Comprehensive Antenatal Care Checklist for British Columbia, Canada
The standard antenatal care in British Columbia follows a comprehensive schedule of visits, screenings, and interventions designed to optimize maternal and fetal health outcomes through early detection and management of complications.
First Trimester (0-13 weeks)
Initial Visit (6-8 weeks)
- Complete medical, obstetrical, and family history
- Physical examination including blood pressure, weight, height
- Dating ultrasound (7-12 weeks)
- Laboratory tests:
- Complete blood count
- Blood type and antibody screen
- Rubella immunity
- Hepatitis B surface antigen
- HIV screening
- Syphilis serology
- Urine culture and sensitivity
- Pap test if due
- Genetic screening options discussion:
- First trimester screening (11-14 weeks)
- Non-invasive prenatal testing (NIPT)
- Prenatal vitamin recommendation (containing 0.4-1.0 mg folic acid)
- Lifestyle counseling (nutrition, exercise, substance use)
Follow-up Visits
- Monthly visits (every 4 weeks)
- Blood pressure monitoring
- Weight monitoring
- Urine dipstick for protein and glucose
- Fetal heart rate assessment when detectable
Second Trimester (14-26 weeks)
16-20 Weeks
- Maternal serum screening (if not done in first trimester)
- Detailed anatomy ultrasound (18-22 weeks)
- Assessment for preeclampsia risk factors
- Low-dose aspirin 81 mg daily (start between 12-16 weeks) for high-risk women
24-26 Weeks
- Gestational diabetes screening (50g glucose challenge test)
- Complete blood count to assess for anemia
- Blood pressure monitoring
- Fundal height measurement
- Fetal movement discussion
Third Trimester (27-40+ weeks)
28-32 Weeks
- RhD immunoglobulin administration (if mother is Rh negative)
- Group B Streptococcus screening (35-37 weeks)
- Assessment of fetal position
- Discussion of labor signs and birth plans
- Breastfeeding education
36 Weeks to Delivery
- Weekly visits after 36 weeks
- Blood pressure monitoring
- Fundal height measurement
- Fetal position assessment
- Cervical assessment as indicated
- Discussion of postpartum care and contraception options
Special Considerations for Midwifery Care in BC
Midwifery Scope of Practice
- Midwives in BC provide full primary care during pregnancy, labor, birth, and postpartum period
- Care typically involves home visits in addition to clinic appointments
Consultation Requirements
Midwives must consult with a physician when the following conditions arise:
Mandatory Consultation Conditions:
- Hypertensive disorders of pregnancy
- Significant placental abnormalities
- Multiple gestation
- Preterm labor or PROM before 37 weeks
- Gestational diabetes requiring medication
- Abnormal fetal growth (IUGR or macrosomia)
- Significant fetal anomalies
- Non-vertex presentation at term
Transfer of Care Conditions:
- Severe preeclampsia or HELLP syndrome
- Placenta previa with bleeding
- Placental abruption
- Preterm labor before 34 weeks
- Severe fetal growth restriction
- Fetal distress requiring immediate delivery
Additional Monitoring for High-Risk Pregnancies
Diabetes in Pregnancy
- Additional monitoring includes:
- Low-dose aspirin 81 mg daily (start between 12-16 weeks)
- Detailed fetal anatomy ultrasound
- Fetal echocardiogram
- Antepartum fetal surveillance starting at 32-34 weeks
- Growth ultrasounds every 4 weeks
- Individualized delivery planning based on glycemic control
Hypertensive Disorders
- Additional monitoring includes:
- More frequent blood pressure checks
- 24-hour urine protein collection or protein/creatinine ratio
- Blood tests for liver enzymes, renal function, and platelets
- Fetal growth ultrasounds every 3-4 weeks
- Umbilical artery Doppler studies if growth restriction present
Cancer During Pregnancy
- Additional ultrasounds every 3-4 weeks to document fetal growth
- Fetal umbilical artery Doppler exams for growth restriction
- Middle cerebral artery peak systolic velocity measurements to evaluate for fetal anemia when chemotherapy is administered 1
Key Pitfalls to Avoid in Antenatal Care
- Delayed initiation of low-dose aspirin - Should be started between 12-16 weeks for high-risk women to prevent preeclampsia
- Inadequate screening for gestational diabetes - Universal screening at 24-28 weeks is recommended
- Insufficient monitoring of fetal growth - Serial measurements are essential, especially in high-risk pregnancies
- Failure to recognize and act on warning signs of preeclampsia - Regular blood pressure monitoring and prompt intervention for severe hypertension (≥160/110 mmHg)
- Inappropriate timing of delivery for medical complications - Balance risks of prematurity against maternal/fetal risks of continuing pregnancy
Postpartum Follow-up
- Initial assessment within 24-48 hours after discharge
- Comprehensive assessment at 6 weeks postpartum
- Blood pressure monitoring for women with hypertensive disorders every 4-6 hours for at least 3 days postpartum 2
- Slow tapering of antihypertensive medications after days 3-6 2
- Follow-up within 1 week if still on antihypertensives at discharge 2
This comprehensive antenatal care checklist reflects the standard of care in British Columbia and emphasizes the importance of regular monitoring, early detection of complications, and appropriate consultation or transfer of care when indicated.