To achieve the best possible outcome for mother and child, ANTENATAL CARE consists of history taking and examination of the expectant mother complemented by screening and assessment using a combination of methods, including biochemical, haematological and ultrasound. Efforts are made to maintain maternal physical and mental well being, prevent preterm delivery, to anticipate difficulties and complications at delivery, ensure the birth of a live health infant, and to assist the couple in preparation for parenting.
Schedule of visits during pregnancy
The pregnant woman is seen by her general practitioner as soon as possible following the first missed period and after an initial assessment is referred on to the hospital for her first (booking) hospital visit between 8-14 weeks to confirm normal pregnancy and rule out any fetal abnormality. The antenatal visits are monthly until 32 weeks gestation, then fortnightly until 36 weeks, and weekly thereafter until delivery..
The preconception visit
The ideal first 'antenatal' visit is at a pre-conception clinic where health education and risk assessment can be directed towards the planned pregnancy. At that time the patient's general health and well being can be fully assessed, rubella, hepatitis and HIV status can be established, and appropriate action taken where indicated.
General advice regarding nutrition and lifestyle can be given at this time. Even a single antenatal nutritional education session during pregnancy has a significant effect on birth weight.
Advice can be given regarding the avoidance of teratogens, including those linked with excesses such as vitamin A, cigarette smoking, while ensuring an optimal dietary intake of folic acid. it is recommended that at least 0.4mg folic acid is taken daily during the peri-conceptional period. Abnormal blood glucose control during the peri-conceptional period is associated with increased fetal complications and this is also an ideal time to ensure that such factors have been taken care of by sound dietary education and adjustment, and where necessary, medication.
Booking visit (8-14 weeks)
The main purpose of the booking visit to obtain a comprehensive history, establish the gestational age and identify maternal and fetal risk factors. Baseline investigations are performed.
Women are offered a first trimester ultrasound scan for pregnancy dating, the exclusion of structural fetal abnormalities and measurement of the fetal nuchal translucency.
A management plan is then drawn up for the pregnancy, based upon the risk assessment. It is by no means inflexible and is subject to alteration at subsequent visits. If the patient has a known medical problem, e.g. diabetes, the patient is referred to a dedicated combined clinic. If there is a history of genetic or familial problems, referral to a feto-maternal specialist is arranged.
The mid-trimester risk assessment visit (20-24weeks)
The results of the ultrasound scan for fetal abnormality are also reviewed. Doppler ultrasound screening of the uterine arteries may be done to identify women at high risk of subsequent pre-eclampsia and intra-uterine growth restriction. Further care is then planned in line with risk assessment based on the ultrasound scan and other findings.
Antenatal visits in the second half of pregnancy
Any incidental maternal symptoms are dealt with. This period is also important in ensuring the education of the woman regarding the rest of pregnancy and her delivery. Contraception and plans for the birth should also be discussed from an early stage especially with regards to sterilization or other permanent contraception. This is in order to avoid unnecessary duress under emergency conditions if a Caesarean operative delivery is decided upon during labor.
Antenatal classes and the familiarization hospital visit
During the antenatal visits informal education is provided for the pregnant woman and those supporting her through pregnancy. There are formal classes organized where the prospective parents are encouraged to discuss the pregnancy and delivery, and any apprehensions they may have. There are also usually sessions with others involved in their care to discuss topics like breast feeding, pain management during the delivery etc. The common objectives of these formal educational sessions include the promotion of good health habits, allaying anxiety, increasing the feelings of control and satisfaction with the pregnancy and delivery by the mother, preparation for the postnatal period, infant feeding, and subsequent contraception.
Antenatal visit with hospital team (usually around 36-38 weeks)
The primary objective of this visit is to anticipate any problems regarding the prospective delivery. Several factors are considered, including the past obstetric history, e.g. a previous Caesarean delivery for lack of progress in labor. Fetal malpresentation or malposition is sought because these may also indicate a high likelihood of operative delivery