Pregnancy


Screening/ImmunizationFrequency
WeightDiscuss with patient
Blood PressureInitial visit, and all follow-up visits
HematocritFirst visit
Urine culture or urinalysis for bacteuriaFirst visit
2Hepatitis B surface antigen (HBsAg) First visit
RPR/VDRLFirst Visit
History of genital herpetic lesions``Discuss with patient
7Chlamydia third trimester screen All women age 25 and younger and other women at increased risk for chlamydia Discuss with patient
Rubella serologyFirst visit
Vaccination history (general)First visit
14Tetanus and diphtheria(Td)First visit if person had received the primary series and the last dose was 10 years ago. 
D (Rh) incompatibilityFirst visit, repeat 24-28 weeks for unsensitized D negative
Offer HIV counseling & screeningDiscuss with patient
Chorionic villus screening (CVS) and counseling or amniocentesis and counseling  > 35 years of age<13 weeks 15-18 weeks
Multiple marker testingTo be performed
AlphaFeto-protein To be performed
Glucose tolerance test GDM screeningTo be performed according to ACOG and American Diabetes Association recommendations. 
Gonorrhea cultureTo be performed – High Risk according to ACOG
Group B streptococcal bacteriaAt initial visit and last trimester
10Ultrasonography To be performed – high risk population
6Influenza VaccinationTo be performed if pregnancy is at 2nd or 3rd trimester during influenza season
Prenatal care To be performed within the first 14 days of pregnancy diagnosis.  (Medi-Cal recommends the first 7 days of pregnancy diagnosis.)
Postpartum visit To be performed within three to eight weeks following delivery.
Additional Recommendations
Physicians should discuss with their female patients about taking 400 micrograms of folic acid to decrease the risk for fetal birth defects of the brain or spine.
17Meningococcal:  The CDC recommends vaccination for high-risk populations.
 
Counseling
Counseling to promote breastfeeding infant through at least 6 months of age.

Nutrition with counseling to maintain caloric balance, Injury Prevention, Seat Belt Use, Violence Prevention, Domestic Violence, Substance Avoidance (tobacco, alcohol, drugs, sexual behavior (sexually transmitted disease, HIV preventive education), Dental Health, Mental Health(depression), Regular Physical Activity to prevent coronary artery disease, hypertension, obesity and diabetes

 

Notes

1.Hematocrit See AAP Nutrition Handbook (1998) for a discussion of universal and selective screening options. Consider earlier screening for high-risk infants (e.g. premature and low birth weight). See also Recommendations to Prevent and Control Iron Deficiency in the United Sates. MMWR. 1998: 47 (RR-3): 1-29.


14.Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15 to `18 months. The final dose in the series should be given at age >4 years.

10.Routine Ultrasound Examinations The USPSTF does not recommend routine ultrasound examination of the fetus in the third trimester based on multiple trials and meta-analyses showing no benefit for either the pregnant woman or her fetus. There is currently insufficient evidence to recommend for or against a single routine mid-trimester ultrasound in low-risk pregnant women.

11.Hepatitis A vaccine is recommended for children and adolescents in selected states and regions and for certain high-risk groups; consult your local public health authority. Children and adolescents in these states, regions and high-risk groups who have not been immunized against hepatitis A can begin the immunization series during any visit. The 2 doses in the series should be administered at least 6 months apart. See MMWR 1999; 48(RR-12); 1-37

3.Varicella vaccine is recommended at any visit on or after the first birthday for susceptible children, i.e., those who lack a reliable history of chickenpox and who have not been immunized. Susceptible persons age 13 or older should receive two doses at least 4 weeks apart.

17.Meningococcal vaccine CDC recommendations are for routine immunization for patients age 11years and for patients age 15 years who have not been previously vaccinated. Immunization also recommended for high risk patients including: college freshman living in dormitories, microbiologists who are routinely exposed to N. meningitdis isolates, military recruits, persons living in or traveling to countries in which N. meningitdis is hyperendemic or epidemic, persons who have terminal complement deficiencies, persons who have anatomic or functional asplenia. MMWR May 27, 2005. Volume 54, No. RR-7 (1-17).

16.Pneumococcal vaccine. The Heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children age 2 to 23 months. It is also recommended for certain children age 24 to 59 months. The final dose in the series should be given at age >12 months.

2.Hepatitis B (HepB) vaccine. All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge; the first dose may also be given by age 2 months if the infant’s mother is hepatitis B surface antigen (HBsAg) negative. Only monovalent HepB can be used for the birth dose. Monovalent or combination vaccine containing HepB may be used to complete the series. Four doses of vaccine may be administered when a birth dose is given. The second dose should be given at least 4 weeks after the first dose, except for combination vaccines, which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 24 weeks.

6.Influenza vaccine. For Children and Adolescents influence vaccine is recommended annually for children aged ≥6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV and diabetes. In addition, healthy children ages 6-23 months and close contacts of healthy children ages 0-23 months are recommended to receive influenza vaccine, because children in this age group are at substantially increased risk for influenza-related hospitalizations. Children receiving trivalent inactivated influenza vaccine (TIV) should be administered a dosage appropriate for their age (0.25 mL if 6-35 months or 0.5 mL if ≥3 years). Children aged ≤8 years who are receiving influenza vaccine for the first time should receive 2 doses (separated by at least 4 weeks for TIV and at least 6 weeks for live, attenuated influenza vaccine [LAIV]).

9.Tuberculosis screening – The AAFP strongly recommends screening for tuberculosis by applying the mantoux test to patients at high risk for tuberculosis, including those with close contacts to a person with known or suspected TB, health care workers, immigrants from countries with high TB prevalence, HIV positive individuals, alcoholics, injection drug users, residents of long term care facilities, and medically underserved low income people.

13.Measles, mumps and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4 to 6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11 to12 year old visit.
Measles Component: Adults born before 1957 may be considered immune to measles. Adults born in or after 1957 should receive at least one dose of MMR unless they have a medical contraindication, documentation of at least one dose or other acceptable evidence of immunity. A second dose of MMR is recommended for adults who are recently exposed to measles or in an outbreak setting; were previously vaccinated with killed measles vaccine; were vaccinated with an unknown vaccine between 1963 and 1967; are students in post-secondary educational institutions; work in health care facilities; plan to travel internationally.

7.Chlamydia Routine screening is recommended for all sexually active female age 25 and younger, and other asymptomatic women at high risk of infection (new or multiple partners, history of sexually transmitted diseases, inconsistent or incorrect use of condoms). Pregnant women at high risk of infections (including age 25 and younger) should be tested, timing is uncertain. There is insufficient evidence to recommend for or against screening all women during pregnancy. See Centers for Disease Control and Prevention. Recommendations for the Prevention and Management of Chlamydia Trachomatis Infections, 1993. MMWR 1993; See also CDC Treatment of Sexually Transmitted Disease Guidelines 1998.

8.Cervical Cancer: AAFP strongly recommends routine screening with Papanicolaou (Pap) testing be performed at least every 3 years for all women who have ever had sex and have a cervix.

12.

Total Cholesterol Screening –AAFP strongly recommends screening for lipid disorders with either a fasting
lipid profile or nonfasting total cholesterol and HDL cholesterol in males age 35 and older, and females age 45 and older.

 

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