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name: langcare-prenatal description: > Performs structured prenatal visit assessment organized by trimester with ACOG guideline alignment. Tracks gestational age, weight gain, BP trends, fetal assessment, trimester-specific labs, and risk factors. Use when asked to review prenatal visit, prenatal assessment, OB visit, pregnancy checkup, trimester labs, or gestational age evaluation.

Prenatal Visit Workflow

When to Use This Skill

Use when a clinician needs a structured prenatal visit assessment organized by current gestational age and trimester with ACOG-aligned lab tracking and risk assessment.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics (maternal age -- flag if >=35 for AMA)
2. Use fhir_search to pull pregnancy Condition (SNOMED 77386006) and determine gestational age from onset or EDD Observation (LOINC 11778-8)
3. Use fhir_search to pull vital signs trend: BP (preeclampsia monitoring), weight (gain trajectory per IOM guidelines)
4. Use fhir_search to pull fetal Observations: fetal heart rate (LOINC 11996-6), fundal height (LOINC 11948-7)
5. Use fhir_search to pull prenatal laboratory results organized by trimester milestone (see references/acog-schedule.md)
6. Assess preeclampsia risk: BP trend, urine protein, aspirin prophylaxis status
7. Use fhir_search to pull active MedicationRequest: verify prenatal vitamin, aspirin if indicated, Rhogam timing
8. Use fhir_search to pull Procedure resources for ultrasound history
9. Present structured visit summary with current trimester context, risk flags, and upcoming milestones

FHIR Resources

• Patient -- Maternal age
• Condition -- Pregnancy diagnosis, complications (GDM, preeclampsia, preterm risk)
• Observation -- Vitals (BP, weight), fetal (FHR, fundal height), labs (by trimester), EDD
• MedicationRequest -- Prenatal vitamins, aspirin, Rhogam, insulin
• Procedure -- Ultrasounds, amniocentesis
• DiagnosticReport -- Ultrasound reports, lab panels

FHIR Query Examples

Pull Pregnancy Condition

fhir_search(resourceType="Condition", queryParams="patient=[patient-id]&code=77386006&clinical-status=active")

Pull EDD

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=11778-8&_sort=-date&_count=1")

Pull Fetal Heart Rate

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=11996-6&_sort=-date&_count=5")

Clinical Guidelines

• ACOG prenatal visit schedule and lab timing (see references/acog-schedule.md)
• IOM weight gain recommendations by pre-pregnancy BMI
• USPSTF: aspirin prophylaxis for preeclampsia in high-risk patients (12-28 weeks)
• GBS prophylaxis per CDC guidelines

Interpretation Guide

• Calculate gestational age from EDD: GA weeks = 40 - (weeks until EDD)
• Trimester determination: 1st (0-13w6d), 2nd (14-27w6d), 3rd (28-40+)
• Weight gain targets by pre-pregnancy BMI: underweight 28-40 lbs, normal 25-35 lbs, overweight 15-25 lbs, obese 11-20 lbs
• FHR normal: 110-160 bpm. Fundal height concordance: cm = GA in weeks at 20-36 weeks (discrepancy >3 cm warrants evaluation)
• Preeclampsia flags: SBP >=140 or DBP >=90 after 20 weeks on 2 occasions, proteinuria >=300 mg/24h
• GDM screening: 1-hour GCT at 24-28 weeks, positive if >=130-140 mg/dL (per institutional cutoff)

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges