Note from the National Guideline Clearinghouse (NGC) and the Institute for Clinical systems Improvement (ICSI): For a description of what has changed since the previous version of this guidance, refer to Summary of Changes Report - August 2007.

The recommendations for routine prenatal care are presented in the form of a table with accompanying annotations. Clinical highlights and a table for routine prenatal care follow. The reader is directed to the original guideline document for further discussion of each of the following topics.

Clinical Highlights

• Identify patients with greater potential for high-risk for pregnancy and provide appropriate preconception counseling (Annotation #4 -- see original guideline document)
• Each pregnant patient should receive visit-specific screening tests, education, immunizations, and chemoprophylaxis as described on the prenatal care table.
• 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 (Annotations #2, 4 -- see the original guideline document).
• For patients with previous Cesarean section, provide education of risks and benefits associated with vaginal birth after Cesarean (VBAC). Assess and document patients' desire and appropriateness for VBAC (Annotation #21 -- see original guideline document).
• 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 (Annotation #23 – see original guideline document)

[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.
** Should also include all subjects listed for the preconception visit if none occurred.

Abbreviations: ABO, BMI, body mass index; CPR, cardiopulmonary resuscitation; GC, gonococci; GDM, gestational diabetes mellitus; HDL, high density lipoprotein; HIV, human immunodeficiency virus; MMR, measles/mumps/rubella; OB, obstetrics; PTL, preterm labor; RhoGAM, Rho(D) immune globulin; VBAC, vaginal birth after Cesarean; VZIG, varicella zoster immune globulin

Practices to Consider Discontinuing

• Pelvimetry
• Routine urine dipsticks and routine urinalysis
• Routine evaluation for edema
• Routine testing for cytomegalovirus (CMV), parvovirus, toxoplasmosis
• Routine nutritional supplements
• Routine testing for bacterial vaginosis (may be necessary in women with a history of preterm labor)

ICSI, 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; telephone, (952) 814-7060; fax, (952) 858-9675; e-mail: icsi.info@icsi.org; Web site: www.icsi.org.

ICSI's conflict of interest policy and procedures are available for review on ICSI's Web site at http://www.icsi.org.

Electronic copies of the updated guideline: Available from the Institute for Clinical Systems Improvement (ICSI) Web site.

Print copies: Available from ICSI, 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; telephone, (952) 814-7060; fax, (952) 858-9675; Web site: www.icsi.org; e-mail: icsi.info@icsi.org.

• Routine prenatal care. Executive summary. Bloomington (MN): Institute for Clinical Systems Improvement, 2007 Aug. 1 p. Electronic copies: Available from the Institute for Clinical Systems Improvement (ICSI) Web site.
• ICSI pocket guidelines. April 2006 edition. Bloomington (MN): Institute for Clinical Systems Improvement, 2006. 298 p.

Appendices A – I of the original guideline document include risk assessment forms, prenatal worksheets, screening algorithms, and additional educational material.

Print copies: Available from ICSI, 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; telephone, (952) 814-7060; fax, (952) 858-9675; Web site: www.icsi.org; e-mail: icsi.info@icsi.org.

Electronic copies: Available from the Institute for Clinical Systems Improvement (ICSI) Web site.

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