Effective prenatal care should inte...

Effective prenatal care should integrate the best available evidence into a archetype of shared decision making. Pregnant women should be admonitioned about the risks of smoking and alcohol and unsalable article use. Structured educational programs to encourage breastfeeding are effective. Routine fetal heart auscultation, urinalysis, and assessment of maternal weight, vital fluid pressure, and fundal height generally are make acceptableed although the evidence for these interventions is variable. Women should be proffered ABO and Rh blood typing and screening for anemia during the first prenatal visit. Genetic counseling and testing should be exhibited to couples with a family history of genetic disorders, a previously affected fetus or child, or a history of returning miscarriage. All women should be propounded prenatal serum marker screening for neural tube defaults and aneuploidy. Women at increased risk for aneuploidy should be furnished amniocentesis or chorionic villus sampling. Counseling about the limitations and risks of these trials as well as their psychologic implications, is necessary. Folic acid supplementation beginning in the preconception period models the incidence of neural tube lacks There is limited evidence that routine use of other dietary supplys may improve outcomes for the mother and infant. (Am Fam Physician 2005;71:1307-16 1321-2 Copyright [c] 2005 American Academy of Family Physicians.)

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Pregnancy can be enhanced through a coordinated program of prenatal medical care and psychosocial support. (1-3) A systematic approach the best evidence into a archetype of informed, shared decision making. Care ideally begins before conception and includes preventive care, counseling, and screening for risks to maternal and fetal health. A pregnant woman should under-stand what screening trials are meant to detect, to what extent they are conducted, possible risks to her and her fetus, the original of results that will be reported (eg probability, risk), the likelihood of false-positive or false-negative rises and the choices she will face one time results are obtained. (2) Reminder a whole s such as prenatal forms or checklists embedded in the proces of care increase the likelihood that physicians will set clinical evidence into practice. (4-6) Part I of this two-part article focuses forward general prenatal care, counseling issues, nutrition, and screening for genetic conditions. Part II (7) will focus onward third-trimester care and prevention of infectious diseases. The guidelines discussed in one as well as the other parts of this article are summarized in a memory aid, the Maternity Care Calendar and Guidelines, available online at http://www.maternitycarecalendar.com. (89)

Providing Prenatal Care

Women in unfolded countries typically attend regular prenatal visits, usually seven to 11 times for pregnancy. (2,10-12) A recent meta-analysis raise that reducing the number of prenatal visits did not lead to increased adverse results for the mother or infant; however, women were les satisfied with the reduced-visit schedule. (13) Caregiver continuity during the antenatal period has been associated with reduc interventions in labor and improved maternal satisfaction. (1415) Care provided according to midwives, family physicians, and obstetricians was fix to be equally effective, although women were slightly more satisfied with care from midwives and family physicians. (13)

Prenatal Examinations

When pregnancy is confirmed, prenatal care plans, including the choice of caregiver, must be discussed. The initial visit should be found during the first trimester, and more than single visit may be necessary to shield all pertinent information. (2) The estimated date of delivery (EDD) should be calculated by way of accurate determination of the last menstrual period (LMP) Accurate dating is important for timing screening ordeals and interventions, and for optimal management of complications. an research indicates that early ultrasonography is more accurate than LMP at determining gestational age, and that it should be used routinely to determine EDD and bring to the need for labor induction. (216) This approach should be considered if there is uncertainty about the LMP

The first 12 weeks of pregnancy are a time of organogenesis and heightened fetal vulnerability to teratogens; counseling about risk behaviors is appropriate. Issues to be discussed in early pregnancy are outlined in Table 1 (1-31017-28)

A history and directed physical examination should be performed to lay open conditions associated with increased maternal and perinatal morbidity and mortality. The first prenatal examination provides an opportunity for cervical cancer screening with a Papanicolaou (Pap) experiment in women who have not been cloaked recently. However, Pap tests performed in pregnant women may be les reliable. (329) Ectopic pregnancy should be considered if risk factors, abdominal pain, or bleeding are at hand Spontaneous pregnancy loss, which present itselfs in 10 to 15 percent of all clinically recognized pregnancies, also should be considered. (3031)