Abstract

PIP: Implementation of the Safe Motherhood initiative in India calls for the institution of good prenatal care for all women. The first aspect of prenatal care is collecting the patient's history and reviewing the health history of her family. The physical examination should include inspection for reproductive tract diseases, a bimanual examination early in pregnancy to correlate the size of the uterus and the reported last menstrual period, and routine abdominal palpation. Ultrasonography should be performed at least once. Laboratory tests should include analysis of hemoglobin and hematocrit levels, urine analysis, blood grouping and Rh typing, serological tests for syphilis, antibody screening and screening for rubella and hepatitis antigen, and cervical cytology. Additional screening and genetic testing may be necessary in certain cases. Women with no complications should be seen once a month for 28-30 weeks, once every two weeks until 36 weeks, and once a week thereafter. High-risk patients should be seen more frequently. Infections detected during pregnancy must be properly treated with antibiotics, although, in general, women should avoid medications during pregnancy. In India, hematinics and vitamins should be given to all pregnant women. Drugs and substances to be avoided during pregnancy include tetracycline, chloramphenicol, streptomycin, cotrimoxazole, diuretics, alcohol, trimethadone, warfarin, lithium, quinine, sex hormones, anesthetics, tobacco, vitamin D, and all live vaccines except BCG. Common sense should dictate the safe level of activity for a pregnant woman.