If the yolk sac-a brightly echogenic ring with an anechoic center-is seen within the gestational sac, an intrauterine location for the pregnancy is confirmed. The yolk sac can normally be seen by the middle of the ifth week. As shown in Figure 9-3, after 6 weeks, an embryo is seen as a linear structure immediately adjacent to the yolk sac. Cardiac motion is typically noted at this point. Up to 12 weeks' gestation, the crown-rump length is predictive of gestational age within 4 days (Chap. 10, p. 183).
Prenatal care is ideally initiated early. Major goals are to: (1) deine the health status of the mother and fetus, (2) estimate the gestational age, and (3) initiate a plan for continued obstetrical care. Typical components of the initial visit are summarized in Table
Subsequent care may range from relatively infrequent routine visits to prompt hospitalization because of serious maternal or fetal disease.
Use of a standardized record within a perinatal health-care system greatly aids antepartum and intrapartum management.
TABLE 9-1 . Typical Components of Routine Prenatal Care
Chap. 9, p. 161
Chap. 9, p. 163
Chap. 40, p. 71l1
Chap. 9, p. 165
Chap. 9, p. 163
Chap. 9, p. 164
Chap. 9, p. 165
Chap. 56, p. 1075
Chap. 15, p. 301
Chap. 15, p. 301
Chap. 63, p. 1193
Chap. 57, p. 1108
Chap. 14, p. 278
Chap. 14, p. 283
Chap. 14, p. 289
Chap. 4, p. 66
Chap. 53, p. 1026
Chap. 64, p. 1215
Chap. 65, p. 1l237
Chap. 65, p. 1239
Chap. 65, p. 1240
Chap. 55, p. 1064
Chap. 65, p. 1247
Chap. 64, p. 1220
Chap. 51, p. 996 aFirst-trimester aneuploidy screening may be ofered between 11 and 14 weeks. A Performed at 28 weeks, if indicated.
8 Test should be ofered.
C High-risk women should be retested at the beginning of the third trimester.
o High-risk women should be screened at the first prenatal visit and again in the third trimester.
culture should be between 35 and 37 weeks.
HIV human immunodeficiency virus.
Standardizing documentation allows communication and care continuity between providers and enables objective measures of care quality to be evaluated over time and across diferent clinical settings (Gregory, 2006). A prototype is provided by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2017) in their Guidelines or Perinatal Care, 8th edition.
Several deinitions are pertinent to establishment of an accurate prenatal record.
1. Nulligravida-a woman who currently is not pregnant and has never been pregnant.
2.
Gravida-a woman who currently is pregnant or has been in the past, irrespective of the pregnancy outcome. With the establishment of the first pregnancy, she becomes a primigravida, and with successive pregnancies, a multigravida.
3.
Nullpara-a woman who has never completed a pregnancy beyond 20 weeks' gestation. She may not have been pregnant or may have had a spontaneous or elective abortion(s) or an ectopic pregnancy.
4.