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OB Care
Disclaimer: This background information is not intended to be a comprehensive
scientific discussion of the topic, but rather an attempt to provide a baseline level
of information for anyone unfamiliar with the subject matter.
Background:
Prenatal Care
The overall utility of prenatal care as a series of visits conducted from the time of
conception through parturition has been well established. (Huntington, 1994). All
prenatal visits, including the preconception visit, are organized to include screening and
assessment maneuvers, counseling, education and intervention, and immunization and
chemoprophylaxis.
In 1989, the Expert Panel on the Content of Prenatal Care established guidelines on the
timing and content of prenatal care, including a schedule consisting of prenatal visits.
Timing and focusing prenatal visits at these intervals, along with providing designated
education pieces at each visit, should serve to provide a comprehensive and satisfying
prenatal program. (American College of Obstetrics and Gynecologists, 1989; Public
Health Service Expert Panel, 1989).
Each pregnant patient and each patient planning a pregnancy should receive a
comprehensive risk assessment and appropriate risk-related interventions, including risks
for preterm labor, relevant infectious diseases, and relevant genetic disorders.
For patients with previous Caesarean section, provide education of risks and benefits
associated with Vaginal Birth After Caesarean section (VBAC). Assess and document
patients' desire and appropriateness for VBAC.
Counseling for appropriate aneuploidy testing (screening) should be offered to all
pregnant women regarding the different screening options and the limitations and
benefits of each of the screening and diagnostic tests.
Labor and Delivery
Once it has been determined that a women is in labor, there are characteristics of routine
care for a patient at time of admission to the hospital:
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The patient’s prenatal history should be reviewed.
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A cervical exam is performed.
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Appropriate supportive care/comfort measures are provided.
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Documentation of the progress of labor using a graphic medium is helpful to the
patient as well as clinicians.
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Pain relief is administered
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The fetal heart rate is monitored
Supporting Evidence
American College of Obstetrics and Gynecologists, Practice Bulletins and
Committee on Obstetric Practice recommendations http://www.acog.org
Provides expert opinion, and evidence based guidelines defining basic, speciality and
subspeciality practices in perinatal care. Practice Bulletins summarize current
information on techniques and clinical management issues for the practice of obstetrics
and gynecology. Practice Bulletins are evidence-based documents, and recommendations
are based on the evidence.
Institute for Clinical Systems Improvement, Routine Prenatal Care Guideline,
August 2008.
This guideline pertains to the care of all women who are pregnant or are considering
pregnancy. All visits are outpatient/clinic based. It is an evidence-based guideline that
provides a comprehensive approach to the provision of prenatal services, counseling,
education and disease screening for average risk women.
Institute for Clinical Systems Improvement, Management of Labor Guideline, and
Admission for Routine Labor Order Set, March 2007.
This guideline and order set are evidence-based documents that outline and recommend
procedures and interventions for women who present in labor. This includes pre-term
management, active management of labor, fetal heart rate monitoring, failure to progress
in labor and vaginal birth after Caesarean section (VBAC).
U.S. Preventive Services Task Force http://www.ahrq.gov
An independent panel of experts in primary care and prevention convened by the
Public Health Service to conduct systematic reviews of the evidence to assess the
merits of preventive measures, including screening tests, counseling,
immunizations, and preventive medications.
Areas of Current Clinical Review and Discussion
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Counseling for appropriate aneuploidy testing (screening) should be offered to all
pregnant women regarding the different screening options and the limitations and
benefits of each of the screening and diagnostic tests.
•
Recognize and implement cultural differences among the practices of labor and
delivery.
Baskets of Care Scope Samples
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Routine prenatal care of all women who are pregnant. All visits are OP/Clinic
based. This does not include management of labor and delivery.
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Routine care of all pregnant women who present to an inpatient facility in
obstetric labor at 37 weeks gestation or greater. This excludes a Caesarean
delivery (planned or unplanned), and operative vaginal delivery procedures.
•
Care of all pregnant women who present at an inpatient facility for a scheduled
Caesarean delivery.
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Care of all pregnant women who present in labor. This would include Pre-term,
Full-term, VBAC, Failure to Progress and Caesarean delivery patients.