Prenatal care aims to keep the pregnant client and fetus healthy, detect complications early, and prepare the family for birth and parenting. Early and regular care lowers maternal and perinatal illness and death.

Obstetric history terms

• Gravida — number of pregnancies (including the current one); para — number of births after 20 weeks (live or stillborn; twins count as one)
• GTPAL: Gravida, Term births (≥ 37 weeks), Preterm births (20 0/7–36 6/7 weeks), Abortions/losses before 20 weeks, Living children
• Example: pregnant now, one term child, one set of preterm twins (both living), one miscarriage → G4 T1 P1 A1 L3

Dating the pregnancy

• Naegele's rule: first day of LMP + 7 days − 3 months + 1 year (assumes a 28-day cycle). LMP 10 June 2026 → due date 17 March 2027
• First-trimester ultrasound (crown–rump length) is the most accurate dating method; if it differs from LMP dating by more than the accepted range, the ultrasound date is used
• Ovulation occurs about 14 days before the next expected period (not necessarily day 14)
• Trimesters: first to 13 6/7 weeks, second 14–27 6/7 weeks, third from 28 weeks

Visit schedule (typical for uncomplicated pregnancy): every 4 weeks until 28 weeks, every 2 weeks from 28 to 36 weeks, then weekly until birth. The WHO recommends at least 8 contacts. High-risk pregnancies need more frequent visits.

First visit

• Complete health, obstetric, gynecologic, family, genetic, medication, nutrition, and psychosocial history; intimate partner violence screening (ask privately); depression screening; substance use
• Physical exam, baseline BP and weight, BMI, pelvic exam as indicated

Every visit

• Blood pressure (correct cuff size, seated, arm at heart level) — ≥ 140/90 mmHg after 20 weeks needs evaluation
• Weight — compare with the recommended gain for prepregnancy BMI
• Fundal height (from about 20 weeks): measure in centimeters from the top of the symphysis pubis to the top of the fundus with the client's bladder empty. Between 20 and 36 weeks, centimeters ≈ weeks of gestation (± 2 cm) — e.g., 30 cm at 32 weeks is within normal range. A difference of more than about 2–3 cm → ultrasound (growth restriction, fluid abnormality, wrong dates, multiples)
• Fetal heart rate (Doppler from about 10–12 weeks): normal 110–160/min
• Fetal movement (after quickening)
• Edema, urine protein when indicated, danger signs, discomforts, questions
• Leopold maneuvers (third trimester) — palpation to identify fetal lie, presentation, and position

Recommended testing schedule

• Screening tests estimate risk (cfDNA, serum screens); diagnostic tests confirm: chorionic villus sampling (about 10–13 weeks) and amniocentesis (from about 15 weeks). Risks of diagnostic tests: small risk of pregnancy loss, cramping, leakage of fluid, infection; give Rh immune globulin after the procedure if Rh-negative
• MSAFP: high — open neural tube defect, abdominal wall defect, multiple gestation, underestimated gestational age; low — associated with some trisomies
• Oral glucose tolerance test instructions: for the 100-g 3-hour test, fast for 8–14 hours overnight, follow a normal carbohydrate diet for several days before, remain seated and do not smoke or eat during the test; the 50-g 1-hour screen does not require fasting

Vaccines in pregnancy (US)

Nutrition and supplements

• Extra energy: about +340 kcal/day in the second trimester and +450 kcal/day in the third (none extra in the first for most)
• Folic acid 0.4–0.8 mg daily; iron 27 mg/day (prenatal vitamin); calcium 1,000 mg/day (1,300 mg for adolescents); iodine and choline in the prenatal vitamin
• Fish: 2–3 servings/week of low-mercury fish (e.g., salmon, sardines, tilapia); avoid high-mercury fish — shark, swordfish, king mackerel, tilefish, bigeye tuna, marlin, orange roughy
• Food safety: avoid raw or undercooked meat, fish, and eggs; unpasteurized milk and soft cheeses; deli meats and hot dogs unless heated until steaming (Listeria); wash produce
• Caffeine under about 200 mg/day; no alcohol; stop tobacco, vaping, cannabis

Activity

• About 150 minutes/week of moderate exercise for healthy pregnancies
• Avoid contact sports, activities with fall risk, scuba diving, hot yoga, and hot tubs/saunas; avoid long periods lying flat on the back after the first trimester
• Stop and seek care for vaginal bleeding, fluid leakage, regular painful contractions, chest pain, dizziness, calf pain or swelling

Other care

• Dental care is safe and encouraged
• Travel: seat belt with the lap belt below the abdomen across the hips and shoulder belt between the breasts; walk and hydrate on long trips (VTE)
• Low-dose aspirin for preeclampsia prevention in eligible clients (see Hypertensive Disorders topic)
• Childbirth and breastfeeding education, birth plan, infant car seat

Listed in priority order.

1. Identify danger signs and act — e.g., BP 150/100 mmHg with proteinuria and headache or visual changes → possible preeclampsia with severe features → notify the provider immediately and prepare for hospital evaluation
2. Accurate baseline and ongoing assessment — BP, weight, fundal height, FHR, labs, screening results; follow up abnormal results
3. Ensure timely screening, Rh immune globulin, and vaccines
4. Health promotion teaching at each visit, tailored to trimester, literacy, and culture
5. Psychosocial support — screen for depression, anxiety, IPV, food and housing insecurity; refer as needed

Warning signs — call or seek care now

• Vaginal bleeding or leaking fluid
• Severe or persistent headache, vision changes, pain under the ribs/upper abdomen, sudden swelling of face or hands
• Decreased fetal movement (later in pregnancy)
• Regular contractions or pelvic pressure before 37 weeks
• Fever, chills, painful urination, flank pain
• Chest pain, trouble breathing, calf pain or swelling
• Persistent vomiting, thoughts of self-harm

Common discomforts (details in Physiologic Changes topic)

• First trimester: nausea, breast tenderness, fatigue, urinary frequency, gum swelling and bleeding (estrogen-related gingivitis)
• Later: heartburn, constipation, back pain, leg cramps, edema, varicose veins, shortness of breath, round ligament pain, supine dizziness — lie on the side

Other teaching

• Take the prenatal vitamin daily; iron is better absorbed with vitamin C and apart from milk, tea, or antacids
• Handwashing, avoid cat litter and undercooked meat (toxoplasmosis)
• Kick counts may be advised in the third trimester per provider
• Plan for labor: signs of labor, when to come to the hospital

• Naegele's rule: LMP + 7 days − 3 months + 1 year; first-trimester ultrasound is the most accurate dating
• GTPAL — twins count as one birth (P) but two living children (L)
• Visits: every 4 weeks to 28, every 2 weeks to 36, then weekly
• Fundal height (cm) ≈ weeks from 20 to 36 (± 2 cm); umbilicus at 20 weeks
• Glucose screening 24–28 weeks; Rh immune globulin at 28 weeks if Rh-negative and unsensitized
• GBS culture at 36 0/7–37 6/7 weeks
• Syphilis screening at first visit, third trimester, and birth for all
• Tdap 27–36 weeks every pregnancy; RSV vaccine 32–36 weeks in season; no live vaccines in pregnancy
• Cell-free DNA is screening; CVS and amniocentesis are diagnostic
• Avoid high-mercury fish, unpasteurized dairy, undercooked meat; caffeine < 200 mg/day; no alcohol
• Warning signs: bleeding, fluid leak, severe headache/visual change, decreased fetal movement, preterm contractions