Objectives of Antenatal Care

1. Early and Accurate Assessment of Gestational Age

• Confirm pregnancy and calculate the estimated date of delivery (EDD) using Naegele's rule (LMP − 3 months + 7 days)
• Establish accurate dating — critical for interpreting all subsequent screening tests and planning delivery
• Ultrasound is used to confirm or refine dating, especially when the LMP is uncertain

2. Risk Identification and Stratification

• Take a thorough medical, surgical, obstetric, and psychosocial history
• Identify pre-existing conditions: hypertension, diabetes, renal disease, cardiac disease, autoimmune disorders
• Screen for risk factors for preterm birth, fetal growth restriction, pre-eclampsia, gestational diabetes
• Refer high-risk women to appropriate specialty care early

3. Screening and Management of Complications

• Detect and manage pregnancy-specific complications: pre-eclampsia, gestational diabetes mellitus, placenta praevia, fetal growth restriction, anaemia
• Detect and manage pre-existing conditions that worsen in pregnancy
• Perform recommended laboratory tests at each trimester (blood group and Rh typing, CBC, RPR/syphilis, hepatitis B, rubella immunity, urine culture, diabetes screen at 26–28 weeks, GBS at 35–37 weeks)
• Perform anatomic ultrasound in the second trimester to detect fetal anomalies

4. Monitoring Fetal Growth and Wellbeing

• Serial symphysis-fundal height measurements to track growth
• Ultrasound to assess fetal size, amniotic fluid, and placental location
• Doppler studies where indicated (e.g., risk of growth restriction)
• Assess fetal movements
• Identify and manage multiple pregnancies

5. Promotion of Maternal Health

• Encourage optimal nutrition and appropriate gestational weight gain (individualised by BMI)
• Promote safe exercise (unless obstetric contraindication exists)
• Supplement with folic acid (reduce neural tube defects), iron, and other micronutrients as needed
• Monitor and manage blood pressure, weight, and urinalysis at each visit

6. Prevention of Complications

• Aspirin for women at risk of pre-eclampsia (started ≤16 weeks)
• Progesterone for women with prior spontaneous preterm birth or short cervix
• Anti-D (Rh) immunoglobulin for Rh-negative mothers to prevent alloimmunisation
• Vaccinations: influenza, Tdap (whooping cough), COVID-19 as recommended
• Intermittent preventive treatment of malaria in endemic areas (e.g., sulfadoxine-pyrimethamine)
• Prophylaxis and treatment of iron-deficiency anaemia

7. Screening and Counselling for Infections

• Screen for and treat: syphilis, HIV, hepatitis B, rubella, group B Streptococcus, UTIs
• Offer HIV testing and initiate antiretroviral therapy to prevent mother-to-child transmission
• Counsel on STI prevention
• Advise on hand hygiene to prevent community-acquired infections

8. Genetic and Anomaly Screening

• First-trimester combined screening (nuchal translucency + PAPP-A + β-hCG) for chromosomal anomalies
• Cell-free fetal DNA (cfDNA/NIPT) where indicated
• Second-trimester anomaly scan
• Amniocentesis or CVS for diagnostic testing in high-risk cases
• Emery's Elements of Medical Genetics notes that women with a low PAPP-A should receive additional monitoring (serial growth scans from 28 weeks, induction at term)

9. Education and Psychosocial Support

• Educate on physiologic changes of pregnancy, warning signs, and when to seek help
• Counsel on teratogens: alcohol, smoking, recreational drugs, medications, hot tubs, workplace hazards
• Promote breastfeeding preparation
• Provide psychosocial assessment and support — screen for domestic violence, substance use, anxiety/depression
• Address sexual activity during pregnancy
• Prepare the mother for labour, delivery, and postpartum care (including contraception planning)

10. Birth Planning and Preparation

• Discuss birth preferences and plan for labour and delivery
• Identify the appropriate setting and level of care for delivery (primary, secondary, or tertiary)
• Ensure the patient knows warning signs requiring urgent attendance (bleeding, reduced fetal movements, headache, visual disturbance, leaking liquor)
• Plan postpartum care: neonatal feeding, postnatal depression screening, contraception

Schedule of Visits

• Every 4 weeks up to 28 weeks
• Every 2 weeks from 28–36 weeks
• Weekly from 36 weeks to delivery

• Textbook of Family Medicine, 9th ed. (Rakel), pp. 479–480
• Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice
• Swanson's Family Medicine Review