What to expect at the antenatal clinic

QI am four months pregnant. I recently got a cold and went to see a doctor, who was horrified that I had not started my antenatal clinics. I always thought you should go after five months. When is the right time to start attending these clinics? What exactly goes on during these visits? It is my first pregnancy.

A. There is a common myth that clinic visits should be started after five months of pregnancy. I do not know the source, but many women are convinced.

The truth is that you should visit a health facility and start clinics the minute you discover that you are expecting.

The visits allow for interaction between the expectant mum and the healthcare provider. For some women, this is the only time they ever visit a healthcare facility. So what happens at the prenatal clinics?

During the first visit, also known as the booking visit, a very detailed medical and obstetric history is taken.

Of interest are previous illnesses requiring hospitalisation, previous pregnancies and their outcomes, and the use of contraception.

Family history of chronic disease such as hypertension and diabetes is also important.

After the history is taken, a complete medical examination is carried out. This forms the basis of all future examinations and follow-up.

Parameters like weight, height, blood pressure and BMI are taken and recorded. Some routine tests are also carried out.

These include a haemoglobin test to detect anaemia, a urine test to look for protein in the urine, glucose, blood, bacteria etc. All these findings have medical implications and are important.

Other important blood tests include screening for HIV, syphilis, Hepatitis B, blood sugar levels and the blood group of the patient.

There are also other tests that can be done depending on the institution and also the needs of the patient.

The first ultrasound scan is usually ordered at the booking visit. First trimester ultrasounds are usually most accurate in dating the pregnancy.

Subsequent scans will monitor the growth of the baby. They can also detect any problems with the baby and mother, which can affect the timing and method of delivery of the baby.

The ultrasound is very safe, and it is an important test to undergo. During the antenatal visits, some medication can be given, depending on the test results.

Commonly, pregnancy supplements are prescribed, with special emphasis on iron and calcium.

Some patients require treatment for urinary tract infections, and for excessive nausea. In malaria endemic areas, malaria tablets and treated mosquito nets are issued.

All pregnant mothers are vaccinated against tetanus. Other vaccinations will depend on the needs of the mother.

Close monitoring

Subsequent visits to the clinic are for growth monitoring and trouble-shooting. During a pregnancy, many things can arise, and these need to be followed up and resolved.

Some patients have difficult pregnancies, and close monitoring of conditions such as diabetes or high blood pressure in pregnancy is very vital.

The management of HIV in pregnancy is important, to prevent mother-to-child transmission of the virus.

All pregnant women routinely undergo screening for HIV, and those found to be infected are put on treatment and followed up more closely.

Many other medical conditions can co-exist with pregnancy, and some are initially diagnosed during antenatal visits. The frequency of the visits depends on the patient’s needs.

Some women need only four or five visits, whereas others need to see the doctor more often. Routine antenatal care is very important for all expectant women.