Achieving Pregnancy

ACHIEVING PREGNANCY

DEFINITION

Achieving Pregnancy is identifying and assessing clients who desire pregnancy. Counseling and education (including key messages on achieving pregnancy) and addressing misperceptions that many women, men and adolescents have about fertility and infertility will occur for clients who respond to the reproductive life plan question with a “desire for pregnancy.”

SUBJECTIVE

Must include:

A. Reproductive Life Plan

- When she/they want to get pregnant

- Length of time she/they have been trying to get pregnant

- History of pregnancies or infertility

- Partner involvement (support system, reflect on LGBTQ considerations, Single parent, cultural/familial considerations, other sensitivities to be aware of or Influences to discuss

B.Medical history

1.Immunizations

2.Medications

3.Present infectious or chronic health conditions

4.Genetic conditions

5.Environmental exposures

6.Social history/risk behaviors

7.Sexual health assessment and risk assessment

8.Mental health

9.Zika Risk Assessment

1) Travel-self and partner(s)

a. Past travel –last 8 months –where and when

b. Plans for future travel –where and when

Must Include for Females:

1.Reproductive history

2.Obstetrical/Gynecology history

3.Family history

4.Intimate partner violence

Must include for Men

1.Past medical/surgical history that might impair reproductive health

2.Medical conditions associated with reproductive failure that could reduce sperm quality

OBJECTIVE

Must include:

A. Height, weight, BMI (screen for obesity)

B. BP (screen for hypertension)

1.All clients—screen yearly

2.If BP <120/80---screen yearly, continue yearly

3.If BP 120-139/80-89 (either treated or untreated), recheck BP again in same visit and if average BP >140/90 recheck at next visit or in 1 week and refer if sustained BP >140/90.

C.No physical exam is needed for Achieving Pregnancy. Exams may be needed to evaluate problems raised by review of systems or complaints raised by the client.

LABORATORY

May include, as indicated based on client medical and sexual history and level of readiness

A.STD testing

B.Diabetic screening

C. Consider Zika screening if indicated by Zika Risk Assessment.

ASSESSMENT

Assess and update the client’s physical, sexual and medical history. This may reveal additional issues in the person’s health history that need to be addressed. The results can also help determine the need for additional information like fertility awareness or other health services such as: STD screening, preconception care, infertility services, Zika sexual transmission counseling, and other preventative health services.

PLAN (also see Fertility Awareness)

While Fertility Awareness education is not required for clients who wish to achieve pregnancy, it can be very helpful (and interesting) for them to know:

• How pregnancy occurs, including the basics of male and female fertility, and

• When during the menstrual cycle a woman is most likely to get pregnant,

• Different ways to observe and keep track of naturally occurring signs of fertility,

• Tips for maximizing fertility, including how certain diet and lifestyle factors can enhance

Or reduce) fertility, and also affect a developing fetus (even before you know you’re pregnant)

PATIENT EDUCATION (also see Preconception)

A.Importance of regular preventive health care and chronic disease management.

B.Some medications might be contraindicated in pregnancy, and any current medications taken during pregnancy need to be reviewed by a prenatal care provider (e.g., an obstetrician or midwife).

C.Encourage to take a daily supplement containing (400-800 mcg) of folic acid (or a prenatal vitamin).

D.Avoid smoking, alcohol and other drugs

E.Avoid eating fish that might have high levels of mercury (e.g., King Mackerel, Shark, Sword fish, Tile fish)

F.Offer/Refer for any needed STD screening (including HIV)

G.Refer for age appropriate vaccinations, if indicated

H. Menstrual calendar, cycle beads, fertility awareness,

1. Timed coitus every other day at least 3 times starting 2-3 days prior to ovulation. Ovulation may be calculated using prior cycle lengths, cycle beads or urine ovulation detection tests.

I. Nutritional counseling and recommend weight loss if patient overweight.

J. Zika virus education and prevention strategies

1. Avoid traveling to impacted areas

2. Avoiding mosquito bites if traveling to impacted areas

3. Using condoms to prevent transmission of virus

4. Avoiding pregnancy if infected or partner infected

1) Risk to unborn fetus

REFER TO MD/ER

None

REFERENCES

CDC. Providing Quality Family Planning Services MMWR. April 25, 2014, Vol. 63, No. 4.
Hatcher RA, et al (editors). Contraceptive Technology, 20th Ed. New York: Ardent Media 417-433.
Centers for Disease Control and Prevention (CDC) Zika Virus Homepage-http://www.cdc.gov/zika/index.html

Reviewed/Revised 2017