What is Antepartum?
Antepartum refers to the period of pregnancy before childbirth begins, specifically the time from conception until the onset of labor. 1
Clinical Definition and Timeframe
Antepartum encompasses the entire gestational period prior to labor onset, distinguishing it from intrapartum (during labor and delivery) and postpartum (after delivery). 1
The term is used interchangeably with "prenatal" in clinical practice, though antepartum more specifically emphasizes the pre-labor phase of pregnancy. 1
In clinical documentation and coding, antepartum care includes all prenatal visits and interventions from the first prenatal visit through 28 weeks of gestation, though the biological antepartum period extends until labor begins regardless of gestational age. 1
Clinical Significance in Pregnancy Management
Antepartum care focuses on maternal and fetal surveillance to optimize pregnancy outcomes and reduce morbidity and mortality. 2
The antepartum period is when critical interventions occur, including screening for pregnancy complications, fetal growth assessment, and management of maternal comorbidities like diabetes mellitus and hypertension. 1, 2
Risk stratification during the antepartum period identifies pregnancies requiring specialized surveillance, such as those with pregestational diabetes, multiple gestations, or inherited thrombophilias. 1, 3
Key Antepartum Interventions
Antepartum fetal surveillance (nonstress testing, biophysical profiles) typically begins between 32-34 weeks of gestation in high-risk pregnancies to reduce stillbirth risk. 1, 2
Antepartum prophylaxis for venous thromboembolism may be indicated in pregnant women with specific thrombophilias and risk factors, using low-molecular-weight heparin throughout the antepartum period. 1
Low-dose aspirin (81 mg daily) should be initiated between 12-28 weeks of gestation, optimally before 16 weeks, for preeclampsia prevention in women with diabetes or other risk factors. 1
Detailed fetal anatomy ultrasound and fetal echocardiography are performed during the second trimester as part of routine antepartum assessment in high-risk pregnancies. 1
Common Antepartum Complications
Antepartum hemorrhage, preterm premature rupture of membranes, and preterm labor are major complications requiring immediate intervention during the antepartum period. 1, 4, 5
Antepartum stillbirth (fetal death after 16 weeks' gestation before labor onset) is associated with maternal hypertension, HIV/AIDS, multiple pregnancy, and fetal growth restriction, with a hazard ratio of 4.6 for birth weight below the 3rd centile. 6
Intrahepatic cholestasis of pregnancy diagnosed in the antepartum period requires bile acid monitoring and consideration of delivery between 36-39 weeks depending on severity. 1