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Obstetric nuchal dating scan

The guidelines discussed in both parts of this article are summarized in a memory aid, the Maternity Care Calendar and Guidelines, available online at A recent meta-analysis found that reducing the number of prenatal visits did not lead to increased adverse outcomes for the mother or infant; however, women were less satisfied with the reduced-visit schedule.13 Caregiver continuity during the antenatal period has been associated with reduced interventions in labor and improved maternal satisfaction.14When pregnancy is confirmed, prenatal care plans, including the choice of caregiver, must be discussed. The initial visit should occur during the first trimester, and more than one visit may be necessary to cover all pertinent information.2 The estimated date of delivery (EDD) should be calculated by accurate determination of the last menstrual period (LMP).

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The evidence supporting these practices is variable Dipstick urinalysis does not detect proteinuria reliably in patients with early preeclampsia; measurement of 24-hour urinary protein excretion is the gold standard but is not always practical. The first 12 weeks of pregnancy are a time of organogenesis and heightened fetal vulnerability to teratogens; counseling about risk behaviors is appropriate. Issues to be discussed in early pregnancy are outlined in A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series. Recommendation statement: screening and behavioral counseling interventions in primary care to reduce alcohol misuse. Trace glycosuria also is unreliable, although higher concentrations may be useful.43A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series. See page 1245 for more information Dipstick urinalysis does not detect proteinuria reliably in patients with early preeclampsia; measurement of 24-hour urinary protein excretion is the gold standard but is not always practical. Trace glycosuria also is unreliable, although higher concentrations may be useful.43A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series. Sc., is associate professor and director of research in the Department of Family Practice at the University of British Columbia Faculty of Medicine, where he received his medical degree. D., University of British Columbia Faculty of Medicine, 200–2475 Bayswater St., Vancouver, British Columbia, Canada, V6K 4N3 (e-mail:[email protected]).

See page 1245 for more information Education is an important component of prenatal care, particularly for women who are pregnant for the first time. Reprints are not available from the authors The authors thank Carl Wiebe, M.

Genetic counseling should be offered to couples who did not receive it before conception.

Patients who belong to an ethnic group with an increased incidence of a recessive condition should be offered disease-specific screening as early in pregnancy as possible if they were not tested before conception 61 Most physicians use the mid-trimester maternal serum screen, which measures human chorionic gonadotropin (h CG), unconjugated estriol, and α -fetoprotein levels at 15 to 20 weeks’ gestation (optimal timing is 16 to 18 weeks’ gestation).1062 The maternal serum screen is approximately 65 percent sensitive for detecting aneuploidy and 95 percent specific.63 In some centers, fetal nuchal translucency can be measured by ultrasonography combined with maternal serum analyte levels (i.e., free h CG and pregnancy-associated plasma protein A).64 This testing can be performed at 10 to 14 weeks’ gestation. P., is clinical professor in the Department of Family Practice at the University of British Columbia Faculty of Medicine. Harris also is head of the Department of Family Practice at the Children’s and Women’s Health Centre of British Columbia, Vancouver.

Women at increased risk for aneuploidy should be offered amniocentesis or chorionic villus sampling. The implications of introducing the symphyseal-fundal height-measurement.

Counseling about the limitations and risks of these tests, as well as their psychologic implications, is necessary.

The first prenatal examination provides an opportunity for cervical cancer screening with a Papanicolaou (Pap) test in women who have not been screened recently. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. C.: American College of Obstetricians and Gynecologists, 2002.