Prenatal screening

Pregnancy Screening & Testing

First prenatal visitBlood type & Rh Factor
Rubella IgG and IgM — positive IgG only = immune
VDRL (syphilis) — can use EIA Ab then RPR. Re-screen @ delivery
HIV antibody
STI (chlamydia, gonorrhea) — with NAAT
Varicella IgG — (+) means immune
Safe vaccines = Tdap, flu, HBV
Unsafe vaccines = HPV, MMR, Varicella, live attenuated influenza
Diclectin® (pyridoxine/doxylamine) for nausea/vomiting
Second prenatal visitPAP smear if not done in last 3 years
Week 11Dating ultrasound @ 8-12 weeks
Week 11-14: Beta-hCG, PAPP-A, nuchal translucency
Week 15-20: MSAFP, Beta-hCG, estrogen, inhibin A
Chorionic villus sampling (week 10), amniocentesis (week 15)
Week 20Ultrasound anatomy scan offered
Week 24-28Tdap @ 27-32 weeks
Week 35-37GBS swab
Week 38-39“Stretch & Sweep” — sweeping membranes to reduce incidence of late term pregnancy (low evidence, conditional recommendation)
Week 39 (full term)induce @ 39 weeks if GDM or older mom (≥40 years)
Late term induce when ≥41 weeks
C-section indications>4500g baby in GDM mom
>5000g baby in any mom
IOL (induction of labor)oxytocin or misoprostol
GBS- ROM — can do IOL or expectant management for 24h but no digital exams until active labor