Prima

Follow-Up Visits

Monitoring

Manoeuvre	Time, Frequency
Prenatal Visits	> Weekly (if needed)
Routine Prenatal Bloodwork	> Baseline, repeat at discretion of clinician
AST, ALT	> Baseline, repeat at discretion of clinician
HBV, HCV, HIV, VDRL, Mantoux	> Baseline > Continue q 3 months if negative and at continued risk
Pap smear Chlamydia, Gonorrhea	> Baseline > Baseline, repeat in third trimester (if at continued risk) > Consider urine testing, if pelvic exam is problematic
Ultrasound	> Baseline for dates (if needed) > 18-20 weeks anatomic scan > As needed to monitor for interval growth
Biophysical Profile (BPP) Non-stress Test (NST)	> As indicated clinically for monitoring high-risk pregnancies
Drug Toxicology Testing	> Discuss rationale for testing and obtain informed consent (See Toxicology testing section)

Child Protection

> Anyone who has reasonable grounds to suspect that a child
   is or may be in need of protection much take the report directly
   to child protection services. Inform women of your
   responsibility.

> The definition of need for protection or at-risk varies by
   province and territory. Please contact your local authorities to
   clarify specific responsibilities regarding the definition of risk
   as it applies to substance-using parents.

> In Canada, a fetus is not recognized legally as a person for
   any reason, including child protection; however, there is a
   legal obligation to report once the child is born.

> Do not call protective services prenatally without prior discussion
   and consent from the women.

> Encouraging women to self-report prenatally can increase
   self-efficacy, dignity and stability, while promoting open and
   informed decision-making by child protection authorities. If a
   patient chooses not to self-report, speak to child protection
   services after the child is born and in the presence of the woman.

> Consider earlier referral if woman has children in her care.

Management of Substance Use

> Discuss and encourage substance abuse treatment for support and safety
- many facilities will give expedited entry to pregnant women

> Discuss harm reduction and/or relapse prevention at every visit

> Educate about maternal and fetal effects

> Offer supervised urine drug screens, if acceptable to patient (reduces confusion or surprises around delivery
and provides support for women around future child protection issues)

> Offer continued assistance with basic needs - food, housing, transportation, etc.