Pregnancy - Antenatal Checkups

More than a century ago, a woman consulted the doctor once to confirm pregnancy and later at the time of delivery.  Pregnancy care and antenatal checkups (checkups during the course of pregnancy) in pregnancy have started about a century ago.  In the early 20^th century the nurses of Instructive Nursing association, Boston, had started visiting women registered for delivery at Boston Lying-in Hospital.  The dramatic improvements in the health of the newborn and mother laid foundation to the regular antenatal checkups and special care during and after delivery.

Presently a pregnant woman consults doctor (obstetrician) a week or two after the missed period till three months after delivery – totally for about one year she will be under the care of obstetrician.  Checkups in pregnancy can be categorized as – antenatal checkups or antenatal care, intranatal care – at the time of delivery and postnatal checkups/care in the following three months after delivery.

The aim of regular checkups in pregnancy is to recognise high risk pregnancy and take appropriate care to minimize complications to mother and fetus.

Obstetricians date the pregnancy in weeks.  The normal duration of pregnancy is 40 weeks from the day of first day of last menstrual period.  The first 14 weeks is termed first trimester, later upto 28 weeks is called second trimester and the last 12 weeks is the  third trimester.  The regular checkups are advised once in 4 weeks until 28 weeks, after 28 weeks till 36 weeks - once in 2 weeks and after that weekly until delivery.  After delivery, the woman should have at least two postnatal checkups, once after three weeks of delivery later in the 12th week.

  In general gravida should undergo monthly checkups till 7^th month, fortnightly till ninth month and weekly until delivery.  If the gravida has any risk associated with pregnancy she will have to visit more frequently, as advised by the obstetrician. 

In India, or any other developing country for various reasons gravida may not be visiting the obstetrician regularly.  If the woman is healthy, and has no risk factor, with the advice of the obstetrician she can cut down her visits.  A minimum of four checkups during the course of pregnancy will help to safeguard the health of gravida.  These should be once to confirm pregnancy in first three months, 2^nd visit in the fifth month, third in the 7^th month and 4^th in the ninth month.  If the gravida does not deliver in 15days she should again have another checkup.  If any risk factor is noticed during these checkups the gravida will be advised consultations accordingly.

I generally advise/persuade rural woman who are averse and ignorant of health care in pregnancy to, at least, have four antenatal checkups, use iron tablets for three months, two tetanus toxoid injections, a day admission for delivery in the hospital.  Following this simple principle will help to reduce maternal and fetal mortality and morbidity to a great extent.