Recommended Services for Healthy Pregnancies

The guidelines for immunizations and medical exams have been designed to help you and your physician determine what preventive services are right for you. It is important to note that these guidelines are recommended for individuals who have no current disease symptoms or other specific risk factors. Depending on your individual lifestyle and family history, you may need some tests more frequently than others. For this reason, it is important to discuss these guidelines with your physician.

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Routine Services for Healthy Pregnancies

Visit Screenings Counseling and Education Immunizations, Supplements, Medications
Preconception Visit
  • Risk profiles
  • Height and weight/BMI
  • Blood pressure
  • History and physical
  • Cholesterol & HDL
  • Cervical cancer screening
  • Rubella/rubeola
  • Varicella
  • Domestic violence
  • Depression
  • Preterm labor education and
    prevention
  • Substance use
  • Nutrition and weight
  • Domestic violence
  • List of medications, herbal
    supplements, vitamins
  • Accurate recording of menstrual dates
  • Tetanus booster
  • Rubella / MMR
  • Varicella / VZIG
  • Hepatitis B vaccine
  • Folic acid supplement

Visit 1
6-8 Weeks
  • Risk profiles
  • GC/Chlamydia
  • Height and weight/BMI
  • Blood pressure
  • History and physical*
  • Rubella
  • Varicella
  • Domestic violence
  • Depression
  • CBC
  • ABO/Rh/Ab
  • Syphilis
  • Urine culture
  • HIV
  • [Blood lead screening 21]
  • [VBAC 22]
  • Viral hepatitis

[Bracketed] items refer to high-risk groups only.

* It is acceptable for the history and physical and laboratory tests listed under Visit 1 to be deferred to Visit 2 with the agreement of both the patient and the provider.
  • Preterm labor education and
    prevention
  • Prenatal and lifestyle education:
    • Physical activity
    • Nutrition
    • Follow-up of modifiable
      risk factors
    • Nausea and vomiting
    • Warning signs
    • Course of care
    • Physiology of pregnancy
  • Discuss fetal aneuploidy
    screening
  • Tetanus booster
  • Nutritional supplements
  • Influenza
  • [Varicella/VZIG 9]
  • Pertussis

[Bracketed] items refer to high-risk groups only.

Visit 2
10-12 weeks
  • Weight
  • Blood pressure
  • Fetal aneuploidy screening
  • Fetal heart tones
  • Preterm labor education and prevention
  • Prenatal and lifestyle education:
    • Fetal growth
    • Review labs from
      visit 1
    • Breastfeeding
    • Nausea and
      vomiting
    • Physiology of
      pregnancy
    • Follow-up of
      modifiable risk
      factors

Visit 3
16-18 weeks
  • Weight
  • Blood pressure
  • Depression
  • Fetal aneuploidy screening
  • Fetal heart tones
  • OB Ultrasound (optional)
  • Fundal height
  • Preterm labor education and
    prevention
  • Prenatal and lifestyle education:
    • Follow-up of
      modifiable risk
      factors
    • Physiology of
      pregnancy
    • Second-trimester
      growth
    • Quickening
  • [Progesterone]

[Bracketed] items refer to high-risk groups only.

Visit 4
22 weeks
  • Weight
  • Blood pressure
  • Fetal heart tones
  • Fundal height
  • Preterm labor education and
    prevention
  • Prenatal and lifestyle education
  • Follow-up of modifiable risk
    factors
  • Classes
  • Family issues
  • Length of stay
  • Gestational diabetes mellitus
    (GDM)
  • [RhoGam]

[Bracketed] items refer to high-risk groups only.

Visit 5
28 weeks
  • Preterm labor risk
  • Weight
  • Blood pressure
  • Depression
  • Fetal heart tones
  • Fundal height
  • Gestational diabetes mellitus
    (GDM)
  • Domestic abuse
  • [Rh antibody status]
  • [Hepatitis B Ag]
  • [GC/Chlamydia]

[Bracketed] items refer to high-risk groups only.
  • Psychosocial risk factors
  • Preterm labor education and
    prevention
  • Prenatal & lifestyle education:
    • Follow-up modifiable risk
      factors
    • Work
    • Physiology of pregnancy
    • Preregistration
    • Fetal growth
  • Awareness of fetal movement
  • [ABO/Rh/Ab 17]
  • [RhoGAM 17]

[Bracketed] items refer to high-risk groups only.

Visit 6
32 weeks
  • Weight
  • Blood pressure
  • Fetal heart tones
  • Fundal height
  • Preterm labor education and
    prevention
  • Prenatal & lifestyle education:
    • Follow-up of modifiable risk factors
    • Travel
    • Contraception
    • Sexuality
    • Pediatric care
    • Episiotomy
  • Labor & delivery issues
  • Warning signs/pregnancyinduced
    hypertension
  • [VBAC 22]

[Bracketed] items refer to high-risk groups only.

  

Visit 7
36 weeks
  • Weight
  • Blood pressure
  • Fetal heart tones
  • Fundal height
  • Cervix exam
  • Confirm fetal position
  • Culture for group B streptococcus
  • Prenatal and lifestyle education:
    • Follow-up of modifiable risk factors
    • Postpartum care
    • Management of late pregnancy symptoms
    • Contraception
    • When to call provider
    • Discussion of postpartum depression

Visit 8-11
38-41 weeks
  • Weight
  • Blood pressure
  • Fetal heart tones
  • Fundal height
  • Cervix exam
  • Prenatal and lifestyle education:
    • Follow-up of modifiable risk factors
    • Postpartum vaccinations
    • Infant CPR
    • Post-term management
  • Labor and delivery update

Reference: Institute for Clinical Systems Improvement (2010)
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