Antenatal Care: When to Start, Number of Visits, and Tests

Antenatal care

Antenatal care or prenatal care refers to healthcare provided from the start of pregnancy until the day the baby is delivered. Prenatal care should begin as soon as you find out you are pregnant by scheduling a checkup with your obstetrician to confirm the pregnancy and start prenatal care programs, which include screening for pregnancy risk factors and tracking fetal growth. Antenatal care also includes preparing for physical and mental well-being by receiving advice from an obstetrician on the best antenatal care practices to ensure a safe pregnancy, lower pregnancy risks, and have a high-quality pregnancy. The mother is in good physical health, and the fetus is developing normally, without complication until the expected date of confinement, when the mother can safely give birth to her baby.

Why is antenatal care important?

Pregnancy is a critical period in life. When pregnant, both mother and baby face health risks, such as miscarriage and maternal death during pregnancy, birth defects or congenital abnormalities in the fetus, such as Down syndrome, anencephaly, cleft lip and cleft palate, thalassemia, or high-risk pregnancy, such as neonatal sepsis or infections after childbirth, low birth weight, or other complications. Antenatal care is therefore very necessary to help find any risks in pregnancy, including before pregnancy, during pregnancy, on the delivery date, and after delivery, to ensure every stage of pregnancy is safe and free from complications, allowing the mother and unborn baby to receive timely treatment in case of necessity.

When should I start antenatal care?

Pregnant women should start antenatal care as soon as they find out they are pregnant. The optimal time to start antenatal care is between 4 and 8 weeks of pregnancy, no later than 12 weeks from the first day of the last menstruation. However, the obstetrician suggests that the best time to start antenatal care is 1 month before pregnancy. Parents can schedule an appointment with an obstetrician for family planning before having a child and undergo an in-depth health examination to identify health issues, hereditary diseases, or infertility in both men and women, particularly if the woman has a physical health problem, which increases the risk of pregnancy and necessitates close care from an expert obstetrician throughout the pregnancy and postpartum period.

How many antenatal care appointments do I have to visit?

The number of antenatal care appointments varies depending on when the care starts, including the mother’s and the fetus’s health, and the degree of risk of pregnancy complications. Typically, the appointment schedule for antenatal care for pregnant mothers aged 18 to 35 who are in good health is as follows:

1. Gestational age less than 28 weeks; appointments every four weeks.
2. Gestational age between 28 and 32 weeks; appointments every 2–3 weeks.
3. Gestational age between 32 and 40 weeks; appointments every week.

In addition, obstetricians may schedule more frequent appointments, particularly for pregnant women who are at high risk of pregnancy.

What is included in the first antenatal care visit?

• Medical history: the obstetrician obtains a detailed medical history, including:
  
  • Menstrual history, including the first day of the last menstrual period (LMP).
  • Congenital diseases, medications, and a history of drug allergy
  • Pregnancy history, twin pregnancies, childbirth, miscarriage, complications during pregnancy, during and after birth, history of surgery such as uterine fibroids and ovarian cysts, history of accidents.
  • Family health history with hereditary diseases such as diabetes, thalassemia, and Down syndrome.
  • Smoking history, drug, or narcotic use by pregnant mothers and/or family members.
• Weigh the pregnant mother to determine the relationship between the mother’s weight and the fetus's development. Mothers who are 3 months or more pregnant should gain half a kilogram per week.
• Measure height: to determine labor dystocia (difficult or obstructed labor), particularly pregnant mothers whose height is less than 140 centimeters may be at risk for difficult births due to a narrow pelvic floor. To reduce risk, the obstetrician will plan a suitable delivery method for the mother to reduce the risk.
• Measure blood pressure: before, during, and after pregnancy. Hypertension during pregnancy can cause the kidneys and other organs to malfunction, resulting in low birth weight and premature birth. Low blood pressure, on the other hand, may prevent the fetus from receiving adequate oxygen and nutrients, resulting in slow baby growth, low birth weight, and premature birth.
• Physical examination: to assess the mother's health and physical readiness, look for abnormalities in the body such as anemia, jaundice, swelling, and an enlarged neck, as well as check the heartbeat, lungs, and abdomen to assess the fetal growth.
• Urine test: to determine sugar content and diabetes risk; to rule out bladder infection, and to assess kidney function by measuring protein levels. If the kidneys do not function properly and detect high blood pressure, there may be a high-risk of pregnancy. Urine tests can also detect dehydration, ketones, and bacteria in the urine, particularly during the 20th week of pregnancy.
• Blood tests: complete blood count (CBC; Hct/Hb MCV), blood type test (blood group ABO), thalassemia trait test (DCIP), Rh blood group system (Rh blood type test), hepatitis B surface antigen (HBsAg), thyroid-stimulating hormone test (TSH), and iron test (Ferritin test). In addition, blood tests measure the immune system, rubella, and sexually transmitted infections (STIs) such as HIV testing (anti-HIV) or syphilis testing (VDRL), which can result in infant disability or death.
• Abdominal ultrasounds: To confirm a pregnancy or twin pregnancy, examine the gestational sac, placental position, baby gender, development of fetal organs (organogenesis), and organ structure, such as the heart, fingers, and toes. Check the structure of the skull, brain, and face; examine the baby's posture; and check for abnormal structures, and amniotic fluid, etc.
• Confirm pregnancy: identify gestational age and estimate delivery confinement/delivery (EDC/EDD) based on the first day of the last menstrual period.

