Antepartum Care

Definition

The antepartum or pre-natal period starts when the woman’s pregnancy is diagnosed and ends just before the baby is delivered. Antepartum care promotes patient education and provides ongoing risk assessment and development of an individualized patient management plan. The major goal of prenatal care is not only to ensure that a healthy baby is born but also to promote the optimum health for the mother.

The following are the goals of antepartum care:

• To evaluate the health status of the mother and the fetus
• To estimate the gestational age
• To identify the patient at risk for complications
• To anticipate problems before they occur and prevent them if possible.
• To promote patient education and communication

Diagnosis of pregnancy

• 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.

Estimating Gestational Age

Age of gestation (AOG) should be estimated to calculate the exact date of delivery and the estimated weight and height of the fetus. The following are some estimates of AOG methods:

• Nagele’s Rule
• McDonald’s Method
• Bartholomew’s Rule
• Haase’s Rule
• Johnson’s Rule

Identifying Patient at Risk for Complications

Risk Factors

• Age < 16 or > 35
• 2 spontaneous or induced abortions
• < 8th grade education
• > 5 deliveries
• Abnormal presentation
• Active TB
• Anemia (Hgb <10, Hct <30%)
• Chronic pulmonary disease
• Cigarette smoking
• Endocrinopathy
• Epilepsy
• Heart disease class I or II
• Infants > 4,000 gm
• Isoimmunization (ABO)
• Multiple pregnancy (at term)
• Poor weight gain
• Post-term pregnancy
• Pregnancy without family support
• Preterm labor (34-37 weeks)
• Previous hemorrhage
• Previous pre-eclampsia
• Previous preterm or SGA infant
• Pyelonephritis
• Rh negative
• Second pregnancy in 9 months
• Small pelvis
• Thrombophlebitis
• Uterine scar or malformation
• Venereal disease