Ambulatory management of XXXX .

@entity1 @entity1501 @entity6677 @entity117 @entity1468 @entity6981 @entity460 @entity2462 @entity413 @entity68
Ambulatory management of @entity6677 requires careful and continuing care by the obstetrician. The initial evaluation should include a comprehensive history, including use of fertility enhancing drugs and ART, family history, social history; a general physical examination, including a pelvic examination; laboratory evaluation, including complete blood cell count, dipstick urinalysis for protein and @entity413 , urine culture, blood type, Rh factor and irregular blood antibody determination, serology for @entity2462 , syphilis, hepatitis B surface antigen and varicella (if there is no history). A Papanicolaou smear should be done at the time of the pelvic examination, as should evaluation for @entity6981 . Ultrasound assessment of placentation should be done at 14 weeks' gestation, but vaginal or perineal ultrasound of cervical length should be done at the initial visit. Other testing procedures should include repeat ultrasound evaluation for fetal growth every 4 weeks in a dichorionic placentation and every 3 weeks if monochorionic placentation is present. Triple screen MSAFP at 16-18 weeks' gestation and blood sugar screening at 22-26 weeks should be performed. After the first trimester, the @entity1 should schedule physician visits every 2 weeks or less. Routine medications should include one prenatal vitamin per day, additional @entity1501 supplementation of 1.0 mg per fetus, supplemental @entity68 preparation, and additional @entity460 to equal 1500 mg/day. The use of low-dose @entity117 to prevent @entity1468 in twin gestations has not been adequately studied. Continuing vigilance by the knowledgeable obstetrician should occur. Multiple gestations should not be cared for by non-physician providers or by family physicians. Referral to a maternal-fetal medicine unit is recommended.
