Initial Antepartum Care

Excerpt

Antepartum care, or prenatal care, is the health care provided during pregnancy to optimize outcomes for both the mother and the fetus. The primary objective of the initial antenatal care visit is to establish the estimated delivery date, identify high-risk pregnancies, and perform maternal and fetal screening. During the initial visit, which ideally occurs in the first trimester, prenatal care assessments involve taking a complete medical history, performing physical and gynecological exams, and conducting laboratory and imaging studies. High-risk pregnancies necessitate more frequent surveillance.

Prenatal care has become the most frequently utilized healthcare service within the United States (US), with 98% of women who give birth initiating regular care at some point in their pregnancy. After the first positive pregnancy test, care is typically sought by patients and begins after a confirmed sonographic intrauterine pregnancy. In addition to initial medical history, the first antepartum visit involves complex clinical assessments, including potential exposures to infections or toxins, and psychosocial assessments to identify issues such as mental health concerns, barriers to care, and exposure to violence and monitoring for potential complications, including maternal metrics (eg, blood pressure, weight, and height), fetal heart activity, and screens for maternal-fetal conditions (eg, anemia, infections, and sexually transmitted diseases).

Ultrasound examinations are essential for accurate gestational dating, detecting multiple pregnancies, and screening for congenital anomalies. Prenatal genetic screening for conditions like aneuploidies and carrier screenings for genetic disorders are also offered. Laboratory tests during prenatal visits confirm pregnancy and screen for conditions such as anemia, infections, and sexually transmitted diseases. Based on individual risk factors, targeted screenings for thyroid function, diabetes, and other conditions are performed. With the increasing focus beginning in the early 1990s on preventing maternal and fetal morbidity and mortality, great efforts have been made to improve access to quality antepartum care for low socioeconomic and minority populations. Although still prevalent despite efforts, the growing disparities between minority populations are rooted in lack of access and complex obstetric and medical risk factors leading to poor obstetric outcomes. Consequently, this approach to antepartum care ensures early identification of potential complications, enabling timely interventions, improved maternal and fetal outcomes, and an enhanced antepartum experience for the patient.