Antepartum Care

Excerpt

Antepartum care, also referred to as prenatal care, consists of the all-encompassing management of patients throughout their pregnancy course. Antepartum care has become the most frequently utilized healthcare service within the United States, averaging greater than 50 million visits annually. After the first positive pregnancy test, care is typically sought by patients and begun after confirmed sonographic intrauterine pregnancy. The average number of visits ranges between twelve to seventeen visits, depending on the complexity of the pregnancy course.

The prenatal course is typically separated into trimesters, for which each of the three trimesters serves a specific purpose for maternal/fetal monitoring, gestation-specific examinations and laboratory work, and screening for potential pregnancy abnormalities. Traditionally, prenatal visit frequencies are typically scheduled at 4-week intervals until 28 weeks of gestation, at which time visits are scheduled every 2 weeks until 36 weeks of gestation, followed by weekly visits until delivery. Visits may be adjusted to more frequent follow-ups when high-risk pregnancy complications are present, when pertinent lab values must be reviewed, or if patients require closer monitoring for risk factors.

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 to low socio-economic and minority populations. Although still prevalent despite efforts, the growing disparities between minority populations (specifically among Hispanics and African Americans) are rooted in lack of access and complex obstetric and medical risk factors leading to poor obstetric outcomes. Thus, an adequate evaluation of a patient’s medical history, related risk factors, and potential obstacles to healthcare must be attained, followed by a patient-centered discussion regarding the potential prenatal plan of care.