Pregnant women require a relatively high level of care during their pregnancy. Routine testing and examinations can reveal the presence of conditions and issues that may be dangerous to the mother and/or the fetus. In addition, careful monitoring can identify possible risks for birth injuries. A failure to perform standard antenatal care, or to follow up on potential risk factors, can lead to birth injuries and other complications.
What Type of Antenatal Care Should an Expectant Mother Receive?
When a woman becomes pregnant, she will typically be cared for throughout her pregnancy by an ob-gyn team. Physicians and related health care providers should monitor, assess, and care for pregnant women pursuant to best practices and the standard of care for the profession.
The standard elements of prenatal care include:
- Routine physical examination, including a pelvic examination at the initial visit
- Abdominal palpitation (Leopold maneuvers) to assess fetal presentation beginning at 36 weeks
- Evaluation for edema
- Maternal weight and blood pressure checks at all visits
- Fetal heart rate auscultation after 10 to 12 weeks with a Doppler monitor, or after 20 weeks with a fetoscope
- Fundal height check after 20 weeks
- Fetal lie by 36 weeks
In addition, prior to conception or after confirmation of pregnancy, folic acid supplements should be recommended. The obstetric team should also counsel expectant mothers on proper nutrition and dietary guidelines, such as limiting or avoiding the consumption of deli meats, raw fish, and alcohol.
Per The American College of Obstetricians and Gynecologists (ACOG), expectant mothers should have a number of routine laboratory tests performed early in pregnancy. This includes:
- Complete blood count (CBC): can reveal the presence of anemia, issues with blood clotting, and number of white blood cells
- Blood type: to show if an expectant mother has the Rh factor, a protein present on the surface of red blood cells. This is important because if a fetus is Rh positive and mother is Rh negative, the mother’s body may develop antibodies that will damage the fetus’ red blood cells in a future pregnancy
- Urinalysis: to screen for urinary tract disease, urinary tract infections, and glucose (which may be a sign of diabetes), and high protein levels, which may be a sign of preeclampsia)
- Urine culture: to screen for urinary tract infections
- Rubella (German measles): rubella can cause birth defects if an expectant mother is infected during pregnancy
- Hepatitis B and hepatitis C: both viruses can damage the liver, and may be passed from an expectant mother to the fetus
- Sexually transmitted infections (STIs): to screen for syphilis, gonorrhoea, chlamydia, which can cause pregnancy complications
- Human immunodeficiency virus (HIV): if a pregnant woman has HIV, she may pass this virus onto her fetus. Medications can reduce the risk of transmission.
- Tuberculosis (TB)
Later in pregnancy, the ACOG recommends repeating the CBC test, checking for the presence of Rh antibodies, performing a glucose screening test, and testing for Group B streptococci (GBS). The Rh antibody test will only be performed if the expectant mother is Rh negative. If the presence of Rh antibodies is detected, the mother can be given a shot to prevent further production of antibodies. A glucose screening test is an essential component of antenatal care as it can reveal the presence of gestational diabetes (diabetes that is diagnosed during pregnancy).
GBS is a type of bacteria that lives in the vagina and rectum. If an expectant mother has GBS, it can be passed to the fetus during birth. In some cases, babies who get GBS from their mothers may become ill, and may even die. If an expectant mother tests positive for GBS, antibiotics should be prescribed.
Depending on the expectant mother’s health conditions, additional testing may be warranted. For example, an expectant mother with a history of thyroid disease or symptoms of thyroid disease during pregnancy should have their thyroid-stimulating hormone levels checked. A high-risk may also require additional monitoring and testing.
Beyond routine tests, an obstetrician should perform screening tests and diagnostic tests for birth defects. Screening tests are performed to determine the risk that a fetus has certain birth defects, but does not reveal whether the fetus actually has a birth defect. For example, an ultrasound examination can be used in combination with blood tests to measure the level of certain substances in the mother’s blood.
In contrast, diagnostic tests can reveal the presence of many (but not all) birth defects, including genetic disorders and chromosomal defects (such as Down Syndrome or Trisomy 21). If a couple has a family history of a birth defect, belongs to a particular ethnic group, or already has a child with a birth defect, diagnostic tests will typically be ordered. Some types of diagnostic tests carry risks, including potential pregnancy loss. Diagnostic tests may include an amniocentesis, chorionic villus sampling, or a targeted ultrasound exam.
Potential Complications of Negligent Antenatal Care
If an obstetrician-gynaecologist fails to provide adequate antenatal care, including ordering appropriate tests, both the mother and fetus may suffer an injury. The specific complication depends on the condition that an expectant mother or fetus experiences.
Ectopic pregnancies, which occur when a fertilized egg attaches somewhere other than an expectant mother’s uterus, can cause serious complications. If the egg attaches in the fallopian tube, the ectopic pregnancy is known as a tubal pregnancy. The fallopian tube may burst, causing life-threatening bleeding. Proper prenatal care includes screening for ectopic pregnancy and treating it through medical or surgical procedures.
Gestational diabetes can lead to a number of complications, including high blood pressure and preeclampsia, having a surgical delivery (cesarean section or c-section), and future diabetes. For the fetus, gestational diabetes increases the risk of:
- Excessive birth weight, which can lead to failure to progress or shoulder dystocia during labour and delivery
- Preterm birth
- Respiratory distress syndrome
- Low blood sugar (hypoglycaemia), which may lead to seizures after birth
- Obesity and Type 2 diabetes later in life
Hypertension (high blood pressure) in pregnancy that is not properly treated (preeclampsia) can cause serious or fatal complications, including:
- Fetal growth restriction due to an inability of the placenta to receive adequate blood
- Preterm birth
- Placental abruption, which is a separation of the placenta from the inner wall of the uterus, which can cause heavy bleeding that may be fatal for both mother and baby
- HELLP syndrome, or hemolysis elevated liver enzymes and low platelet count, which can be life-threatening
- Eclampsia, a combination of preeclampsia and seizures
- Organ damage to the kidneys, liver, lung, heart, or eyes
- Stroke or brain damage
- Cardiovascular disease
Negligent monitoring of or care for an expectant mother during pregnancy can also increase the risk of birth injuries. For example, the height and weight of the fetus should be monitored to determine if there is a risk of shoulder dystocia or failure to progress, as the fetus may be too large to move down the birth canal. A medical professional’s failure to evaluate the fetus and mother for these possibilities can cause further complications.