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MARIANO MARCOS MEMORIAL HOSPITAL &

MEDICAL CENTER

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Title
Policies &

Department/ Section:
OBSTETRICS AND
GYNECOLOGY

Antenatal/Prenatal Care

Guidelines
Manual

Medical Policy

Category

OPD Services

Section

OB-GYNE Department

Review Responsibility

Protocol Committee

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Department/ Section:
MARIANO MARCOS MEMORIAL
OBSTETRICS AND
HOSPITAL &
GYNECOLOGY
MEDICAL CENTER
Department Chairman

Effective Date

Immediately

Team Members

OB-GYNE Consultants and Residents


Trainees, Midwives, Nurses

Physician Order Requirements

Yes

Approving Authority:

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Department/ Section:
OBSTETRICS AND
GYNECOLOGY

Dr. Ma. Lourdes K. Otayza, MD, MHA, CESO V, FPOGS


Chief of Hospital
Introduction:
In the Philippines, common causes of maternal mortality are hemorrhage,
hypertension and infections. These are usually preventable causes of maternal
mortality and morbidity.
I. Definition:

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MARIANO MARCOS MEMORIAL
OBSTETRICS AND
HOSPITAL &
GYNECOLOGY
MEDICAL CENTER
Prenatal care is a comprehensive antepartum care program that
involves a coordinated approach to medical care and psychosocial support
that optimally begins before conception and extend throughout the
antepartum period.

The contents of such a comprehensive program sincludes


1.
2.
3.
4.

Pre conceptional care


Prompt diagnosis of pregnancy
Initial presentation of pregnancy care
Follow up prenatal visits

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Department/ Section:
MARIANO MARCOS MEMORIAL
OBSTETRICS AND
HOSPITAL &
GYNECOLOGY
MEDICAL CENTER
Prenatal care is initiated as soon as pregnancy is diagnosed.

II. Goals of prenatal care:


1. To define the health status of the mother and fetus
2. To estimate the gestational age of the fetus.
3. To initiate a plan for continuing obstetrical care.
III. Guidelines:
Initial Visit:

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MARIANO MARCOS MEMORIAL
OBSTETRICS AND
HOSPITAL &
GYNECOLOGY
MEDICAL CENTER
1. Each patient is provided her own hospital record wherein a
complete history is taken with emphasis on the menstrual
obstetrical and medical history.

2. Laboratory work-ups done which include CBC, blood typing, urinalysis / culture,
Hep BsAg testing, Rubella screening, Papsmear.
3. Complete physical exam done including blood pressure and weight recording.
4. Pelvic ultrasonography may requested if necessary.
5. Testing for the major blood groups ABO is recommended.
6. Routine screening for Siphilis using non treponemal serologic test VDRL or
RPR.

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Department/ Section:
OBSTETRICS AND
GYNECOLOGY

Subsequent Visit:
The timing of subsequent prenatal visits has been scheduled at intervals of 4
weeks until 28 weeks and then every 2 weeks until 36 weeks and weekly thereafter.
1. Prenatal Surveillance is to determine the well being of the mother and
fetus, the following should be taken in every visit.
Fetal:
Fetal Heart Rate

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Size / current and rate of change
Amount of Amniotic Fluid
Presenting part and station (late in pregnancy)
Activity

Maternal:

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GYNECOLOGY

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MARIANO MARCOS MEMORIAL
OBSTETRICS AND
HOSPITAL &
GYNECOLOGY
MEDICAL CENTER
*Blood pressure measurement current and extent of change
*Weight monitoring current and amount of change
*Mild to moderate exercise 3 or more times per week
*Symptoms including headache, altered vision, abdominal
pain, nausea, vomiting, vaginal bleeding, vaginal fluid,
leakage and dysuria.
*Height in centimeters of uterine fundus from symphysis pubis
*Vaginal examination as necessary.

2. Assessment of Gestational Age : Fundic ht. , FHT, Ultrasonography


3. Subsequent Laboratory Test Universal screening of pregnant women
for gestational diabetes mellitus (GDM), routine screening for Syphilis

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MARIANO MARCOS MEMORIAL
OBSTETRICS AND
HOSPITAL &
GYNECOLOGY
MEDICAL CENTER
4. Immunization for tetanus toxoid : History of tetanus immunization
should be taken at the initial visit.

Universal screening of pregnant women for gestational diabetes mellitus (GDM)


using the 50-Gram Challenge Test between 24 and 28 weeks gestation is recommended. A
test value > 140 mg/dl or 7.8 mmol/li for plasma glucose is considered elevated.
All pregnant women should be instructed to perform daily fetal movement counting
starting at the third trimester of pregnancy.
The patients with the following past medical history are recommended for referral to
physician on first visit.

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Department/ Section:
OBSTETRICS AND
GYNECOLOGY

Past OB/GYN History:


-

Prior preterm delivery ( <37 weeks)


Intrauterine Fetal demise (IUFD) 10 weeks with no cardiac activity
Prior cervical / uterine surgery
Prior preterm labor requiring admission ( e.g., early cervical change)
Fetal anatomic abnormality ( e.g., open neural tube defects in prior child or first
degree relative)
Past complicated pregnancy

Medical History:

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-

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Department/ Section:
OBSTETRICS AND
GYNECOLOGY

Pre existing diabetes


Gestational diabetes

HIV

Chronic hypertension
Systematic disease that requires ongoing care ( e.g., severe asthma, lupus, and
inflammatory bowel disease)
Current mental illness requiring medical therapy
Cancer

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Seizure disorders
Hematologic disorders
Recurrent urinary tract infections/stones

Psycho Social :
-

Substance use disorders


Eating disorders
Postpartum depression

Conditions in Current Pregnancy :

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Age ( <16 or >35 years at delivery)
Vaginal bleeding

Effectivity Date:

Department/ Section:
OBSTETRICS AND
GYNECOLOGY

REFERENCES:
WILLIAMS OBSTETRICS 22ND EDITION by F. Gary Cunningham et al.
2005, Mcgraw Hill Companies, Inc., USA
Contemporary Management Options in Obstetrics and Gynecology, 2004
Annual Postgraduate Course, Dept. of OB-GYNE, Philippine General
Hospital, July 12-12,2004.

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TETANUS TOXOID SCHEDULE
TT1 1st prenatal
TT2 4 weeks after TT1
TT3 6 months after TT2
TT4 1 year after TT3 or during next pregnancy
TT5 - 1 year after TT4 or during next pregnancy

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MARIANO MARCOS MEMORIAL HOSPITAL &


MEDICAL CENTER

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Department/ Section:
OBSTETRICS AND
GYNECOLOGY