Antenatal Care
Antenatal care encompasses all medical examinations, laboratory tests, counseling, and monitoring processes conducted from the beginning of pregnancy until delivery.
Pregnancy is considered a physiological process in healthy women. However, with the increasing age of pregnancy due to modern work-life patterns and the widespread use of assisted reproductive technologies, conditions such as chronic hypertension, type II diabetes, obesity, and thyroid disorders have become more common during pregnancy. These comorbidities must be carefully evaluated, and both the mother and fetus should be monitored as high-risk cases when necessary.
Definition of High-Risk Pregnancy
A high-risk pregnancy refers to a pregnancy in which the mother or fetus faces a greater-than-normal risk of complications compared to the general population.
Low-risk pregnancy follow-up includes:
- Educating the expectant mother and her family
- Managing minor pregnancy-related discomforts
- Conducting clinical and laboratory-based screening programs
High-risk pregnancy management additionally requires:
- Early detection of maternal or fetal conditions that may threaten health
- Prevention and timely treatment of complications
Importance of Antenatal Care
Studies show that women who do not receive regular antenatal care experience poorer pregnancy outcomes. Structured follow-up programs are essential for:
- Early diagnosis
- Timely intervention
- Protection of maternal and fetal health
Maternal Education
An important component of antenatal care is educating expectant mothers.
Key topics include:
- Signs of preterm labor
- Risks of gestational diabetes and hypertension
- Prevention of infections
Education significantly reduces perinatal and maternal complications.
Follow-Up and Monitoring
Each pregnancy is evaluated individually.
The follow-up plan is shaped according to the mother’s general health status, previous obstetric history, and current risk factors.
During routine antenatal visits, the following are performed:
- Measurement of maternal weight and blood pressure
- Assessment of uterine growth
- Screening tests and ultrasonography
- Discussion of symptoms and concerns
These evaluations are conducted regularly throughout pregnancy.
Frequency of Antenatal Visits
The frequency of visits varies by gestational age:
- Up to 28 weeks: Every 4 weeks
- 28–36 weeks: Every 2 weeks
- From 36 weeks to delivery: Weekly
If indicated, the monitoring frequency may be increased.
Key Risk Factors to Evaluate
1. General Demographic Factors
- Maternal age
- Ethnicity
- Socioeconomic status
- Nutritional habits
- Occupational exposures
2. Obstetric History
- Gravidity, parity, abortion, and ectopic pregnancy history
- Prior pregnancy outcomes: delivery method, birth weight, complications (preterm birth, premature rupture of membranes, intrauterine growth restriction, preeclampsia, intrauterine fetal demise, chromosomal/genetic abnormalities)
- Number of living children
- Postpartum depression history
3. Medical History
- Smoking, substance, or alcohol use
- Chronic illnesses and ongoing medications
- History of blood transfusion
- Previous surgeries, type of anesthesia, and complications
4. Gynecological History
- Subfertility
- Contraceptive use
- Menstrual regularity
- History of sexually transmitted infections (HIV, HPV, HBV, HCV, gonorrhea, chlamydia)
5. Family History
- Congenital anomalies
- Diabetes mellitus
- Hypertension
- Renal disease
- Thromboembolic disorders
- Maternal preeclampsia or preterm birth history
6. Pregnancy-Related Additional Risk Factors
- Multiple pregnancy
- Vaginal bleeding
- Reduced or abnormal fetal movements
- Abnormal uterine size or amniotic fluid volume
- Excessive weight gain
During each physical examination, blood pressure, weight, and uterine fundal height should be recorded.
Diagnostic and Screening Tests in Pregnancy
- Complete urinalysis
- Complete blood count
- Blood typing and antibody screening
- Serological tests (HBV, HCV, HIV, TORCH, syphilis)
- Ultrasound (fetal growth, anomalies, placental location, multiple pregnancy)
- Doppler ultrasonography (fetal circulation and placental function)
- First and second trimester biochemical screenings, MSAFP
- Asymptomatic bacteriuria screening
- Cervical smear
- Group B Streptococcus vaginal culture
- Thyroid function tests for high-risk cases
Antenatal and Neonatal Care
The primary goal of antenatal care is to identify pregnancies with risk factors early, ensure continuous follow-up, and prevent or manage complications effectively.
Thanks to advances in neonatal intensive care, it is now possible to support survival even from 24 weeks of gestation.
However, preterm birth remains one of the leading causes of neonatal morbidity and mortality.
Specific attention should be given to risk groups such as multiple pregnancies, previous preterm deliveries, and prolonged standing or physically demanding work.
In such cases:
- Vaginal cultures should be performed.
- Cervical length should be measured via transvaginal ultrasound.
- Fetal fibronectin testing may be used to assess preterm labor risk.
- If uterine contractions or pelvic pressure occur, the patient should seek immediate medical care.
Corticosteroid administration significantly reduces the risk of respiratory distress syndrome (RDS), intraventricular hemorrhage, and necrotizing enterocolitis in preterm infants.
Risk Scoring in Pregnancy
Risk assessment can be divided into general and specific scoring systems.
The advantage of a general scoring system is to standardize care by classifying pregnancies into risk categories. Such systems have been developed for perinatal mortality, preterm birth, and perinatal asphyxia prediction.
Although many countries use standardized scoring models, in practice, identifying specific risk factors remains a priority.
When a risk factor is identified, preventive and therapeutic measures specific to the condition are implemented in addition to routine antenatal care — ensuring optimal outcomes for both mother and baby.
