) on all patients at initial visit if not
previously documented.
17.
HIV testing and counseling on initial visit if permitted by patient consent.
Repeat in the third trimester.
18.
Pap smear on initial visit according to American Society of Colpoposcopy
and Cervical Pathology Guidelines (ASCCP). I abnormal, follow-up is
provided per agency Pap Guidelines/Pap Screening Manual: A Guide for
Health Departments and Providers.
19.
Urine culture to include Group B Screen on initial visit.
20.
Group Beta Strep culture at 35-37 weeks and /or when indicated for PTL
(preterm labor). The only exception is when GBS is positive in urine culture
prior to 36 week testing then do not repeat test.
21.
Fetal Fibonectin when indicated for PTL (MD consult).
22.
To obtain form 4010 use the following link and click on maternity services:
http://whb.ncpublichealth.com/provPart/forms.htm\
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Columbus County Health Department Policy and Procedure
Maternal Health Laboratory and Testing
B.
If positive test results are indicated on the following, agency protocols for treatment,
CDC, STD Guidelines and NC STD Treatment Guidelines (as needed).
1.
2.
3.
4.
5.
Serology
Gonorrhea culture
Wet mount
Chlamydia
GBS culture
Laws and Rules:
Title X
Reference(s):
ASCCP guidelines.
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