A 25-year old Caucasian female presents at the clinic on the 1-15-2013, and reports having had her last menstrual period on December 1st, 2012. Using the Naegele’s formula, and basing the dates on the last normal menstrual period, the expected date of delivery is the 8th of September 2013. Gestation by dates is six weeks and three days. The formula requires that one adds seven days to the LMP and then subtracts three months. As such, the most important patient factor is the last normal menstrual period or LMP.
Based on the dating of the patient’s pregnancy, she is still in her first trimester at six weeks three days. This is a period characterized by the formation of organs within the developing embryo and is therefore prone to developmental disorders. Hence, the clinical guidelines and procedures for screening are aimed at ensuring appropriate organ development which translates into a healthy baby. According to the ACOG Guidelines for Perinatal Care, the first prenatal visit assessment should be done followed by education and counseling, routine laboratory tests as well as genetic and infectious disease counseling and testing.
First-trimester assessment involves initial physical, family, the medical and genetic history of the mother, with a general examination that confirms the pregnancy. A complete needs assessment is done, and the mother is advised on preterm labor risks and how to prevent them. Furthermore, the mother is assessed on the use of tobacco, alcohol, and other drugs, and may also be screened for depression. On education and counseling, the mother is provided with the scope of pregnancy care, the schedule of subsequent ANC visits, as well as a discussion of high-risk conditions. Further emphasis is placed on genetic and drug use counseling, and influenza vaccination is done.
Important routine laboratory and diagnostic studies that must be done include a complete blood count and blood grouping, urinalysis as well as urine culture and sensitivity. The mother is then screened for syphilis, hepatitis B and C, gestational diabetes, and HIV. The basis of blood tests is to determine the amount of blood and presence or absence of anemia, and the various other screening done is used to know the status of the mother and prevent mother to child transmission of these diseases. Furthermore, genetic testing and counseling allow for the development of a healthy baby without any genetic condition that can cause debilitating conditions that might even be incompatible with life. Furthermore, the goals of these tests and screening are to improve the timeliness for prenatal care, monitor the pregnancy process, and assess the well being of both mother and the fetus.
Pharmacological treatments during the first trimester include the provision of folic acid to prevent neural tube defects, antimicrobials to manage urinary tract infections, as well as iron supplements to prevent iron deficiency. Also, patients in malaria-endemic areas are given prophylactic treatment using various antimalarial drugs. Non-pharmacological treatment may then include the provision of insect treated nets. Besides, education and counseling must incorporate the scope of care during pregnancy, specific complications, high-risk conditions, nutrition, exercise, labor, and delivery as well as practices that promote and maintain health such as breastfeeding, safety restraints, and barriers to care.