NU576 Unit 8 Seminar Notes: Prenatal & Postpartum Care Guidelines

NU576 Unit 8 Seminar Notes: Prenatal & Postpartum Care Guidelines

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NU576 NP II – Primary Care of Women’s Health

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NU576 Unit 8 Seminar Notes: Prenatal & Postpartum Care Guidelines

Prenatal care focuses on early identification of maternal and fetal risks, routine screening, health promotion, and timely management of complications. During pregnancy, healthcare providers evaluate medical history, medications, nutrition, lifestyle factors, fetal development, and maternal well-being through scheduled exams and evidence-based testing. Postpartum care continues this approach by monitoring physical recovery, preventing complications, and supporting mental health.

Prenatal Testing Guidelines

Initial Prenatal Assessment

The first prenatal visit includes a comprehensive review of the patient’s health history, current medications, supplements, allergies, vaccines, and lifestyle habits. Providers should identify risk factors that may affect pregnancy outcomes and provide appropriate education and referrals.

Key assessment areas include:

• Medication and supplement review, including prenatal vitamins and folic acid use

• Allergy history

• Vaccination status

• Past medical and surgical history

• Family and genetic history

• Social history, including substance use, safety concerns, and access to healthcare

• Diet, exercise, and lifestyle habits

Healthcare providers should also evaluate behaviors that may negatively affect pregnancy, counsel patients on avoiding teratogens, treat existing medical conditions, and provide resources for healthy pregnancy practices.

Genetic counseling referral may be recommended based on family history, maternal age, previous pregnancy complications, or identified genetic risks.

Routine Prenatal Laboratory Testing

Initial prenatal laboratory evaluation helps identify conditions that may affect maternal or fetal health.

Common prenatal tests include:

• Complete blood count (CBC)

• Comprehensive metabolic panel (CMP)

• Iron studies, including ferritin levels

• HIV screening

• Hemoglobin A1c when indicated

• Thyroid-stimulating hormone (TSH)

• Rubella and varicella immunity testing

• Hepatitis panel

• Pap smear when due

• Gonorrhea and chlamydia (GC/CT) testing

• Wet preparation testing when indicated

Additional testing may be based on individual patient history and risk factors.

Pregnancy Signs and Symptoms

Common early signs of pregnancy include:

• Amenorrhea (absence of menstruation)

• Nausea and vomiting

• Breast tenderness

• Increased urination

• Fatigue

Physical examination findings that may support pregnancy assessment include:

• Increased uterine size

• Chadwick sign (bluish discoloration of the cervix and vagina)

• Hegar sign (softening of the uterine isthmus)

• Fetal heart tones (FHT)

Pregnancy Dating and Documentation

Accurate pregnancy dating is important for monitoring fetal growth and scheduling appropriate testing.

Providers should:

• Calculate gestational age

• Estimate the expected delivery date (EDD)

• Track menstrual cycle history

• Review medication safety

• Begin or continue folic acid supplementation

• Discuss nutrition, exercise, and pregnancy safety

Documentation commonly includes patient-reported symptoms such as:

• Denies vaginal pain

• Denies vaginal bleeding

• Denies abnormal discharge

Referral discussions may include consultation with a midwife or obstetrician-gynecologist (OB/GYN) when appropriate.

Additional Pregnancy Testing by Gestational Age

First Trimester Testing

Initial pregnancy testing includes routine prenatal labs along with:

• Blood type and Rh factor

• Urine culture

Additional tests may be considered depending on patient history:

• Cystic fibrosis screening

• Cytomegalovirus (CMV) testing

• Diabetes screening

• Lead level testing

• Herpes testing

• Thyroid evaluation

• Tuberculosis (TB) screening

Second Trimester Testing

Between 15 and 20 weeks:

• Quad screen

• Alpha-fetoprotein (AFP) testing

Between 24 and 28 weeks:

• Glucose challenge test for gestational diabetes screening

• Repeat hemoglobin testing

• Rh-negative evaluation and management when indicated

Third Trimester Testing

Between 35 and 37 weeks:

• Group B Streptococcus (GBS) screening

• Sexually transmitted infection (STI) retesting when indicated

Fetal Well-Being Assessment

Routine fetal monitoring evaluates growth, development, and overall pregnancy health.

