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
Immunization &
Screening Maneuvers Counseling & Education
Chemoprophylaxis
 Risk Profiles: family history  Lifestyle & Promotion of  Nutritional supplements
& genetic risks healthy behaviors including: (daily prenatal vitamin
 Current Medications -Dental care containing Folate 400mcg
 Height & Weight to calculate -Wearing seat belts per day; ideally women
BMI to determine weight -Continued exercise should start 12 weeks prior to
gain guidelines. -Avoiding substance & conception; women who
 OB History & Physical Exam hazardous-chemical exposure have had prior complicated
 Hemoglobin -Minimal use of hot tubs or pregnancies with fetal neural
 Urine saunas tube defects will require
 Rubella Status -Sexual activity higher doses of Folate at 4mg
 ABO/Rh/Ab -Smoking cessation per day.)
 RPR or VDRL -Working  Offer Inactivated Influenza
 Hepatitis B -Air travel vaccine anytime during
 Chlamydia/  Nutrition including: pregnancy if necessary
Visit #1 Gonorrhea/Syphilis screening -Prevention of Listeriosis during the Influenza season
(women at high risk or in -Caffeine Intake limited to October through May.
6-12 high prevalence areas should < 200mg per day
weeks be rescreened in the 3rd  Weight gain
trimester)  Warning signs
 Blood Pressure  Course of Care
 Fetal heart tones  Fetal growth
 HIV testing discussion  Breast-feeding
 Domestic Abuse Screening  Body mechanics
 Psychosocial Screening  Review lab results
 Integrated Screen  Occupational hazards
 Chorionic Villus sampling  Risk Assessment including:
(*if desired, coverage by -Female Genital Mutilation
insurance will vary, check with (FMG)
patient’s insurance) -Prior C-Section
 MaterniT21 Test (test for
pregnant women considered to
have a high risk of a child with
Trisomy 21. Coverage by

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 Immunization &
Screening Maneuvers Counseling & Education
Chemoprophylaxis
insurance will vary, check with
patient’s insurance)
 Genetic screening for cystic
fibrosis & muscular atrophy
 Further testing based on
physician discretion
 Weight  Second trimester growth
 Blood Pressure  Quickening
 Fetal heart tones  Lifestyle
 Fetal activity  Physiology of pregnancy
 Integrated Screen
 Quad Screen
 Fundal height
 Urine albumin & glucose
Visit #2  HgA1c for high risk
gestational diabetes
16-18  Genetic amniocentesis (*if
weeks 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)
 Weight  Preterm labor signs
 Blood Pressure  Childbirth Classes
Visit #3
 Fetal heart tones  Family issues
 Fundal height  Length of stay
20
 Fetal activity  Newborn care provider
weeks
 Urine albumin & glucose
 OB Ultrasound (optional)
 Weight Tdap ideally between 27 and
Visit  Blood Pressure 36 weeks of gestation.
#4  Fetal heart tones
 Fundal height
24  Fetal activity
weeks  Urine albumin & glucose
 Psychosocial Screening
 Preterm labor risk  Work  Rhogam (if indicated)
 Weight  Physiology of pregnancy  Influenza (optional)
 Blood Pressure  Pre-registration
Visit #5  Fetal heart tones  Fetal growth
 Fundal height  Awareness of fetal
28  Hemoglobin movement - kick count
weeks  Gestational diabetes  Preterm labor symptoms
screening  Birthing options
 Urine albumin & glucose  Baby feeding
 Fetal activity
Visit #6  Weight  Travel
 Blood Pressure  Sexuality
31  Fetal heart tones  Pediatric care
weeks  Fundal height  Circumcision

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 Immunization &
Screening Maneuvers Counseling & Education
Chemoprophylaxis
 Urine albumin & glucose  Episiotomy
 Edema  Labor & Delivery issues
 Fetal activity & position  Warning signs

 Weight
 Blood Pressure
Visit #7  Fetal heart tones
 Fundal height
34  Urine albumin & glucose
weeks  Edema
 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
weeks follow-up exam
 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 Counseling & Education
 Weight  Postpartum Depression
 Blood Pressure  Birth Control
 Breast Exam  Breastfeeding (if applicable)
 Abdominal Exam  Pelvic Floor Muscle Exercises (Kegel’s)
 Pelvic Exam  Women with pregnancies complicated by
 Physical, Social, & Psychological well- preterm birth, gestational diabetes, or
being including: hypertensive disorders of pregnancy should
be counseled that these disorders are
-Lack of sleep
Postpartum associated with a higher lifetime risk of
-Fatigue maternal cardiometabolic disease.
-Pain  Women with chronic medical conditions
-Breastfeeding difficulties such as hypertensive disorders, obesity,
diabetes, thyroid disorders, renal disease,
-Stress
mood disorders, and substance use disorders
-New onset or exacerbation of mental health should be counseled about the importance
disorders of timely follow up with the OB-GYN or
-Lack of sexual desire PCP for ongoing coordination of care.

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 -Urinary incontinence  For a woman who has experienced a
miscarriage, stillbirth, or neonatal death, it
is essential to ensure follow up with an OB-
GYN. 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.

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.

Original: 10/98 Revised: 06/02 Reviewed: 06/07 Revised: 11/12

Reviewed: 09/99 Revised: 10/03 Revised: 07/08 Revised: 07/14
Reviewed: 10/99 Revised: 06/04 Reviewed: 09/09 Reviewed: 04/16
Revised: 10/00 Revised: 01/05 Reviewed: 11/10 Revised: 01/18
Reviewed: 09/01 Revised: 01/06 Reviewed: 11/11 Revised: 05/20

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