An updated model of preconception and prenatal care

In December 2019, a new coronavirus was discovered that lead to the COVID-19 worldwide pandemic. The pandemic completely upended the traditional approach to prenatal care, probably for a long time. For now, a top priority during COVID-19 and beyond is to keep patients, their partners, support staff, and communities safe. The new approach (not only to prenatal care but all medical visits) means that contact is limited by reducing in-person visits at your doctor’s office and the hospital and replacing some visits with virtual prenatal care. 

There are several important recommendations for routine prenatal care:

1. Limit clinic visits to those that require in-person services (like ultrasounds and lab tests)
2. Encourage virtual prenatal visits for care that can be done remotely
3. Perform certain monitoring at home

Previously, the average number of prenatal office visits was 8-14 during pregnancy, once a month and every week in the last month. Because of COVID-19, in-person prenatal care visits have been reduced significantly.

Here is an example of recommendations, reducing in-person visits from 8-14 per pregnancy to 5-6 visits during the pregnancy: 

1. An initial prenatal visit (plus blood tests)
2. The ultrasound at 11-13 weeks (could be done as an initial visit)
3. The anatomy ultrasound at 19-22 weeks
4. Three office visits at 28 weeks, 36 weeks, and 39-week

All labs will be conducted during these visits, rather than in a separate appointment as is sometimes done.

Do this first: Your Personalized Online Pregnancy Risk Report 

The reduced visits open an opportunity for pregnant women to have virtual prenatal visits and to add pregnancy monitoring at home in order to screen for and reduce complications.

Resources for the new prenatal care:

1. Your Personalized Online Pregnancy Risk Report 
2. Is your morning sickness a problem?
3. The first-trimester screen test
4. Weight loss before pregnancy
5. Am I at risk for severe nausea and vomiting (hyperemesis gravidarum)?
6. Do I need baby aspirin (am I at risk for preeclampsia)? (starting optimally 12-16 weeks)
7. Monitoring your blood pressure and check for signs of preeclampsia
8. Monitoring your weight and check the pregnancy weight change calculator
9. Ultrasound information and calculators
10. Checking your urine for several parameters  
11. Monitoring for abnormal vaginal discharge (e.g., color, consistency, flow, pH, etc)
12. Check your temperature with a thermometer
13. Premature labor risk calculator
14. Am I at risk for domestic violence/intimate partner abuse?
15. Monitoring your baby's heart rate  
16. Monitoring your baby's activity with a baby kick count
17. Checking for labor
18. Get an oximeter to monitor oxygen levels
19. Interactive pregnancy complication checklist
20. Do I have postpartum depression?
21. Do I have significant postpartum problems checklist?

Examples of risk pregnancies possibly requiring more visits:

Some high-risk patients may require more frequent in-person visits and include but are not limited to those pregnant women with:

• Twins
• Older or younger age
• Diabetes
• Hypertension
• Risk of preterm delivery
• Prior preterm delivery
• Incompetent cervix
• Amniotic fluid issues
• Placenta issues
• Heart disease
• Kidney problems
• Infections
• Cancer
• Weight issues
• Lung disease
• Liver disease
• Drug issues
• history of Infertility
• IVF Pregnancy

Monitoring your blood pressure 

We believe it is safe to complete your virtual visits without a blood pressure cuff to monitor your blood pressure, as long as you do not have a history of high blood pressure. However, if you would like to purchase a blood pressure cuff, we recommend one of the following models. Please be sure to read the instructions that come with your device, and reach out to your provider with any questions.

Monitoring your weight

Gaining weight in pregnancy is normal and to be expected because the uterus, the placenta, the amniotic fluid, and to a certain extent your body needs to grow. But if you gain too little or too much weight, especially if it happens quickly,  there are possible complications. Read more about your pregnancy weight and calculate your recommended weight gain here.

Checking your urine

When you see your doctor in the office, you usually provide a sample of urine to be checked. Read more about this urine test here.

Monitoring your baby's heart rate 

We believe it is safe to complete your virtual visits without a fetal Doppler monitor. However, if you would like to purchase a home fetal Doppler monitor, we recommend one of the following models. Please be sure to read the instructions that come with your device, and reach out to your provider with any questions. 

We also recommend purchasing extra ultrasound gel to use with your fetal Doppler, such as Parker Aquasonic 100 Ultrasound Transmission Gel(link is external).

In addition, there are a number of apps to help you measure your baby's heart rate at home. These devices are not FDA approved, but may be helpful for providing reassurance during your pregnancy!

Apps to monitor the fetus' heartbeat:

• Fetal Beats (iOS)
• Hear My Baby Heartbeat (iOS)
• My Baby Heart Rate Record.er (iOS)
• Tiny Beat (iOS)
• Babyscope (iOS)
• Fetal Doppler Unborn Heart (iOS/Android)
• Baby Heartbeat Listener (Android)
• Baby Heartbeat Monitor (Android)
• Baby Heartbeats Lite (Android)

Routine tests in pregnancy (ACOG)

• Coronavirus: Separating Fact from Fiction 
• Coronavirus 2019-nCoV COVID-19 and Pregnancy
• Thriving During Pregnancy Amid the Coronavirus Outbreak
• Are Pregnant Women at Higher Risk of Contracting Coronavirus?
• How to Protect Yourself From Coronavirus Transmission