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Follow-up Visits

Monitoring

Manoeuvre

Time, Frequency

Prenatal Visits

o       Weekly (if needed)

Routine Prenatal Bloodwork

o       Baseline, repeat at discretion of clinician

AST, ALT

o       Baseline, repeat at discretion of clinician

HBV, HCV, HIV,
VDRL, Mantoux

o       Baseline

o       Continue q 3 months if negative and at continued risk

Pap smear
Chlamydia, Gonorrhea

o       Baseline

o       Baseline, repeat in third trimester (if at continued risk)

o       Consider urine testing, if pelvic exam is problematic

Ultrasound

o       Baseline for dates (if needed)

o       18-20 weeks anatomic scan

o       As needed to monitor for interval growth

Biophysical Profile (BPP)
Non-stress Test (NST)

o       As indicated clinically for monitoring high-risk pregnancies

Drug Toxicology Testing

o       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.

This site last edited: June 2008