Prenatal care, also known as antenatal care, is a type of
preventive healthcare
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
. It is provided in the form of medical checkups, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins, which prevents potential health problems throughout the course of the pregnancy and promotes the mother and child's health alike.
The availability of routine prenatal care, including
prenatal screening and diagnosis, has played a part in reducing the frequency of
maternal death
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pre ...
,
miscarriage
Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...
s,
birth defects
A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...
,
low birth weight
Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an
infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal inten ...
,
neonatal infection
Neonatal infections are infections of the neonate (newborn) acquired during prenatal development or in the first four weeks of life (neonatal period). Neonatal infections may be contracted by mother to child transmission, in the birth canal dur ...
s and other preventable health problems.
Traditional prenatal care in high-income countries generally consists of:
* monthly visits during the first two
trimesters
Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occurs by sexual intercourse, but ca ...
(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 traditional form of antenatal care has developed from the early 1900s and there is very little research to suggest that it is the best way of giving antenatal care.
Antenatal care can be costly and uses many staff. The following paragraphs describe research on other forms of antenatal care, which may reduce the burden on maternity services in all countries.
Visits numbers
The WHO recommends that pregnant women should all 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 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 down to chance results).
In fact, Dowswell et al.’
Cochrane Reviewfindings 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.
A new alternative for some of the routine prenatal care visits is
Telemedicine.
There are many ways of changing health systems to help women access antenatal care, such as new health policies, educating health workers and health service re-organisation. Community interventions to help people change their behavior can also play a part. Examples of interventions are media campaigns reaching many people, enabling communities to take control of their own health, informative-education-communication interventions and financial incentives.
A review looking at these interventions found that one intervention helps improve the number of women receiving antenatal care.
However interventions used together may reduce baby deaths in pregnancy and early life, lower numbers of low birth weight babies born and improve numbers of women receiving antenatal care.
The World Health Organization (WHO) reported that in 2015 around 830 women died every day from problems in
pregnancy
Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occurs by sexual intercourse, but ca ...
and
childbirth
Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...
.
Only 5 lived in high-income countries. The rest lived in low-income countries.
A study examined the differences in early and low-weight birth deliveries between local and immigrant women and saw the difference caused by prenatal care received. The study, between 1997 and 2008, looked at 21,708 women giving birth in a region of Spain. The results indicated that very preterm birth (VPTB) and very low birth weight (VLBW) were much more common for immigrants than locals (Castelló et al., 2012). The study showed the importance of prenatal care and how universal prenatal care would help people of all origins get proper care before pregnancy/birth (Castelló et al., 2012).
Group versus individual care
Group antenatal care has a couple of obvious benefits: it costs less than one-to-one visits and the women have more hours of care as a group than on their own.
Only small studies have been conducted looking at group care but they have found that mothers knew more about pregnancy, birth and parenting in the group setting.
The mothers reported liking the group care and the review found no difference between how the pregnancies developed between the group and individual settings.
Midwife-led care
Midwife-led care for low-risk women is where a midwife team (and GP if needed) leads the care a woman receives and she does not usually see a specialist doctor in her pregnancy. Women with midwife-led pregnancies are more likely to give birth without being induced but have natural labours. However they are less likely to have their waters broken, an instrumental delivery,
episiotomy
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening ...
or preterm birth.
Around the same number of women in each group had a caesarean section.
Prenatal examinations
At the initial antenatal care visit and with the aid of a special booking checklist the pregnant women become classified into either normal risk or high risk.
In many countries, women are given a summary of their case notes including important background information about their pregnancy, such as their medical history, growth charts and any scan reports.
If the mother goes to a different hospital for care or to give birth the summary of her case notes can be used by the midwives and doctors until her hospital notes arrive.
A review looking into women keeping their own case notes shows they have more risk of having a caesarean section.
However the women reported feeling more in control having their notes and would like to have them again in future pregnancies.
25% of women reported their hospital notes were lost in hospital though none of the women forgot to take their own notes to any appointments.
Prenatal diagnosis or prenatal screening (note that "Prenatal Diagnosis" and "Prenatal Screening" refer to two different types of tests) is
testing
An examination (exam or evaluation) or test is an educational assessment intended to measure a test-taker's knowledge, skill, aptitude, physical fitness, or classification in many other topics (e.g., beliefs). A test may be administered verba ...
for diseases or conditions in a
fetus
A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...
or
embryo
An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male spe ...
before it is born.
Obstetricians
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a sur ...
and
midwives
A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery.
The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; co ...
have the ability to monitor mother's health and
prenatal development
Prenatal development () includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal devel ...
during pregnancy through series of regular check-ups.
Physical examinations generally consist of:
* Collection of (mother's)
medical history
The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...
