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Saturday, August 8, 2009

Basic Prenatal Care Checklist

Here are some items I have been checking every so often. If you are choosing to do your own prenatal care feel free to copy and paste this list and adjust to your own needs. Occasionally I may skip some of the lab work for the following reasons: it is not available in home test kit form or private lab setting, is not really necessary, I have records of previous lab tests or symptoms can easily be resolved/prevented with therapies and treatments.



Basic Equipment


-BP Cuff


-Watch with seconds


-Strips for testing protein or glucose in urine

-Sterile Gloves


-Tape Measure

-Antiseptic soap


1st Checkup: Date: ________________


LMP ___________________ Due Date __________________

Symptoms checklist:

1. Visual Disturbances Y/N/Slight 12. Breast Changes Y/N/S

2. Headaches Y/N/S 13. Abdominal Pain Y/N/S

3. Fevers Y/N/S 14. Heart Burn Y/N/S

4. Fatigue Y/N/S 15. Variation in heart Rhythm Y/N/S

5. Nausea Y/N/S 16. Constipation Y/N/S

6. Vomiting Y/N/S 17. Leg Cramps Y/N/S

7. Dizziness Y/N/S 18. Backache Y/N/S

8. Shortness of Breath Y/N/S 19. Edema Y/N/S

9. Back Pain Y/N/S 20. Infections Y/N/S

10. Pain when Urinating Y/N/S 21. Varicosities Y/N/S

11. Vaginal Discharge Y/N/S 22. Date Baby’s Movements 1st felt Y/N/S

If Yes describe:





Previous Pregnancies:

Date: Conditions:

Previous Medical History:


Nutritional Deficiencies:

Cancers, diabetes etc:

Family History:

Blood Pressure:_____________

Present Weight:______________

Protein in Urine: Y/N

Glucose in Urine: Y/N

Taking Prenatal Vitamins: Y/N/Sometimes

Edema in Feet Legs Vagina: Y/N/Slight

Thyroid Gland: Good/Bad

Pelvic Exam:

4-5 Weeks: (Hegar’s Sign) Soft cervix (like lips not nose): Y/N

5-6 Weeks: Paper Thin Junction between cervix and uterus: Y/N

6 Weeks: Larger than Normal: Y/N

6 Weeks: Cyanosis (Chadwick’s Sign - Blue color of birth canal): Y/N

10 Weeks: Size of a Tennis Ball: Y/N

I use the twelve week checkup as a pattern for other weeks I give my self a checkup. The symptoms checklist are matched and located in the 1st checkup.

Twelve Weeks Date: ___________________

Symptoms Checklist

1. Y/N/S 12. Y/N/S
2. Y/N/S 13. Y/N/S
3. Y/N/S 14. Y/N/S
4. Y/N/S 15. Y/N/S
5. Y/N/S 16. Y/N/S
6. Y/N/S 17. Y/N/S
7. Y/N/S 18. Y/N/S
8. Y/N/S 19. Y/N/S
9. Y/N/S 20. Y/N/S
10. Y/N/S 21. Y/N/S
11. Y/N/S 22. Y/N/S

If Yes describe:




Blood Pressure: __________________

Weight: ______________

Fundal Height: ________________

Fetal Heart Rate: __________________

Lab Work:

CBC: ___________

HCT: ____________ (35)

Hemoglobin Blood Type: ______________ (about 11.0)

Coombs Test: __________

Rubella Titre: _______________

RPR: ______________

VDRL: ________________

Hepatitis B: __________________

Rh antibodies: ________________

I will continue on the twelve week pattern until 24 weeks, not including the lab work

At 28 weeks I will get the following lab work.

Lab work:

HCT: __________________

Hemoglobin: _______________

Glucose Screening: ________________

RH Anti-Body Test: __________________

At 32 weeks I will add the following to the twelve week pattern.

Baby Position ________________

I may or may not take the following lab test at 36 weeks. Heart and Hands has a simple recipe for antiseptic treatment.

Lab work:

Group B Strep Test:___________________

At 38 weeks and the following weeks I will add the following to the twelve week pattern.

Cervix condition:___________________

I will get a checkup on the following weeks:
1st (4-10 weeks), 12 weeks, 16 weeks, 20 weeks, 24 weeks, 28 weeks, 32 weeks, 36 weeks, 38 weeks, 39 weeks, 40 weeks.....birth!

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