What schemes are included in antenatal care?

Schemes Included in Antenatal Care

Antenatal care encompasses a comprehensive, risk-stratified system organized into distinct levels of care facilities (Birth Centers, Level I-IV), combined with specific clinical interventions delivered across trimesters to reduce maternal and perinatal morbidity and mortality. 1

Organizational Framework: Levels of Maternal Care

The ACOG/SMFM classification system structures antenatal care delivery through five facility levels, each with defined capabilities and patient populations 1:

Birth Centers

• Population served: Low-risk women with uncomplicated singleton term pregnancies, vertex presentation 1
• Capabilities: Emergency stabilization, formal hospital transfer agreements, quality improvement programs 1
• Providers: At least 2 professionals per birth (CNMs, CMs, CPMs, licensed midwives, family physicians, ob-gyns) 1

Level I (Basic Care)

• Population served: Uncomplicated pregnancies plus higher-risk conditions (term twins, trial of labor after cesarean, uncomplicated cesarean delivery, preeclampsia without severe features at term) 1
• Capabilities: Emergency cesarean delivery capability, obstetric ultrasonography, laboratory testing, blood bank with massive transfusion protocols 1
• Providers: Continuous RN availability, obstetric provider with cesarean privileges, anesthesia services 1

Level II (Specialty Care)

• Population served: High-risk antepartum, intrapartum, or postpartum conditions requiring specialty care 1
• Capabilities: CT/MRI imaging, basic ultrasonographic services for maternal-fetal assessment, equipment for obese women 1
• Providers: RNs with Level II competence, ability to stabilize and transfer patients exceeding facility capabilities 1

Level III (Subspecialty Care)

• Population served: Complex maternal-fetal conditions requiring subspecialty expertise 1
• Capabilities: Advanced imaging, maternal-fetal medicine consultation, intensive care capabilities 1

Level IV (Regional Perinatal Health Care Centers)

• Population served: Most complex, highest-risk pregnancies 1
• Capabilities: Full subspecialty services, educational resources for lower-level centers, streamlined transport systems 1

Clinical Care Components Across Pregnancy

Preconception and First Trimester 2, 3

• Folic acid supplementation: 400-800 mg daily to reduce congenital malformations 2
• Potassium iodide: 150 mg daily 2
• Pregestational diabetes optimization: Achieve A1C <6.5% before conception 2
• Initial screening: Diabetes, thyroid disease, sexually transmitted infections 2
• Medication review: Discontinue teratogenic agents (ACE inhibitors, ARBs, statins) 2

Second Trimester 1, 2, 3

• Low-dose aspirin: 81-150 mg daily starting between 12-28 weeks (optimally before 16 weeks) for women with major risk factors (previous preeclampsia, chronic hypertension, pregestational diabetes, BMI ≥35, chronic kidney disease, antiphospholipid syndrome) 1, 2, 3
• Detailed fetal anatomy ultrasound: Between 16-22 weeks 2, 3
• Fetal echocardiogram: For women with pregestational diabetes, between 16-22 weeks 1, 2, 3

Third Trimester 1, 3

• Antepartum fetal surveillance: Starting at 32-34 weeks for high-risk pregnancies (nonstress test, amniotic fluid assessment, biophysical profile) 1, 3
• Fetal growth assessment: Ultrasound evaluation, particularly for women with risk factors 1, 3
• Aspirin continuation: Until 36 weeks for those on preeclampsia prophylaxis 2

Delivery Planning 1, 3

• Timing for good glycemic control, no vascular complications: 39 0/7 to 39 6/7 weeks 1, 3
• Timing for poor glycemic control, vascular complications, or prior stillbirth: 36 0/7 to 38 6/7 weeks 1, 3
• Cesarean consideration: If estimated fetal weight ≥4500 g 1

Universal Care Elements Throughout Pregnancy

Screening and Prevention 2, 3, 4, 5

• Preeclampsia monitoring: Blood pressure, proteinuria, symptoms (headache, visual disturbances, epigastric pain) at every visit after 20 weeks 2
• Infectious disease management: Malaria, HIV, tuberculosis, syphilis, tetanus (population-dependent) 5
• Anemia screening: Hemoglobin determination, particularly around week 30 (high Hb is a danger signal) 5
• Gestational diabetes screening: Oral glucose tolerance test 4
• Mental health assessment: At every consultation with connection to resources 2, 3, 4
• Intimate partner violence screening: Universal assessment 5

Education and Counseling 2, 4, 5

• Nutritional guidance: "Five-a-day" (2 servings fruit, 3 servings vegetables), balanced nutrition 2
• Exercise recommendations: Regular moderate activity (brisk walking, swimming, prenatal yoga) 2
• Substance avoidance: Complete cessation of alcohol, tobacco, recreational drugs 2, 4
• Danger sign recognition: Education on warning symptoms requiring immediate care 5
• Birth preparedness: Planning for delivery location, complications, emergency transport 5
• Family planning: Postpartum contraception counseling 5

Special Population Management 1, 3

• Pregestational diabetes: Multidisciplinary care (endocrinologist, maternal-fetal medicine, dietitian, diabetes educator), strict glycemic targets (fasting <95 mg/dL, 1-hour postprandial <140 mg/dL or 2-hour postprandial <120 mg/dL), comorbidity screening (foot exam, eye exam, thyroid function, urinary protein, electrocardiogram) 1, 3
• Obesity (BMI ≥30): Counseling on pregnancy risks (gestational diabetes, hypertension, miscarriage, stillbirth) 3
• Venous thromboembolism risk: Assessment for all pregnant women, antepartum prophylaxis for hereditary thrombophilia with family history, postpartum prophylaxis for certain thrombophilias 3

Common Pitfalls

Over-utilization in low-risk women and under-utilization in high-risk women is a documented problem—studies show low-risk women often receive more visits than recommended while high-risk women, particularly those with primary education or lower socioeconomic status, receive inadequate care 6. The risk-stratified approach requires active scheduling adjustments to match intensity of care to pregnancy risk level 6.

Inadequate delivery of antenatal education occurs frequently, with more than half of recommended advice topics rarely provided to women 6. This represents a critical gap requiring training interventions to improve provider communication 6.

Focus on risk conditions at the expense of routine care content is common—approximately half of all women receive <80% of recommended routine antenatal care content, with high-risk women showing even poorer compliance 6. Healthcare professionals must balance disease-specific monitoring with comprehensive routine care delivery 6.