The chief objective of prenatal car...

The chief objective of prenatal care is to make secure good pregnancy outcomes. The conception evolved significantly in the 20th hundred years when advances in medical knowledge and practice contributed to a dramatic reduction in maternal and perinatal mortality and morbidity rates. Prenatal care prepares prospective parents for childbirth and permits their active participation in decision-making processes

There have been significant triumphs. Infant and maternal death rates have dropp dramatically. Stillbirths and newborn deaths resulting from maternal-fetal Rh incompatibility and congenital syphilis essentially have become a thing of the past. Improved diabetic repress and fetal surveillance techniques have made it possible for women with diabetes to deliver healthy newborns. Screening and appropriate therapy have l to a drastic reduction in the transmission of human immunodeficiency virus from mother to infant. Universal screening of pregnant women for cluster B streptococcus (GBS)and intrapartum antibiotic therapy have reduc the incidence of early first brunt neonatal GBS infection by 70 percent (1) The recommendation that al l women intending to conceive should take folic acid preconceptually and in early pregnancy has been associated with a reduction of up to 50 percent in the incidence of neural tube wants Prospective parents carrying genes for lethal disorders now have numerous screening options. Advances in ultrasound techniques al depressed physicians to diagnose congenital malformations earlier in pregnancy. Women who have preeclampsia, a condition previously associated with a high perinatal mortality, can be identified and delivered before the disease terminates in death or harm to mother and infant.

In this issue of American Family Physician, Kirkham and colleagues (2) near a broad overview of strategies involved in prenatal care and examine the plain of evidence for each of them.

single of the most important goals of prenatal care is recognizing which women have high-risk pregnancies and triaging these women to appropriate care. (3) Not all pregnancies carry the same risk. Furthermore, strategies that are appropriate for individual high-risk patient may not be appropriate for another. (3)

Evidence addressing the common occurrence and number of prenatal visits was reviewed lately by the World Health Organization.4 It was construct that a model with a reduc number of antenatal visits could be introduced into clinical practice without risk to mother or baby; reducing the number of visits issues in lower costs but les patient satisfaction. (4) Satisfaction generally is greater in low-risk pregnant women who are cared for from family physicians or midwives. (5)

one time identified, women with uncomplicated pregnancies may be triaged to a regimen of fewer prenatal of f ice or clinic visits. In certain geographic regions, family physicians may be the barely point of access to prenatal care. To achieve the best pregnancy issues it is important to recognize and attribute women who require specialized care.

Major medical challenges remain. Preterm birth, intrauterine bourgeoning restriction, and preeclampsia are associated with significant maternal and infant mortality and morbidity. Despite years of research, our understanding of these conditions remains dim and consequently we have not significantly reduc the incidence of these conditions or their adverse effects

The persistent disparities in prenatal care remain challenging. It is commendable that 989 percent of women in the United States receive prenatal care, with 841 percent starting prenatal care within the first trimester. (6) However, black women teenagers, women with addictions, and the poor are at greater risk of receiving late prenatal care or none at all. (6) For example, black women are 33 times more likely than white women not to have prenatal care (27 versus 084 percent) Unfortunately, it is these women who are at increased risk of adverse pregnancy issues Clearly, strategies must be devised to improve access to prenatal care for these women

The events to come must bring strategies to render certain that all pregnant women receive accessible, individualized care, and medical advances to make reductions in the incidence of challenging conditions in the same state [i]or[/i] condition as preterm birth, intrauterine product restriction, and preeclampsia possible.

REFERENCES

(1) Schrag s Gor witz R, Fultz-Butts K Schuchat A. Prevention of perinatal assign places to B streptococcal disease. Revised guidelines from CDC MMWR Recomm Rep 2002;51(RR-11):1-22

(2) Kirkham C Harris s Grzybowski S. Evidence-based prenatal care: part 1.General prenatal care and counseling issues. Am Fam Physician 2005;71:1307-161321-2 3.Kontopoulos EV Vintzileos AM. Condition-specific antepartum fetal testing. Am J Obstet Gynecol 2004; 191:1546-51

(4) Carroli G Villar J Piaggio G Khan-Neelofur D Gulmezoglu M Mugford M et al. WHO systematic review of randomised controll trials of routine antenatal care. Lancet 2001;357:1565-70