* Checking (mother's)
blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
* (Mother's) height and weight
*
Pelvic exam
A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, d ...
*
Doppler fetal heart rate monitor
A Doppler fetal monitor is a hand-held ultrasound transducer used to detect the fetal heartbeat for prenatal care. It uses the Doppler effect to provide an audible simulation of the heart beat. Some models also display the heart rate in beats pe ...
ing
* (Mother's)
blood
Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...
and
urine test
A urine test is any medical test performed on a urine specimen. The analysis of urine is a valuable diagnostic tool because its composition reflects the functioning of many body systems, particularly the kidneys and urinary system, and specimens a ...
s
* 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 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 worked out by looking at the mother's height and weight, and the weights of their previous babies.
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 the health care workers to make.
Obstetric ultrasound
Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedure is a ...
s 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
* Assess possible risks to the mother (e.g.,
miscarriage
Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...
,
blighted ovum
A blighted ovum is a pregnancy in which the embryo never develops or develops and is reabsorbed. In a normal pregnancy, an embryo would be visible on an ultrasound by six weeks after the woman's last menstrual period. Anembryonic gestation is one o ...
,
ectopic pregnancy
Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. ...
, or a
molar pregnancy condition)
* Check for fetal malformation (e.g.,
club foot
Clubfoot is a birth defect where one or both feet are rotated inward and downward. Congenital clubfoot is the most common congenital malformation of the foot with an incidence of 1 per 1000 births. In approximately 50% of cases, clubfoot aff ...
,
spina bifida
Spina bifida (Latin for 'split spine'; SB) is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy. There are three main types: spina bifida occulta, me ...
,
cleft palate
A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate (the roof of the mouth) contains an opening into the nose. The te ...
, clenched fists)
* Determine if an
intrauterine growth retardation
Intrauterine growth restriction (IUGR), or fetal growth restriction, refers to poor growth of a fetus while in the womb during pregnancy. IUGR is defined by clinical features of malnutrition and evidence of reduced growth regardless of an infant's ...
condition exists
* Note the development of fetal body parts (e.g.,
heart
The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...
,
brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
,
liver
The liver is a major Organ (anatomy), organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of proteins and biochemicals necessary for ...
,
stomach
The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
,
skull
The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, the ...
, other
bone
A bone is a Stiffness, rigid Organ (biology), organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red blood cell, red and white blood cells, store minerals, provid ...
s)
* Check the
amniotic fluid
The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products betwee ...
and
umbilical cord
In placental mammals, the umbilical cord (also called the navel string, birth cord or ''funiculus umbilicalis'') is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiologic ...
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 that it's neither molar or ectopic, determine due date
* 13–14 weeks (some areas) — evaluate the possibility of
Down syndrome
Down syndrome or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is usually associated with physical growth delays, mild to moderate intellectual dis ...
* 18–20 weeks — see the expanded list above
* 34 weeks (some areas) — evaluate size, verify placental position
A review looking at routine ultrasounds past 24 weeks found that there is no evidence to show any benefits to the mother or the baby.
Early scans mean that multiple pregnancies can be detected at an early stage of pregnancy
and also gives more accurate due dates so that less women are induced who do not need to be.
Levels of feedback from the ultrasound can differ. High feedback is when the parents can see the screen and are given a detailed description of what they can see.
Low feedback is when the findings are discussed at the end and the parents are given a picture of the ultrasound.
The different ways of giving feedback affect how much the parents worry and the mother's health behaviour although there is not enough evidence to make clear conclusions.
In a small study, mothers receiving high feedback were more likely to stop smoking and drinking alcohol however the quality of the study is low and more research is needed to say for certain which type of feedback is better.
Women experiencing a complicated pregnancy may have a test called a Doppler ultrasound to look at the blood flow to their unborn baby.
This is performed to detect signs that the baby is not getting a normal blood flow and therefore is 'at risk'. A review looked at performing Doppler ultrasounds on all women even if they were at 'low risk' of having complications.
The review found that routine Doppler ultrasounds may have reduced the number of preventable baby deaths but the evidence was not strong enough to recommend that they should be made routine for all pregnant women.
United States
Proper prenatal care affects all women of various social backgrounds. While availability of such services have considerable personal health and social benefits, socioeconomic problems prevent its universal adoption in both developing and developed nations, such as the US. Although women can benefit by utilizing prenatal care services, there exists various levels of health care accessibility between different demographics throughout the United States.
See also
*
Reproductive Health Supplies Coalition
The Reproductive Health Supplies Coalition (RHSC) is a global partnership of public, private and non-governmental organizations. Its aim is to ensure that all people in low- and middle-income countries can choose, obtain and use the supplies and a ...
References
Further reading
*
*
*
*
External links
Pregnancy Education
{{Authority control
Childbirth
*
Midwifery