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Introduction
1. Medical assistant
2. Electronic records
3. Medical terminology and anatomy
4. The fundamentals of infection control
5. Introduction to vital signs
6. The patient interview and history
7. The physical examination
8. Appointment scheduling
9. Insurance billing
10. Diagnostic coding and the ICD-10-CM System
11. Procedural coding
12. Medical billing and reimbursement essentials
13. Assisting with medical specialties
14. Assisting with the musculoskeletal system
15. Assisting with the cardiovascular system
16. Assisting with the respiratory system
17. Assisting with the nervous system
18. Anatomy and physiology of the urinary system
19. Assisting in obstetrics and gynecology
19.1 Assisting in obstetrics and gynecology
19.2 Female reproductive system infections and menopause
19.3 Cancers of the female reproductive system
19.4 Contraception methods
19.5 Diagnostic procedures and treatments in gynecology
19.6 Medical assistant's role in gynecologic examinations: setup and preparation
19.7 Medical assistant's role in gynecologic examinations: assisting the provider
19.8 Prenatal and postpartum care
19.9 Domestic abuse, patient coaching, and professional issues in obstetrics and gynecology
19.10 Obstetric history and the prenatal record
19.11 The first prenatal examination
20. Assisting in endocrinology
21. Assisting in ophthalmology & otolaryngology
22. Assisting in gastroenterology
23. Assisting in the immune & lymphatic systems
24. Assisting in pediatrics: the developmental stages and care
25. The medical assistant’s role in caring for the older patient
26. The role of the medical assistant in physical therapy examination and assessment
27. Preparing for minor surgery: room, solutions, and supplies
28. Introduction to the clinical laboratory
29. Urinalysis
30. Blood collection
31. Analysis of blood
32. Electrocardiography and heart structure
33. The principles of pharmacology
34. Essential calculations and measurement systems
35. Solid, liquid, & solutions medication doses
36. Administering medications
37. Metabolism and core nutrient roles
38. Medical emergencies in the healthcare setting
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19.11 The first prenatal examination
Achievable CCMA
19. Assisting in obstetrics and gynecology

The first prenatal examination

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First prenatal examination

The physical examination during a first prenatal visit includes an overall assessment of the woman’s health status. This would include vital signs, weight, and urinalysis. The medical assistant must prepare the patient. The patient should be asked if she needs to empty her bladder. If she does, she should collect a urine specimen for a routine urinalysis and a possible pregnancy test. The medical assistant should also prepare the exam room, ensuring that the supplies and equipment necessary to obtain pelvic measurements, perform serologic tests, and prepare for laboratory tests are available. The provider will assess the heart, lung, and thyroid. A physical examination will be done to rule out any other abnormalities. Next, the provider performs an obstetric examination that includes measurement of the height of the uterus and an internal or pelvic examination. A Pap test may be performed if one has not been done in the past year.

Pregnancy test

There are two types of pregnancy tests. One is done with a urine sample, and the other is done with a blood sample. Both tests detect human chorionic gonadotropin (hCG), a hormone produced after implantation that maintains the corpus luteum so it keeps producing the progesterone needed to sustain early pregnancy. Blood (serum) tests can detect much lower hCG concentrations than urine tests, so they can confirm a pregnancy earlier. Blood tests are usually performed at the provider’s office or laboratory. Urine tests can be performed at the provider’s office, or the patient may do a home pregnancy test.

Whether the test is performed at home or in the office, the process is the same: a urine sample is placed on the test stick, and the display - a symbol or a word - indicates a positive or negative result.

The estimated date of delivery (EDD), or due date, will be determined at this visit. There are a number of ways to determine the due date. One method is using a gestational wheel: you line up the wheel’s arrow with the first date of the LMP, then read the EDD at the 40-week mark. For example, if a patient’s LMP was March 1, lining the wheel’s arrow up with that date and reading the 40-week mark gives an EDD of about December 8. The EDD may also be calculated by the electronic health record (EHR) or determined by ultrasound.

