Introduction

It is well known that pregnancy is a determining period for the long-term health and well-being of the baby and each member of the expecting family. Despite the family and the healthcare provider’s best efforts, factors may lead to serious complications.

Years of research and trials have demonstrated aspects of prenatal care that may need closer monitoring at certain stages to identify and address any possible complications promptly. This has led to a series of healthcare provider visits, screening tests, and counseling which take place before, during, and after the pregnancy.

These screenings can be provided by an obstetrician, a family physician, a midwife, or a multidisciplinary team, based on your preference and risk factors.

In this post, we discuss these steps briefly and try to explain the rationale behind each step.

Preconception Counselling

It is never too early to start planning and preparing for a new member of the family. While this may include preparing a new baby room and babyproofing the house, when it comes to health and well-being, there are some steps that you may consider with your healthcare provider in a series of pre-conception counseling sessions.

In these sessions, you may ask about the challenges ahead for a better understanding of the journey, especially in those without previous experience of pregnancy.

Furthermore, your healthcare provider may organize your previous medical conditions and medications, add supplementations such as folic acid, Iron, and vitamins, and discuss some lifestyle modifications for lower risk of complications. These may be regarding smoking, alcohol, caffeine, substance cessation, diet management, physical activity, and weight management.

Some laboratory testing aimed at finding any underlying and chronic infections as well as additional genetic testing may be done to assess the risk and prepare for related complications in certain high-risk groups.

Initial Prenatal Visit

This visit usually takes place as soon as the family suspects pregnancy, which is expected to occur within 8-12 weeks of gestation.

In this visit, besides a complete history and physical exam (including blood pressure and weight), the estimated age of pregnancy and date of delivery will be determined based on the last menstrual period. Furthermore, an ultrasound examination for a more precise dating will be offered.

A review of your medications along with planning future visits is done on the first visit.

Also, Initial laboratory tests including blood group, infection screening, and urine analysis are performed.

At the end of this visit, you will have an overview of future routine visits and a plan to address any possible emergencies such as bleeding or abdominal pain.

You may also ask to be educated about nausea and vomiting and any other complications in the first trimester of pregnancy.

Further Prenatal Visits

For uncomplicated pregnancies, it is recommended to visit your healthcare provider at least once every 4-6 weeks until 30 weeks of gestation. Afterward, more frequent visits are recommended. Between 30 to 35 weeks of gestation, a visit every 2-3 weeks is recommended, and from 36 weeks until delivery meet with your healthcare provider every week.

At each visit, the progress of your pregnancy will be assessed through careful history and physical examinations. Fetal Heart Rate (FHR) can be assessed from weeks 10-12 onward. Additional tests or more frequent visits may be ordered based on the gestational age or any possible complications suspected through examination.

A specific physical examination called Leopold’s Maneuver can be performed to identify fetal lie and presentation after weeks 30-32.

Screening and Diagnostic Tests

The screening and diagnostic tests performed during pregnancy vary and depend on the individual circumstances of the family and the clinical judgment of healthcare providers. Some of these tests are done routinely at different stages of pregnancy and include routine bloodwork, infectious diseases screening, urine sample analysis, and pap smear.

Ultrasonography is carried out early on to determine the exact age of pregnancy, and later to assess the fetal wellbeing and situation in the womb, amniotic fluid levels, and placental conditions.

There are different methods of genetic testing to screen or diagnose any congenital or hereditary conditions. These include less invasive methods such as maternal serum sampling or more invasive ones such as chorionic villous sampling (CVS) or amniocentesis (amniotic fluid sampling). The decision on when to do which tests lies between the expecting mother and their healthcare provider, depending on the risk factors.

Assessment of the mother’s glycemic control regarding the development of Gestational Diabetes Mellitus (GDM) is routinely done at weeks 24 to 28 of gestation. Depending on risk factors some may choose to be assessed earlier in their pregnancy. This test, called the oral glucose challenge test (OGCT) consists of an assessment of the mother’s response to consuming glucose after one-to-two hours.

Upon discovering fetal movement by the mother (usually at weeks 18-22), it is recommended to count the movements during a 2-hour period every once in a while, and document the recordings to report to your healthcare provider.

Fetal Surveillance Tests

Other tests that may be performed more toward the end of pregnancy, depending on the indications, include the Non-Stress Test (NST) and the Biophysical Profile (BPP).

• Non-Stress Test (NST): Consists of monitoring the Fetal Heart Rate (FHR) and its relationship to the Fetal Movement (FM) for an extended period.

• Biophysical Profile (BPP): Includes an ultrasonographical assessment of the fetus which could be done along with NST.

Postpartum Visits

The postpartum follow-up visits, done routinely within 6 weeks of labor, bear significant importance and might be overlooked by some due to the completion of their pregnancy journey. Routinely, this visit consists of history taking and physical examination and assessment of both the mother and the baby.

Subjects discussed in the postpartum visits include breastfeeding, supplementation for both the mother and the baby, vaccination, mental health and postpartum depression (known as the baby blues), routine neonatal visits, and proper contraception.

For mothers with complications such as GDM, additional tests may be indicated to rule out the persistence of the condition and assess the return of normal glycemic control.

Conclusion

As discussed in this post, routine visits are aimed to prevent and cover a wide range of medical and psychological complications during pregnancy. While your healthcare provider is your best source of information and planning for routine visits and assessment of the need for any additional tests, it is immensely beneficial to stay informed and educated on the subject of prenatal screening and diagnostic tests, and the complications that may occur for an optimal pregnancy journey.