Pregnancy & Prenatal Care

D8. Pregnancy/Prenatal Care
D8.1 Discuss key pre-conception considerations in healthy women of childbearing age (e.g. folic acid supplementation, smoking, rubella immunity, etc.).
D8.2 Date a pregnancy accurately.
D8.3 Explore the patient’s feelings and concerns about a current pregnancy (e.g. supports, stressors, etc.).
D8.4 Perform an adequate first prenatal visit including taking a history and performing an appropriate focused physical exam with the assistance of available antenatal tracking tools.
D8.5 Screen for and identify pregnancies at risk (e.g. domestic violence, multiple gestation, maternal age, substance use, etc.).
D8.6 Conduct a basic prenatal visit, including BP measurement, weight, fetal heart rate (starting at 12 weeks), symphysis-fundal height (20 weeks and beyond), screening for concerns and complications.
D8.7 Provide basic education and counseling regarding lifestyle during the pregnancy (including weight gain, exercise, nutrition, and supplementation), breastfeeding, and delivery planning.
D8.8 Understand the components and timing of the various prenatal screening and diagnostic tests, including the Frist Trimester Screen, Maternal Serum Screen, Integrated Prenatal Screen,NonInvasive Prenatal Testing, Amniocentesis, and Chorionic Villus Sampling.
D8.9 Identify potential serious complications in the first trimester and their initial work-up, including ectopic pregnancy and miscarriage.
D8.10 Understand the risk, diagnosis, and management of pregnant women who are exposed to Varicella and Fifth Disease.
D8.11 Perform an adequate postpartum visit including:

  1. screen for postnatal complications including postnatal infections and thyroid disease
  2. assess for risk factors for and identifying domestic abuse and postpartum depression
  3. assess breast feeding concerns
  4. physical examination of a postpartum patient
  5. management of common postpartum complications

Articles

Preconception Health Care Tool

Barrett R, Deanna Telner D.  Preconception Health Care Tool.  Centre for Effective Practice.  Revised April 2015.  Available at https://thewellhealth.ca/

Update on Prenatal Care

Zolotor AJ, Carlough MC. Update on prenatal care. Am Fam Physician. 2014;89(3):199-208. doi: d10490 [pii].

Ontario Perinatal Record

Ontario Ministry of Health and Long-Term Care. 2017 Ontario Perinatal Record. 2017. Available at: http://www.pcmch.on.ca/

Sunnybrook DFCM Prenatal checklist

Domb S.  Sunnybrook DFCM Routine Prenatal Checklist.  Sunnybrook Health Sciences Centre.  Revised Oct 2015 Dr. S. Domb, Dr. M. Shuman.

Common Prenatal Problems Clinical Card-2011

Bach TV O’Beirne M Keegan DA.  Common Prenatal Problems.  Canadian Family Medicine Clinical Card.  2011.  Available at: https://sites.google.com/site/sharcfm/

First Trimester Bleeding

Deutchman M, Tubay AT, Turok D. First trimester bleeding. Am Fam Physician. 2009;79(11):985-994.

Diagnosis and Management of Ectopic Pregnancy

Barash JH, Buchanan EM, Hillson C. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2014;90(1):34-40. doi: d10859 [pii].

An Approach to the Postpartum Office Visit

Blenning CE, Paladine H. An approach to the postpartum office visit. Am Fam Physician. 2005;72(12):2491-2496.

Antenatal emodule

Akhtar S, Law M, Mardimae A et al.  Antenatal Primary Care: Family and Community Medicine Clerkship Core Curriculum Module.  University of Toronto.