Gestational wheel used to calculate pregnancy due dates
Gestational wheel
Wikimedia Commons
/
CC BY-SA 4.0

A series of blood tests are also performed during the initial prenatal visit. Prenatal blood and laboratory tests include the following:

  • Hematocrit and hemoglobin levels to check for anemia.
  • Blood type and Rh with antibody screening for possible Rh incompatibility.
  • Rubella titer to determine whether the mother is immune to German measles; rubella infection during pregnancy can cause multiple birth defects, including deafness, vision disorders, and intellectual disability.
  • Syphilis screening; if the result is positive, antibiotic treatment is initiated to protect the fetus from congenital syphilis.
  • Hepatitis B screening because this virus can be passed to the fetus in utero.
  • Human immunodeficiency virus (HIV) screening is suggested; if the result is positive, treatment of the mother greatly reduces the risk of transmission to the fetus.
  • Gonorrhea and chlamydia cultures to prevent infection of the baby at birth.
  • Urinalysis to detect protein, white blood cells, or glucose.

Scope of practice: Whether a medical assistant may collect these specimens, perform the venipuncture, or give an injection such as RhoGAM depends on the supervising provider’s delegation and the medical assistant’s state scope-of-practice law - these prenatal tasks aren’t an automatic part of the role everywhere.

Any concerns that the patient has should be noted and reported to the provider. The medical assistant should be prepared to suggest community resources that can provide assistance to new parents, such as the following:

  • Childbirth and parenting classes
  • Infant cardiopulmonary resuscitation (CPR) courses
  • Nutritional counseling, if needed
  • Contact information for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which helps lower-income expectant mothers get nutritious food

Hemolytic disease of the newborn (HDN)

The blood is tested for the presence of D antigens to determine if someone’s blood type is Rh positive or Rh negative. Rh-positive blood has D antigens; Rh-negative blood does not. If the blood type with Rh factor shows that the mother has Rh-negative blood, there is a concern that hemolytic disease of the newborn (HDN) could develop if the fetus is Rh positive. HDN is also known as erythroblastosis fetalis. If the mother is Rh negative and her fetus is Rh positive, the mother will form antibodies to the Rh-positive factor. Future Rh-positive pregnancies will be in jeopardy because the mother’s anti-Rh antibodies will cross the placenta and destroy fetal blood cells.

HDN can be prevented by giving the mother Rh immune globulin products. RhoGAM, or anti-D immune globulin, is given at 28 to 30 weeks of gestation to Rh-negative mothers, regardless of the father’s Rh type. After delivery, the cord blood is tested, and a dose of RhoGAM is given within 72 hours of delivery, but only if the baby is Rh positive. RhoGAM is also given for miscarriages or abortions. The immune globulin prevents the infant’s Rh-positive cells from stimulating the mother’s immune system, thus preventing HDN.

Exam tip: Don’t mix up the two RhoGAM doses. The antepartum dose (28 to 30 weeks) goes to every Rh-negative mother regardless of the father’s Rh type, since the fetus’s type isn’t yet known. The postpartum dose (within 72 hours of delivery) is given only if the newborn’s cord blood tests Rh positive.

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The first prenatal examination

First prenatal examination

The physical examination during a first prenatal visit includes an overall assessment of the woman’s health status. This would include vital signs, weight, and urinalysis. The medical assistant must prepare the patient. The patient should be asked if she needs to empty her bladder. If she does, she should collect a urine specimen for a routine urinalysis and a possible pregnancy test. The medical assistant should also prepare the exam room, ensuring that the supplies and equipment necessary to obtain pelvic measurements, perform serologic tests, and prepare for laboratory tests are available. The provider will assess the heart, lung, and thyroid. A physical examination will be done to rule out any other abnormalities. Next, the provider performs an obstetric examination that includes measurement of the height of the uterus and an internal or pelvic examination. A Pap test may be performed if one has not been done in the past year.

Pregnancy test

There are two types of pregnancy tests. One is done with a urine sample, and the other is done with a blood sample. Both tests detect human chorionic gonadotropin (hCG), a hormone produced after implantation that maintains the corpus luteum so it keeps producing the progesterone needed to sustain early pregnancy. Blood (serum) tests can detect much lower hCG concentrations than urine tests, so they can confirm a pregnancy earlier. Blood tests are usually performed at the provider’s office or laboratory. Urine tests can be performed at the provider’s office, or the patient may do a home pregnancy test.

