Prenatal care, also known as antenatal care, is a type of preventive healthcare for pregnant women. It is provided in the form of medical checkups and healthy lifestyle recommendations for the pregnant person. Antenatal care also consists of educating the pregnant woman or girl about maternal physiological and biological changes in pregnancy, along with prenatal nutrition, all of which prevent potential health problems throughout the pregnancy and promote good health for the parent and the fetus. The availability of routine prenatal care, including prenatal screening and diagnosis, has played a part in reducing the frequency of maternal death, miscarriages, birth defects, low birth weight, neonatal infections, and other preventable health problems.
Visits Traditional prenatal care in high-income countries generally consists of:
monthly visits during the first two trimesters (from the 1st week to the 28th week) fortnightly visits from the 28th week to the 36th week of pregnancy weekly visits after 36th week to the delivery, from the 38th week to the 42nd week Assessment of parental needs and family dynamics The WHO recommends that pregnant women receive at least eight antenatal visits to spot and treat problems and give immunizations. Although antenatal care is important to improve the health of both mother and baby, many women do not receive the recommended eight visits. There is little evidence behind the number of antenatal visits pregnant women receive and what care and information is given at each visit. It has been suggested that women who have low-risk pregnancies should have fewer antenatal visits. However, when this was tested, women with fewer visits had babies who were much more likely to be admitted to neonatal intensive care and stay there for longer (though this could be down to chance results). A 2015 Cochrane Review findings buttresses this notion, with evidence that in settings with limited resources, where the number of visits is already low, programmes of ANC with reduced visits are associated with an increase in perinatal mortality. Therefore, it is doubtful that the reduced visits model is ideal, even in low-income countries (LICs), where pregnant women are already attending fewer appointments. Not only is visiting prenatal care early is highly recommended, but also a more flexible pathway allowing more visits, from the time a pregnant woman books for prenatal care, as it potentially enables more attention to those women who come late. Also, women who had fewer antenatal visits were not as satisfied with the care they received compared with women who had the standard number of visits.
Examinations
At the initial antenatal care visit, pregnant women are classified into either low risk or high risk. Antenatal risk assessment began in the United Kingdom before becoming a widespread practice. Prenatal screening is testing for diseases or conditions in a fetus or embryo before it is born, and prenatal diagnosis refers to the official confirmation of these potential diseases or conditions. Obstetricians and midwives have the ability to monitor mother's health and prenatal development during pregnancy through series of regular check-ups. Physical examinations generally consist of:
Collection of the mother's (and general family) medical history Checking blood pressure of the mother Documentation of the mother's height and weight Pelvic exam Doppler fetal heart rate monitoring Blood and urine tests on the mother Discussion with caregiver In some countries, such as the UK, the symphysial fundal height (SFH) is measured as part of antenatal appointments from 25 weeks of gestation. (The SFH is measured from the woman's pubic bone to the top of the uterus. A review into this practice found only one piece of research, so there is not enough evidence to say whether measuring the SFH helps to detect small or large babies. As measuring the SFH is not costly and is used in many places, the review recommends carrying on this practice. Growth charts are a way of detecting small babies by the measuring the SFH. There are two types of growth chart:
Population-based chart, which shows a standard growth and size for each baby Customized growth chart, which is calculated by looking at the mother's height and weight, along with the weights of their previous babies. Examples of these growth charts are created by the World Health Organization and Centers for Disease Control and Prevention, which differ based on the sex of the infant, and can be found at: https://www.cdc.gov/growthcharts/who-charts.html A review looking into which of these charts detected small babies found that there is no good quality research to show which is best. More research is needed before the customized growth charts are recommended because they cost more money and take more time for healthcare workers to make.
Ultrasounds Obstetric ultrasounds are most commonly performed during the second trimester at approximately week 20. Ultrasounds are considered relatively safe and have been used for over 35 years for monitoring pregnancy. Among other things, ultrasounds are used to:
Diagnose pregnancy (uncommon) Check for the number of fetuses (e.g., twins, triplets, etc.) Assess possible risks to the mother (e.g., miscarriage, blighted ovum, ectopic pregnancy, or a molar pregnancy condition) Check for fetal malformation (e.g., club foot, spina bifida, cleft palate, clenched fists) Determine if an intrauterine growth retardation condition exists Note the development of fetal body parts (e.g., heart, brain, liver, stomach, skull, other bones) Check the amniotic fluid and umbilical cord for possible problems Determine the due date and how far along the mother is based on measurements and relative developmental progress Generally, an ultrasound is ordered whenever an abnormality is suspected, or along a schedule similar to the following:
… excerpt ends here. Continue reading the full article.
