Графік планового пренатального обстеження

Examination or Test	Initial Visit (usually first trimester)	Every Visit	Second Trimester	Third Trimester
Urine or serum beta-human chorionic gonadotropin to confirm pregnancy (if not already done and if pregnancy not yet confirmed on pelvic ultrasound)	X
General physical examination	Complete general physical examination	Evaluate fetal growth by checking fundal height (starting at 12 weeks in a singleton pregnancy, when fundus can be palpated above the pubic symphysis)	At 20 weeks in a singleton pregnancy, fundal height should be at the level of the umbilicus	Abdominal examination for fetal lie and estimated weight (starting at approximately 36 weeks)
Pelvic examination	Complete pelvic examination			Digital cervical examination (if indicated, starting > 36 weeks)
Papanicolaou (Pap) test (if patient is due for cervical cancer screening)	X
Weight	X	X
Blood pressure	X	X
Urine dipstick for protein	X	X
Fetal heart rate measurement (usually with hand-held Doppler device)	X	X
CBC	X			Repeat at 24 to 28 weeks
Blood type and screen for alloantibodies	X			Repeat in patients with Rh-negative blood type at 28 weeks*
Rubella and varicella immunity	X†
Hepatitis C	X
Hepatitis B	X			Repeat in high-risk patients at 24 to 28 weeks
Human immunodeficiency virus (HIV)	X			Repeat in high-risk patients at 28 to 36 weeks
Syphilis	X			Repeat in high-risk patients at 28 to 36 weeks
Gonorrhea and chlamydia	X			Repeat in high-risk patients at 28 to 36 weeks
Tuberculosis (if at risk)	X
Urine culture	X
Swab of vagina and rectum for Group B beta-hemolytic streptococcus (GBS) colonization				At 36 to 37 weeks‡
Fasting plasma glucose or random plasma glucose				Oral glucose tolerance test to screen for gestational diabetes at 24 to 28 weeks
HbA1C	Only in patients at increased risk of undiagnosed type 2 diabetes
Pelvic ultrasound	Often done in first trimester if needed to estimate gestational age		Anatomy survey at 18 to 22 weeks
Counseling about testing for genetic and anatomic abnormalities; if desired, genetic carrier testing of parents is done prior to pregnancy or in the first trimester, and noninvasive (blood tests and/or ultrasound) and/or diagnostic testing (chorionic villous sampling or amniocentesis) are done in the first and/or second trimester	X
Testing for neural tube defects, if desired			Ultrasound Maternal serum alpha-fetoprotein (MSAFP), at 16 to 18 weeks
Screening for anxiety and depression (screen more frequently if indicated)	X			X
Screening for intimate partner violence (screen more frequently if indicated)	X
* To prevent alloimmunization, pregnant patients with a Rh-negative blood type should receive anti-D immune globulin injection at either 28 weeks or 28 and 34 weeks.
† Rubella and varicella titers are measured unless women have documentation of vaccination or previous infection, thus confirming immunity.
‡ Not required in patients with GBS bacteriuria earlier in the current pregnancy or those who gave birth to a previous neonate with invasive GBS disease (intrapartum antibiotic prophylaxis is already recommended for these patients, so a third trimester vaginal-rectal swab is not necessary).
CBC = complete blood count

Examination or Test

Initial Visit (usually first trimester)

Every Visit

Second Trimester

Third Trimester

Urine or serum beta-human chorionic gonadotropin to confirm pregnancy (if not already done and if pregnancy not yet confirmed on pelvic ultrasound)

General physical examination

Complete general physical examination

Evaluate fetal growth by checking fundal height (starting at 12 weeks in a singleton pregnancy, when fundus can be palpated above the pubic symphysis)

At 20 weeks in a singleton pregnancy, fundal height should be at the level of the umbilicus

Abdominal examination for fetal lie and estimated weight (starting at approximately 36 weeks)

Pelvic examination

Complete pelvic examination

Digital cervical examination (if indicated, starting > 36 weeks)

Papanicolaou (Pap) test (if patient is due for cervical cancer screening)

Weight

Blood pressure

Urine dipstick for protein

Fetal heart rate measurement (usually with hand-held Doppler device)

CBC

Repeat at 24 to 28 weeks

Blood type and screen for alloantibodies

Repeat in patients with Rh-negative blood type at 28 weeks*

Rubella and varicella immunity

X†

Hepatitis C

Hepatitis B

Repeat in high-risk patients at 24 to 28 weeks

Human immunodeficiency virus (HIV)

Repeat in high-risk patients at 28 to 36 weeks

Syphilis

Repeat in high-risk patients at 28 to 36 weeks

Gonorrhea and chlamydia

Repeat in high-risk patients at 28 to 36 weeks

Tuberculosis (if at risk)

Urine culture

Swab of vagina and rectum for Group B beta-hemolytic streptococcus (GBS) colonization

At 36 to 37 weeks‡

Fasting plasma glucose or random plasma glucose

Oral glucose tolerance test to screen for gestational diabetes at 24 to 28 weeks

HbA1C

Only in patients at increased risk of undiagnosed type 2 diabetes

Pelvic ultrasound

Often done in first trimester if needed to estimate gestational age

Anatomy survey at 18 to 22 weeks

Counseling about testing for genetic and anatomic abnormalities; if desired, genetic carrier testing of parents is done prior to pregnancy or in the first trimester, and noninvasive (blood tests and/or ultrasound) and/or diagnostic testing (chorionic villous sampling or amniocentesis) are done in the first and/or second trimester

Testing for neural tube defects, if desired

Ultrasound

Maternal serum alpha-fetoprotein (MSAFP), at 16 to 18 weeks

Screening for anxiety and depression (screen more frequently if indicated)

Screening for intimate partner violence (screen more frequently if indicated)

* To prevent alloimmunization, pregnant patients with a Rh-negative blood type should receive anti-D immune globulin injection at either 28 weeks or 28 and 34 weeks.

† Rubella and varicella titers are measured unless women have documentation of vaccination or previous infection, thus confirming immunity.

‡ Not required in patients with GBS bacteriuria earlier in the current pregnancy or those who gave birth to a previous neonate with invasive GBS disease (intrapartum antibiotic prophylaxis is already recommended for these patients, so a third trimester vaginal-rectal swab is not necessary).

CBC = complete blood count

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