Once the first antenatal care is completed, the obstetrician will record the mother's and fetus' health information gained from the first antenatal care visit into the electronic health system. The obstetrician then prescribes pregnancy vitamins and schedules periodic pregnancy checkups in accordance with the antenatal care program, which is divided into 3 trimesters. The frequency of obstetrician 's appointments will be determined by the gestational age and pregnancy risks.

What is included in the 3 Trimester antenatal care?

1st Trimester antenatal care (1–14 weeks pregnant) includes the following:

Appointment every 4 weeks: The obstetrician will schedule an appointment every 4 weeks to assess the health of the mother and fetus and plan for care from the start.

• Urine tests: determine the amount of protein, sugar, bacteria, or infection in the urinary tract.
• Blood test (first-time antenatal care visit): CBC, blood group ABO, Rh, sexually transmitted diseases, hepatitis B virus, syphilis, HIV, Hb typing, etc.
• None-invasive prenatal testing, or NIPT (between 12 and 16 weeks of pregnancy): to look for fetal DNA in the maternal blood that that could indicate Down syndrome or other chromosomal abnormalities. 
• Transabdominal ultrasound or Transvaginal ultrasound: calculate gestational age and delivery confinement, look for normal fetal pregnancy in the uterus, twin pregnancy, and structural abnormalities of the fetal organs, size, and heartbeat.
• Oral and dental health check: prevent tooth decay during pregnancy, which can lead to premature birth, low birth weight babies, and pre-eclampsia.
• Mental health assessment: assess emotional well-being, stress, depression, pregnancy readiness, and the ability to cope with physical changes.
• Pregnancy vitamins: The obstetrician provides pregnancy vitamins, which include iron, folic acid, calcium, and other pregnancy-related nutrients.
• 1st Trimester recordkeeping: The obstetrician records the 1st Trimester test results in the system. 

2nd Trimester antenatal care (15–28 weeks) includes the following:

Appointment every 3–4 weeks: The obstetrician will schedule appointments every 3-4 weeks to monitor fetal development and prevent complications.

• Blood tests: screen for risk of gestational diabetes or diabetes during pregnancy (50 g glucose challenge test).
• Urine tests: measure the protein and sugar levels in the urine (Urine Strip Test)
• Vaccines during pregnancy: the obstetrician administers the influenza vaccine, diphtheria, tetanus, and whooping cough (depending on each individual's vaccination history).
• Abdominal ultrasound and Transvaginal ultrasound: identify the baby’s gender, whether it is a girl or a boy, monitor fetus development, fetal structural abnormalities, and cervical length measurement.
• Amniocentesis: check abnormal chromosomes in those at high risk of Down syndrome (gestational age between 16 and 20 weeks).
• *COVID-19 Vaccination: The obstetrician will recommend COVID-19 vaccination for some pregnant women to prevent infection (depending on each individual's vaccination history).
• Pregnancy vitamins: The obstetrician continually provides the necessary pregnancy vitamins and supplements.
• 2nd Trimester recordkeeping: The obstetrician records the 2nd  Trimester test results in the system. 

