Risk Assessment


Early and Continuing Risk Assessment

Prenatal care is more effective when the first visit takes place at 6-8 weeks gestation, and not delayed until the second or third trimester. The prenatal visit is a comprehensive process of assessing historical data, laboratory findings, medical, social and obstetrical risk indicators. One important goal of the prenatal visit is to prevent pre-term births which is the chief cause of infant mortality. Prenatal visits are designed:

  • To provide primary health care
  • Identify risks to fetal health and safety
  • To prevent and or control disease
  • To assure delivery of a healthy baby of appropriate weight.

Risk Assessment includes obtaining the following data:

  • Demographic information
  • Gynecologic history, including the date of the last menstrual period (LMP)
  • History of contraceptive use
  • Obstetric history
  • Estimated day of delivery (EDD) determined by the last menstrual period if known. If the date is unknown or a size-date discrepancy exists, an ultrasound examination should be performed before 20 weeks.
  • History of current pregnancy
  • Accurately dating pregnancy
  • Medical/surgical history
  • Genetic history
  • History of dental care
  • Social history/Lifestyle behaviors
  • Environmental exposures
  • Pharmacologic history
  • Nutritional assessment including pregnancy weight and body mass index (BMI)
  • Psycho-social assessment
  • Physical examination
  • Employment history
  • Financial planning

Assessment

The assessment process begins with the initial Prenatal visit, and will be more effective if a preconception visit occurred. It is on-going and ideally starts with the initial visit which should occur between 6-8weeks of gestation. At the initial prenatal visit the patient's database is established, if not prior to conception, and involves assessment or collecting physical, historical and laboratory data from which a plan of care is developed and followed throughout the course of the pregnancy. Historical data include the following:

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