Antepartum Care: Risk Screening, Assessment, and Teaching
Core concepts
Antepartum care is largely a surveillance and teaching role. Know the schedule and purpose of routine visits, the components of a comprehensive initial assessment, and the standard prenatal labs (blood type and antibody screen, CBC, rubella immunity, varicella, syphilis, hepatitis B, HIV, group B strep timing, glucose screening). Be fluent in gravida/para notation and GTPAL, estimated date of delivery by Naegele's rule (first day of last menstrual period minus 3 months plus 7 days), and the difference between screening and diagnostic testing.
High-yield conditions include hypertensive disorders (chronic vs gestational vs preeclampsia with severe features), gestational diabetes, preterm labor risk, placenta previa and abruption, and multiple gestation. Understand warning signs taught to patients: bleeding, severe headache or visual change, decreased fetal movement, fluid leakage, and persistent contractions.
Traps in questions
The most common trap is confusing gravida (all pregnancies including current) with para (births after 20 weeks). Another is mislabeling a screening test as diagnostic. Questions often present a reassuring finding with one red flag; answer the red flag. Watch for gestational-age math errors and for options that recommend a test before it is indicated (for example, glucose screening very early in pregnancy without risk factors).
Rule of thumb
When a prenatal patient reports a symptom, ask: does this represent a threat to mother or fetus now? Bleeding, severe headache, visual changes, decreased fetal movement, or rupture of membranes = urgent evaluation, not reassurance.
Worked example: A patient is pregnant for the fourth time; she has one living child born at 39 weeks, one miscarriage at 9 weeks, and one stillbirth at 22 weeks. She is currently 30 weeks. GTPAL = G4 T1 P1 A1 L1 (the 22-week loss counts as preterm, not term).