Initial Prenatal Evaluation
Pregnancy management begins with confirmation of gestational age and assessment of maternal medical history, obstetric history, and current pregnancy symptoms. [1] Initial prenatal visits typically include blood pressure measurement, weight, and assessment for fetal status such as fetal heart tones. [2] Early risk assessment should include screening needs for hypertensive disorders, diabetes, and infection. [1]
Baseline Laboratory and Risk Stratification
Initial laboratory evaluation commonly includes infectious disease and hematologic testing as part of routine prenatal care. [2] Routine prenatal laboratory testing should include syphilis screening early in pregnancy, repeat testing in the third trimester, and testing at delivery. [2] Prenatal STI evaluation should include assessment for chlamydial infection, gonococcal infection, HIV, and hepatitis as indicated by CDC recommendations for pregnant persons. [3] Risk-based selection of additional tests should be performed based on history, exposures, and local prevalence. [3]
Genetic and Aneuploidy Screening
Genetic screening and diagnostic testing options for fetal aneuploidy should be offered with counseling on screening versus diagnostic approaches. [4] If screening for aneuploidy is accepted, an approach should be selected so that multiple screening tests are not performed simultaneously. [5] Diagnostic testing should remain available for patients who desire definitive diagnosis. [4]
Preeclampsia Prevention and Hypertensive Disorder Surveillance
Hypertensive disorders of pregnancy should be assessed using ACOG diagnostic and management guidance. [6] Low-dose aspirin prophylaxis should be considered for patients at high risk for preeclampsia per ACOG and SMFM guidance. [7] Low-dose aspirin initiation should occur between 12 and 28 weeks of gestation with optimal initiation before 16 weeks. [7] Low-dose aspirin prophylaxis should be continued daily until delivery in appropriate candidates. [7] Aspirin prophylaxis evidence includes subgroup reductions in preterm preeclampsia when aspirin is started before 16 weeks at a daily dose of 100 mg or more. [8]
Gestational Diabetes Screening
Gestational diabetes screening should be performed at 24 to 28 weeks of gestation. [9] Screening for gestational diabetes is recommended using either a 1-step or 2-step strategy, depending on local practice and patient factors. [9]
Antenatal Follow-up and Ongoing Assessment
Prenatal follow-up should include serial monitoring of blood pressure, weight, and fetal assessment as pregnancy progresses. [2] Hypertensive symptoms, including headache, visual changes, and right upper quadrant or epigastric pain, should prompt evaluation for hypertensive disorders of pregnancy using ACOG criteria. [6]
Target Screening and Treatment for STIs
All pregnant persons should be asked about STI risk factors and should be provided access to recommended screening and treatment. [3] CDC STI guidance includes pregnant-person recommendations on retesting intervals, test-of-cure requirements, and repeat screening in patients at continued risk. [10]
Common Pitfalls to Avoid
Concurrent use of multiple screening tests for aneuploidy should be avoided when a single screening approach is planned. [5] Late initiation of aspirin outside the recommended 12 to 28 weeks window, with suboptimal initiation after 16 weeks, should be avoided in candidates for preeclampsia prevention. [7] Failure to perform gestational diabetes screening at 24 to 28 weeks should be avoided due to guideline-based timing. [9]
Practical Management Based on Gestational Age and Risk Profile
Care should be organized around gestational-age specific prevention and screening milestones, including preeclampsia prophylaxis timing and gestational diabetes screening timing. [7][9] Escalation of evaluation should occur when symptoms or abnormal screening results indicate possible hypertensive disorders or infection. [6][3]