design-prenatal-visit-schedule

Design Prenatal Visit Schedule

Map the full pregnancy visit cadence — tests, screenings, and decisions — by week.

Why This Is Best Practice

Adopted by: WHO, ACOG, NICE, SOGC — every major obstetric body publishes a structured visit schedule. Impact: WHO's 2016 shift from 4 to 8+ contacts reduced perinatal mortality by 8 per 1,000 births (WHO ANC RCT, Lancet 2019). Adequate prenatal care reduces preterm birth risk by 20–30% (ACOG 2021). Why best: Irregular care misses narrow screening windows (NIPT before 13 weeks, anatomy scan 18–20 weeks, GBS at 36 weeks). A mapped schedule prevents gaps.

Steps

1. Confirm gestational age — first visit at 8–10 weeks; establish EDD via LMP and/or ultrasound.
2. First trimester (weeks 8–13):
   • Blood panel: CBC, blood type/Rh, rubella, syphilis, HIV, hepatitis B, urine culture
   • Offer cfDNA/NIPT (weeks 10–13) and nuchal translucency ultrasound
   • Start prenatal vitamin with 400–800 mcg folate if not already
3. Second trimester (weeks 14–27):
   • Weeks 15–20: quad screen (AFP, hCG, estriol, inhibin A) if NIPT declined
   • Week 18–20: anatomy ultrasound (fetal anomaly scan)
   • Week 24–28: 1-hour glucose challenge test (GCT); CBC recheck; Rh-negative → Rh immunoglobulin at 28 weeks
4. Third trimester (weeks 28–36):
   • Visits every 2 weeks from week 28; weekly from week 36
   • Week 32–34: growth ultrasound if indicated
   • Week 35–37: Group B Strep vaginal-rectal swab
   • Week 36: review birth plan, confirm hospital bag, discuss labor signs
5. Week 39–41: discuss induction if not in labor by 41 weeks (ACOG recommendation).
6. Postpartum: schedule 3-week visit (wound/mood check) and comprehensive 6-week visit.

Rules

• Never skip the 18–20 week anatomy scan — it's the primary structural anomaly detection window.
• Rh-negative patients must receive Rh immunoglobulin at 28 weeks and within 72 hours of delivery.
• If any visit reveals hypertension (≥140/90), escalate same-day — do not wait for next scheduled visit.

Examples

Low-risk singleton pregnancy: 10 visits total — weeks 8, 12, 16, 20, 24, 28, 32, 36, 38, 40. High-risk (GDM, twins, prior preterm birth): visits every 2 weeks from 28 weeks, ultrasounds every 4 weeks from 32 weeks.

Common Mistakes

• Skipping first-trimester bloodwork because "feeling fine" — baseline labs are time-sensitive.
• Missing GBS swab window (must be done at 35–37 weeks; earlier results are unreliable).
• No postpartum visit plan — 40–50% of maternal deaths occur in the postpartum period (ACOG 2018).

Health Disclaimer: This skill provides general guidance. Individual care plans must be established with a licensed OB-GYN, midwife, or maternal-fetal medicine specialist. Clinical decisions depend on personal medical history, gestational age, and risk factors.