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Old 09-22-2011
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Default CCS- Advanced maternal age

office:
PE--complete.
urine HCG (+ve)

CBC
BMP
UA
urine culture
LFTs
lipid profile
blood type & cross
type and Rh
pt/ptt
EKG
pap smare
USG trans vaginal
mammography
gonorrhea
chlymydia
RPR
Hep B antibody
HIV ELISA
toxo
rubella titer

Educate patient pregnancy
pregnant mother counseling
no smoking, safe sex, seat belt, safety plan
diet (high calory,High protein)
iron oral
folic acid oral
multi vitamins-prenatal

follow up after 1 month in 1st trimester
2nd visit
full physical
vital(BP check)
Weight
UA
Fetal heart monitoring
fundal height


do triple screen --serum HCG, AFP, estradiol [MS AFP], if high amniocentesis
Triple marker screen-TRIPLE TEST
Valproic acid level

send her home..

counsel about the vit and folic and RATED SEX

further diagnostic plan
continue Valproic acid
Genetic counseling
Genetic Sonogram
Amniocentesis
Karotyping of the fetal amniocytes....cells found in the amniotic fluid
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