From the Research
When counseling a patient about perinatal care in Canada, I recommend following a comprehensive approach that addresses screening tests, monitoring, and potential treatments throughout pregnancy, as outlined in the most recent guidelines 1. This approach should include a thorough history and physical examination during the first prenatal visit, as well as baseline laboratory tests such as complete blood count, blood type and antibody screen, rubella immunity, hepatitis B, HIV, syphilis screening, and urine culture.
- Key screening tests and treatments include:
- First trimester screening (11-14 weeks) for chromosomal abnormalities, which includes nuchal translucency ultrasound and serum markers
- Maternal serum screening at 16-20 weeks if first trimester screening wasn't done
- Anatomical ultrasound at 18-22 weeks to assess fetal development
- Glucose challenge testing between 24-28 weeks to screen for gestational diabetes, and repeat complete blood count to check for anemia
- Administration of RhIG (Rhogam) at 28 weeks for Rh-negative mothers
- Throughout pregnancy, it is essential to monitor blood pressure, weight, fundal height, and fetal heart rate at each visit, and provide treatments for specific conditions, such as:
- Iron supplementation (ferrous sulfate 300mg daily) for anemia
- Insulin or dietary management for gestational diabetes
- Appropriate antibiotics for urinary tract infections
- Additionally, recommend daily prenatal vitamins containing 0.4-1mg folic acid throughout pregnancy, as well as screening for asymptomatic bacteriuria, sexually transmitted infections, and immunity against rubella and varicella, and administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), influenza, and COVID-19 vaccines, as recommended by the guidelines 1. The most recent study 2 highlights the importance of first-trimester prenatal care initiation, and the need for comprehensive efforts to address sociodemographic and contextual factors that may impact access to care. However, the highest quality and most recent study 1 provides a comprehensive approach to perinatal care, which should be prioritized when counseling patients. Overall, this comprehensive approach to perinatal care can help optimize maternal and fetal outcomes by identifying and managing potential complications early, and should be tailored to meet the individual needs of each patient, as recommended by recent studies 3.