Assessment includes:

• Fundal height measurement

• Fetal heart tones

• Maternal fetal movement reports

• Maternal weight monitoring

• Blood pressure evaluation

• Urine dipstick testing

Diagnostic tools may include:

• Ultrasound

• Nonstress test (NST)

• Biophysical profile (BPP)

• Amniocentesis

• Chorionic villus sampling (CVS)

Postpartum Care and Assessment

Postpartum care occurs in three stages:

• Immediate postpartum period

• Early postpartum period

• Remote postpartum period

Assessment focuses on maternal recovery, prevention of complications, and emotional support.

Important postpartum evaluations include:

• Pelvic muscle recovery assessment

• Breast examination and breastfeeding support

• Contraceptive counseling

• Mental health screening

Postpartum Hemorrhage

Postpartum hemorrhage is excessive bleeding after childbirth and requires prompt evaluation and treatment.

Early Postpartum Hemorrhage Signs

Early hemorrhage may present with:

• Soft, boggy uterus due to uterine atony

• Cool or clammy skin

• Fever

• Tachycardia

• Dizziness or vertigo

• Tachypnea

Late Postpartum Hemorrhage Signs

Late hemorrhage may occur days to weeks after delivery and may include:

• Heavy lochia

• Foul-smelling lochia

• Fever

• Open cervical os

• Pelvic or back pain

• Uterine tenderness

• Prolonged bleeding

A common cause is subinvolution of the uterus, where the uterus does not return to its expected size after delivery.

Risk factors include:

• Distended bladder

• Retained placental fragments

• Endometritis

• Cesarean section delivery

• Uterine tumors or malignancy

Postpartum Urinary Tract Infection (UTI)

Postpartum UTI symptoms may include:

• Fever

• Costovertebral angle (CVA) tenderness

• Dysuria

• Urinary frequency

• Urinary urgency

Evaluation includes:

• Urinalysis (UA)

• Urine culture and sensitivity testing

Treatment may include antibiotics such as nitrofurantoin (Macrobid) when clinically appropriate.

Postpartum Psychosocial Health

Postpartum mental health conditions vary in severity and require early recognition.

Postpartum Blues

Common symptoms include:

• Crying episodes

• Irritability

• Anxiety

• Mood changes

Postpartum blues are usually temporary and improve with support and monitoring.

Postpartum Depression

Postpartum depression involves more intense and persistent symptoms, including:

• Significant sadness

• Loss of interest

• Difficulty functioning

• Anxiety

• Changes in sleep or appetite

Treatment may include counseling, support services, and medications such as sertraline when appropriate.

Postpartum Psychosis

Postpartum psychosis is a psychiatric emergency characterized by:

• Manic symptoms

• Delirium or confusion

• Hallucinations or delusions

• Severe mood disturbance

Immediate psychiatric evaluation and treatment are required.

Unit 8 Key Clinical Review Points

Important concepts to remember:

• Review medications and start folic acid during prenatal care.

• Identify and reduce exposure to pregnancy teratogens.

• Perform routine prenatal screenings based on gestational age and risk factors.

• Monitor fetal well-being through physical assessment and diagnostic testing.

• Educate patients about nutrition, exercise, and pregnancy safety.

• Recognize postpartum hemorrhage, infection, and mental health complications early.

• Provide appropriate referrals to OB/GYN, midwives, genetics, or specialty care when needed.

References

American College of Obstetricians and Gynecologists. (2021). ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists. https://www.acog.org/clinical

American College of Obstetricians and Gynecologists. (2024). Prenatal care. https://www.acog.org/womens-health/faqs/routine-tests-during-pregnancy

Centers for Disease Control and Prevention. (2024). Pregnancy and vaccination. https://www.cdc.gov/vaccines-pregnancy/

American Academy of Pediatrics, & American College of Obstetricians and Gynecologists. (2017). Guidelines for perinatal care (8th ed.). American Academy of Pediatrics. https://publications.aap.org

NU576 Unit 8 Seminar Notes: Prenatal & Postpartum Care Guidelines

World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. https://www.who.int/publications/i/item/9789241549912

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision). https://www.psychiatry.org/psychiatrists/practice/dsm