3rd Trimester antenatal care (29–40 weeks) includes the following:

Appointment every 1-2 weeks: The obstetrician will schedule weekly appointments to plan the birth, practice before the delivery, and learn how to recognize antenatal signs and symptoms.

• Blood tests: Diagnose hematocrit (HCT), infectious diseases, anti-HIV testing, and syphilis tests in preparation for birth.
• GBS Group B Streptococcus: Test for Group B Streptococci during pregnancy
• Abdominal ultrasounds: determine the maternal and fetal weights; assess the fetus health.
• Check the fetal position near birth, determines the uterine apex, and whether the baby rotates head downward into the pelvic cavity.
• Observe fetal movement: Counting the number of baby kicks in the uterus and listening to the fetus heartbeat.
• Observe the leading symptoms: Learn how to notice the signs and symptoms of true labor before giving birth that require a hospital visit, such as labor pains, amniotic fluid, bloody mucus, and an open cervix.
• Observe abnormal symptoms: Learn how to spot unusual signs and symptoms before giving birth that necessitate immediate hospitalization, such as labor pains, vaginal bleeding, tightness in the epigastric area under the right ribcage, blurred vision, the baby moving less or not moving at all, and fever-related headaches.
• Prepare for childbirth: The obstetrician and midwife provide advice on health care, nutrition, and preparation for childbirth; new parent preparation; proper newborn care; and breastfeeding.
• Plan for an appropriate labor method: The obstetrician plans a safe birth for both mother and baby, whether natural birth or cesarean section.
• Postpartum birth control: The obstetrician assists with postnatal birth control planning.
• Pregnancy vitamins: The obstetrician continues to prescribe the necessary pregnancy vitamins and supplements.
• 3rd Trimester recordkeeping: The obstetrician records the 3rd Trimester test results in the system.

What is quality antenatal care (ANC)?

Quality antenatal care (ANC) is the first antenatal care before 12 weeks and follows the obstetrician's appointment for antenatal care at least 5 times throughout the pregnancy to ensure the mother and unborn baby receive complete and best possible health care throughout pregnancy, delivery, and after birth.

What are the antenatal care requirements?

1. Mother and father's ID cards
2. Medical history includes illness, congenital diseases, drug allergies, pregnancy history, number of children, and childbirth.
3. Information about the last menstrual cycle, starting on the first day of menstruation.

What is the recommendation for pregnancy health care?

• Eat foods rich in nutrients from all five food groups. A pregnant woman's diet consists of 3 main meals and 2 or 3 small meals that include carbohydrates, low-fat protein, healthy fats, vegetables, fruits, and whole grains.
• Take pregnancy vitamins that contain essential nutrients such as folate, iron, calcium, and omega-3 fatty acids.
• Avoid consuming mercury-containing foods, undercooked foods, fermented foods, and unpasteurized milk.
• Light exercise such as walking, swimming, and yoga lowers the risk of diabetes, helps control weight, and promotes a good mood.
• Drinking enough water—at least 10 glasses per day—to avoid dehydration benefits both the digestive system and blood circulation.
• Get enough sleep to reduce fatigue, using the side-lying position to allow blood to flow easily to the fetus.
• Practice stress relief, such as deep breathing, meditation, and talking with family members and doctors.

Antenatal Care at MedPark Hospital

Obstetrics and Gynecology Clinic at MedPark Hospital, Bangkok, Thailand, is overseen by a team of expert obstetricians and gynecologists, midwives, and multidisciplinary teams with extensive experience in providing the best possible antenatal care with safe delivery, who are ready to provide close monitoring of pregnant mothers' health and the development of the baby at every stage of pregnancy. Assists parents with childbirth preparation from the beginning to delivery to ensure a smooth antenatal care journey, free from complications, both the mother and the baby are healthy, and the baby can be born safely, while also providing postpartum care to reduce complications, aid in the mother’s quick recovery, promote the baby’s healthy growth and become a valuable family member.