Whether the test is performed at home or in the office, the process is the same: a urine sample is placed on the test stick, and the display - a symbol or a word - indicates a positive or negative result.

The estimated date of delivery (EDD), or due date, will be determined at this visit. There are a number of ways to determine the due date. One method is using a gestational wheel: you line up the wheel’s arrow with the first date of the LMP, then read the EDD at the 40-week mark. For example, if a patient’s LMP was March 1, lining the wheel’s arrow up with that date and reading the 40-week mark gives an EDD of about December 8. The EDD may also be calculated by the electronic health record (EHR) or determined by ultrasound.

A series of blood tests are also performed during the initial prenatal visit. Prenatal blood and laboratory tests include the following:

  • Hematocrit and hemoglobin levels to check for anemia.
  • Blood type and Rh with antibody screening for possible Rh incompatibility.
  • Rubella titer to determine whether the mother is immune to German measles; rubella infection during pregnancy can cause multiple birth defects, including deafness, vision disorders, and intellectual disability.
  • Syphilis screening; if the result is positive, antibiotic treatment is initiated to protect the fetus from congenital syphilis.
  • Hepatitis B screening because this virus can be passed to the fetus in utero.
  • Human immunodeficiency virus (HIV) screening is suggested; if the result is positive, treatment of the mother greatly reduces the risk of transmission to the fetus.
  • Gonorrhea and chlamydia cultures to prevent infection of the baby at birth.
  • Urinalysis to detect protein, white blood cells, or glucose.

Scope of practice: Whether a medical assistant may collect these specimens, perform the venipuncture, or give an injection such as RhoGAM depends on the supervising provider’s delegation and the medical assistant’s state scope-of-practice law - these prenatal tasks aren’t an automatic part of the role everywhere.

Any concerns that the patient has should be noted and reported to the provider. The medical assistant should be prepared to suggest community resources that can provide assistance to new parents, such as the following:

  • Childbirth and parenting classes
  • Infant cardiopulmonary resuscitation (CPR) courses
  • Nutritional counseling, if needed
  • Contact information for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which helps lower-income expectant mothers get nutritious food

Hemolytic disease of the newborn (HDN)

The blood is tested for the presence of D antigens to determine if someone’s blood type is Rh positive or Rh negative. Rh-positive blood has D antigens; Rh-negative blood does not. If the blood type with Rh factor shows that the mother has Rh-negative blood, there is a concern that hemolytic disease of the newborn (HDN) could develop if the fetus is Rh positive. HDN is also known as erythroblastosis fetalis. If the mother is Rh negative and her fetus is Rh positive, the mother will form antibodies to the Rh-positive factor. Future Rh-positive pregnancies will be in jeopardy because the mother’s anti-Rh antibodies will cross the placenta and destroy fetal blood cells.

HDN can be prevented by giving the mother Rh immune globulin products. RhoGAM, or anti-D immune globulin, is given at 28 to 30 weeks of gestation to Rh-negative mothers, regardless of the father’s Rh type. After delivery, the cord blood is tested, and a dose of RhoGAM is given within 72 hours of delivery, but only if the baby is Rh positive. RhoGAM is also given for miscarriages or abortions. The immune globulin prevents the infant’s Rh-positive cells from stimulating the mother’s immune system, thus preventing HDN.

Exam tip: Don’t mix up the two RhoGAM doses. The antepartum dose (28 to 30 weeks) goes to every Rh-negative mother regardless of the father’s Rh type, since the fetus’s type isn’t yet known. The postpartum dose (within 72 hours of delivery) is given only if the newborn’s cord blood tests Rh positive.

More from Assisting in obstetrics and gynecology

  • Assisting in obstetrics and gynecology
  • Female reproductive system infections and menopause
  • Cancers of the female reproductive system
  • Contraception methods
  • Diagnostic procedures and treatments in gynecology