At all visits: Weight, BP, UA

At visits > 10 weeks: FHTs

At visits > 20 weeks: umbilical height

 

Howard Zone:                                          D                                                                           C                                                B                                                            A

Age wks

<10 or 1st Visit

10-13 [2]

15-18 [3]

18-20

20-24 [4]

24-28 [*]

28 [5]

32 [6]

34 [7]

34-36

36 [8]

37 [9]

38 [10]

39 [11]

40 [12]

41 [13]

>41

General Pregnancy

H&P; CBC; ABO/Rh/Ab; Rubella; Syphillis; HIV; HCV; HBV; GC/Chlamydia;

[UA, TSH, UDS]

[1st Trim. Anomoly screening]

Quad Screen

Anatomy US

 

GTT (if risk factors)

GTT @ 28 wk; Rhogam @ 28 wk if ind.

 

 

 

GBS

Fetal position

 

 

 

 

 

IOL

Labor/ PTL

 

 

 

 

 

Steroids, 48 hours of  tocolytics

Expectant Management

Expectant Management or Active Management

 

Previous LTCS, Desires repeat

 

 

 

 

 

 

 

 

 

 

 

 

 

Repeat CS at 39 wks or active labor

 

Prev Active Segment CS

 

 

 

 

 

 

 

 

 

 

Repeat CS in active labor or at 36-37 wks +/- Amnio for FLM

 

ROM

D+C or Expectant Management

Termination if chorio or desired, otherwise EM

Hospitilization, steroids, 7 days of antibiotics,

Delivery if Chorioamnionitis

IOL, EM

 

CHTN-Low Risk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Del. @ 40 wks

 

CHTN-High Risk

 

 

 

 

 

 

 

 

 

 

Delivery at 36-37 wks with + FLM

 

GHTN

 

 

 

 

 

 

 

 

 

 

 

IOL if Bishop score ≥ 6 @ 37 wks

 

 

Del. @ 40 wks

 

Mild Preeclampsia

 

 

 

 

 

Steroids, EM, Hospitilization if < 34 wks

 

 

Delivery at ≥ 37 wks

 

Severe Preeclampsia

 

 

 

 

 

Magnesium Sulfate, Steroids, Delivery at ≥ 34 wks