Essential Prenatal Clinical Assessment and Screening Protocols

Clinical History

Includes information on family history: certain hereditary diseases may affect the course and outcome of pregnancy. Personal history: the doctor provides health status information from earlier in the pregnancy. Obstetrical history: it is relevant if the mother is multiparous, including previous pregnancies, birth weights of children, duration of labor, and any complications during labor or postpartum. All this information must be recorded in the pregnant woman's health record.

Physical Examination

Investigates changes requiring attention, such as dental caries, dietary deficiencies, and weight fluctuations. Weight and blood pressure are measured and recorded in the history to monitor for any significant changes.

Gynecological and Obstetric Review

Assesses the state of the reproductive organs and the birth canal. It is essential to identify tumors or other abnormalities that could affect childbirth. The pelvis is measured to ensure it is wide enough to allow the passage of a medium-sized fetus. Pelvimetry is performed only when manual measurements reveal a small pelvis, a history of difficult births, or suspected cephalopelvic disproportion due to a lack of progress in labor.

Laboratory Tests and Imaging

Urinalysis: Used to detect urinary tract infections (UTI) and check for the presence of glucose (diabetes) or albumin (toxemia).

Blood Tests

• Syphilis: A venereal disease that can be transmitted from mother to fetus, potentially causing deformities or fetal death if untreated.
• Toxoplasmosis: Can lead to abortion, malformation, and hydrocephalus, particularly in the first trimester.
• Rubella: Associated with congenital defects and anencephaly, especially in the first trimester.
• Rh Factor: An antigen present in the erythrocytes of some individuals (85% of the white population), which is hereditary. If the patient is Rh-negative and the husband is Rh-positive, the fetus may be at risk.
• Blood Groups: There are four blood groups (A, B, AB, O). Incompatibility between an O-type mother and a different-type father may lead to ABO incompatibility.
• Hemoglobin and Hematocrit: Checked during the first visit and periodically thereafter. If levels are low, iron supplementation is provided for the mother and fetus. Normal concentrations should be 11-12g/dL for hemoglobin and 35% for hematocrit; lower values indicate anemia.
• Fasting Glucose: Performed during the first visit. If levels exceed 90mg/dL, the O'Sullivan test is conducted. If the second reading exceeds 140mg/dL, a full glucose tolerance curve is requested to screen for gestational diabetes.
• Alpha-fetoprotein (AFP): If elevated between 16-20 weeks, it may indicate fetal malformations.
• HIV and Hepatic Markers: Mandatory testing in the third trimester; results influence neonatal vaccination protocols.
• Pap Smear: Examines cervical cells for precancerous changes.