Prenatal care comprises of all health-related services provided to the fetus and the mother during pregnancy. Prenatal care was first offered as a formal medical service in the early 1900s at a time when the obstetric profession was just emerging and efforts to cut maternal mortality were growing. In the 21st century, the focus of prenatal care has increasingly grown to benefit not only the wellbeing of the mother but also of her future offspring.
Prenatal care involves several visits to obstetricians and gynecologists. An initial visit is usually scheduled for the first trimester. At this point, the doctor takes a detailed obstetric history, determines the gestational age of the fetus and the expected due date. Some tests are carried out to assess the initial level of risk to the mother and baby.
Further care usually includes one visit every four weeks until the 28th week of gestation, followed by a visit every two weeks until the 36th week. Afterwards, the mother-to-be has to visit the obstetric or gynecologist every week until delivery. The increased rate of visits closer to the time of delivery reflects the history of prenatal care. At its onset, it focused on the detection of the hypertension-related disorders of preeclampsia/eclampsia, a leading cause of maternal mortality.
Procedures and techniques involved in prenatal care have greatly developed, with new diagnostic methods emerging. The most common prenatal procedure is the sonogram, or ultrasound. The ultrasound is used not only to diagnose a pregnancy, but also to monitor the fetus's movements and to determine age and sex. The ultrasound technology also allows doctors to observe a multiple pregnancy and to detect abnormalities, like an ectopic pregnancy, which is a condition when the fertilized egg develops outside the uterus. Ultrasound is also a tool used in fetal surgery, as it guides physicians who make more complex tests, such as amniocentesis, cordocentesis and chorionic villus sampling (CVS).
Amniocentesis is usually performed between the 14th and 18th week of the pregnancy to detect a range of chromosome disorders like Down syndrome. The test involves taking a sample of the fluid that surrounds the fetus, which is known as the amniotic fluid. Another test that relies on ultrasound technology is CVS. It involves taking tissue samples from the fetus, which are analyzed for chromosomal, biochemical, and DNA content.
Cordocentesis, or percutaneous umbilical blood sampling (PUBS), is a procedure of taking blood samples from the umbilical cord. These are later tested for a variety of hereditary blood disorders. Another test which is part of prenatal care is measuring maternal serum alpha-fetoprotein (MSAFP) levels. The test samples the blood of the mother for the amount of alpha-fetoprotein, a protein produced by the liver of the fetus. MSAFP levels are indicative of Down syndrome.
Since 1976, analysis of DNA has been included in prenatal care. The procedure involves taking blood samples from the mother and the father. DNA analysis allows the doctors to detect genetic problems that might be transmitted by either parent. More recently, nuclear magnetic resonance imaging (MRI) and nuclear magnetic spectroscopy (NMR) have been introduced to prenatal care as tools to reveal biochemical information about fetal soft tissues, as well as organ structure and function. Fetal tissue sampling and cell sorting are also new testing methods of prenatal care, but experts argue that both still need perfecting. Prenatal care also includes medicating the mother. This can be done in cases when the fetus suffers from respiratory distress syndrome or methylamalonic acidemia, a vitamin metabolism disorder.
Since the 1980s prenatal, or fetal, surgery has been available. This field of prenatal care owes its start to Dr. Albert William Liley (1929-1983), who developed a technique for prenatal blood transfusions in the 1960s in New Zealand. His achievements were later taken up by other surgeons and in 1981 the first open fetal surgery was conducted at the University of California at San Francisco (UCSF).
Several new trends have emerged in prenatal care. First, more attention has been turned toward pre-conceptual care, which aims to detect and treat certain health issues prior to pregnancy, such as smoking, diabetes and eating disorders. Second, there has been an increasing focus on offering specific prenatal care content, proven to be helpful, rather than just raising the number of prenatal care visits. Thus, prenatal care focuses on areas like folic acid consumption, genetic testing, and HIV treatment. Third, there has been an emphasis on provision of psychological support.