Prenatal care
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
'Prenatal care' refers to the medical care recommended for women before and during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible (through recommendations on adequate nutrition, exercise, vitamin intake etc), and to direct the woman to appropriate specialists, hospitals, etc. if necessary. The availability of routine prenatal care has played a part in reducing maternal death rates and miscarriages as well as birth defects, low birth weight, and other preventable infant problems in the developed world[citation needed].
While availability of prenatal care has considerable personal health and social benefits, socioeconomic problems prevent its universal adoption in many developed as well as developing nations.
Studies in Canada and the United States have shown that communities in rural areas as well as minorities are less likely to have available prenatal care and also have higher rates of infant mortality and miscarriage.
One prenatal practice is for the expecting mother to consume vitamins with at least 400 mcg of folic acid to help prevent neural tube defects.
Prenatal care generally consists of:
- monthly visits during the first two trimesters (from week 1-28)
- biweekly from 28 to week 36 of pregnancy
- weekly after week 36 (delivery at week 38-40)
Physical examinations
Physical examinations generally consist of:
- collection of (mother's) medical history
- checking (mother's) blood pressure
- (mother's) height and weight
- pelvic exam
- (mother's) blood and urine tests
- discussion with caregiver
Ultrasound
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 multiple fetuses
- Determine the sex of the fetus
- 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 due date (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:
- 7 weeks - confirm pregnancy, ensure its neither molar or ectopic, determine due date
- 13-14 weeks (some areas) - evaluate the possibility of Down Syndrome
- 18-20 weeks - see the expanded list above
- 34 weeks (some areas) - evaluate size, verify placental position