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The major goal of prenatal care is to ensure a healthy baby and a healthy mother. The goals of antepartum care include the following:
· Evaluation of the health status of both mother and fetus
· Estimation of the gestational age
· Identification of the patient at risk for complications
· Anticipation of problems before they occur, and prevention if possible
· Patient education and communication
Commercial kits are available for the diagnosis of pregnancy, all of which depend on detection of human chorionic gonadotropin (hCG) by an antibody. The various techniques used to detect hCG include agglutination inhibition, radioimmunoassay, enzyme-linked immunosorbent assay, and immunochromatography. Some tests can detect hCG at levels as low as 25 mlU/mL or as early as 1 week after implantation.
Home tests have relatively high positive predictive values. Some of these tests, however, may have high rates of false-negative results.
It is important to identify patients at significant risk of having prenatal, Down syndrome, downs syndrome, ultrasound, amniotic fluid miscarriage, chorionic villus sampling an abnormal fetus or child. This identification may be accomplished by compiling a complete history with the use of a prenatal questionnaire. The patient should be asked about past pregnancies associated with malformations; family history (eg, mental retardation, Down syndrome, NTDs, or other genetic diseases); ethnicity (eg, Eastern European Jewish origin, Mediterranean origin, African origin); and any testing that has been performed (eg, for Tay-Sachs disease, sickle cell disease, or cystic fibrosis). Information about the current pregnancy (eg, medication [prescribed and over the counter]; alcohol, tobacco, and drug use; X-rays; advanced maternal or paternal age) also should be included. Ideally, this assessment should be accomplished preconceptionally.
A very important part of the initial physical assessment is the pelvic examination to ascertain uterine size and gestational age and estimate the expected date of delivery. If there is a discrepancy between uterine size and the last menstrual period or if the latter is unknown, first-trimester or early second-trimester ultrasonography will help establish an expected date of delivery. Ultrasound measurement of the crown-rump length at 5-12 weeks of gestation is the most accurate technique for estimation of gestational age.
The following routine and indicated tests are recommended for individual patients during the initial prenatal visit:
· Blood type
· Rh type
· Antibody screen
· Hemoglobin/hematocrit measurement
· Pap test
· Rubella antibody titer measurement
· Venereal Disease Research Laboratory (VDRL)
· Urine culture/screen
· Hepatitis B virus screen (hepatitis B surface antigen [HBsAg])
· HIV counseling/testing
Patients should be given information regarding the general plan of management for the pregnancy. The plan should include number and frequency of visits; plans for diet, nutrition, and weight gain; and signs and symptoms of potential complications. The patient should be counseled about the benefits of exercise and any restrictions that may be needed in her exercise program.