Routine antenatal care and risk assessment

It is a Tuesday antenatal clinic and the next woman on your list is 31 weeks, booked late, with a blood pressure that has ticked up since her last visit and a fundal height that has stopped climbing. None of it is an emergency yet — and that is exactly the point. Routine antenatal care is the discipline of catching the woman who is leaving normal before she arrives at the labour ward with a catastrophe. The registrar who treats each contact as a re-screening exercise, not a formality, is the one who prevents the stillbirth, the undiagnosed pre-eclampsia and the unrecognised small-for-dates. ^[9]

Overview and definition

Routine antenatal care is the structured package of contacts, investigations, preventive measures and risk reassessment offered to every pregnant woman, with the explicit aim of reducing maternal and perinatal morbidity and mortality. ^[9]

Two ideas govern the whole topic, and you should hold them both at once: ^[9]

• Care is scheduled, not reactive. The visits, the bloods and the scans are timed to windows where a test is valid and an intervention still works. A test done outside its window is either meaningless (too early) or too late (too late).^[9]
• Risk is a status that expires. A woman booked as low-risk is low-risk until she is not, and the transition happens between contacts. Every visit is a fresh risk assessment — a new blood pressure, a new fundal height, a new symptom enquiry — not a repeat of the booking decision.