1. Will be asked about diabetic family history.

Urine specimens need to be clean catch. If they ask for a concentrated urine, this means the she is going to urinate before she goes to bed and then when she wakes up. The morning urine is concentrated and of course, should be done clean catch.

2. CBC: complete blood count.

Hgb = 12g

Hct = 35% or greater

Lower could indicate folic acid deficiency or anemia (iron deficiency). If indicated, will repeat Hgb and Hct in 32-36 weeks.

3. VDRL for syphilis: if the mom has syphilis she should be treated before 18 weeks. This brings the most positive outcome for the fetus. The treatment is done with antibiotics.

4. Blood typing: group and Rh factor.

Rh factor: antigen that is located on the surface of RBC’s.

(+) means you have the antigen and (-) means you do not.

Once an antigen enters the body it develops antibodies.

Problem: Rh(-) mom and Rh(+) baby.

If the mom is Rh(-) then you need to test the father.

If he is (+) there is a 50% - 100% chance the baby will be (+).

If mom is Rh(+), we don’t have to worry about it.

Indirect Coomb’s test: done when mom is Rh(-).

It will screen for maternal antibodies that have been built up against the Rh factor. We hope to find the test is negative.

If blood mixes and baby’s blood gets into mom’s, antibodies will build up and destroy baby’s RBC’s. This can be fatal. It is called Erythroblastosis fatalis. A positive Coomb’s test can cause this also.

An intrauterine transfusion will be tried.

At 28 weeks, the mother is tested again with an indirect Coomb’s test. If (-) they will at this time give RhoGAM (which is an immunoglobulin). RhoGAM prevents mother from building up antibodies against Rh factor. Once she delivers, she gets another shot of RhoGAM within 72 hours. RhoGAM is always given by Z-track method.

If the mother has already built up antibodies, there is nothing we can give her.

Direct Coomb’s: testing blood from the cord to see if the baby has built up antibodies.

5. Rubella titer: German measles. Test to see if she has been exposed or has had the vaccine. If 1:10, then she has NOT been exposed and is NOT immune. Titer should be 1:16 or more. A pregnant woman whose titer is 1:10 should stay away from those who are being vaccinated or those who have it. It is given while the mom is on the way out the door, because it is a live virus.

6. Hepatitis B titer done also.

7. Teach to call the doctor if she has any of the following signs:

diplopia

spots before eyes

vaginal bleeding

flashes of light

persistent severe vomiting beyond first trimester

abdominal cramping

epigastric pain

chills and fever > 101

blurred vision

severe headache

sudden escape of fluid

painful, burning, or scanty urine

sudden weight gain

can’t feel movement of fetus (if too little or too excessive)

* At the doctor’s visit you need to ask about the fetal movements.