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Negligent Prenatal Care
Wednesday, February 3, 2021

After the excitement of finding out you are pregnant, the usual next step is to seek prenatal care. Regular prenatal care from a physician or midwife is essential for a healthy pregnancy. A healthy pregnancy usually results in a healthy baby. Early and regular prenatal is essential in reducing pregnancy complications.

Your first prenatal visit should take place soon as you reasonably believe you might be pregnant after missing a menstrual period. Most first prenatal visits are at approximately 2 months into the pregnancy. At the initial prenatal visit, the health of the mother and baby will be assessed. The obstetrical provider will do a complete history looking specifically at the health of the mother focusing on genetic, medical, obstetrical, and psychosocial factors.  A physical exam, including a pelvic exam, will be done. Various blood and urine testing will be obtained.  At the first prenatal visit, the expected delivery date (EDD) will be determined based on the date of the mother’s last menstrual period. A plan will be set out for the continuation of prenatal care.

During the prenatal course, a pregnant woman should see her obstetrical provider at regular intervals for monitoring. The point of regular prenatal visits is to screen for problems that may arise during the pregnancy. Diagnosing a health condition or complication early allows the obstetrical provider to treat the mother immediately and avoid harm to the baby during or after birth. The frequency of prenatal visits usually reflects the following schedule:

  • Once every four weeks during the first six to seven months of pregnancy

  • Every other week during weeks 31 through 37

  • Every seven days after week 37 until birth

At each prenatal visit, the obstetrical provider will do an examination ensuring that the pregnancy is progressing normally and will screen for problems. At each visit, there will be an assessment of any symptoms the mother might be having such as headache, abdominal pain, nausea, vomiting, bleeding, leakage of amniotic fluid, or urinary complaints. Blood pressure and weight rechecked. A urine sample will be tested for protein and glucose (sugar).  The uterus will be measured. Fetal heart rate and movement are assessed. Good prenatal care also includes teaching at each prenatal visit informing the mother what to expect as the pregnancy progresses towards delivery.

A mother might have various complaints during the pregnancy that are not concerning such as fatigue, hemorrhoids, varicose veins, heartburn, constipation, and backache. A common complaint during the first part of pregnancy is morning sickness characterized by nausea and possibly vomiting. Hyperemesis gravidarum is a condition of severe nausea and vomiting in pregnancy that results in weight loss and may require hospitalization. However, most women experience simple morning sickness, not hyperemesis gravidarum. A mother with morning sickness may require a prescription for nausea medicine. Other medications commonly taken during pregnancy include prenatal vitamins.  Some women also require supplemental iron if they develop anemia during pregnancy.

Some mothers will develop conditions during pregnancy that require special attention. One such condition that can develop pregnancy is gestational diabetes. Women will usually be tested for gestational diabetes between the 24 and 28 weeks of pregnancy. Gestational diabetes, which only occurs during pregnancy, may require consultation with a dietician and in some cases insulin therapy during the pregnancy. Left untreated, gestational diabetes can cause premature delivery, a high birth weight (macrosomia), and other complications.

Another condition that can develop during pregnancy is preeclampsia. Preeclampsia is known as a hypertensive disorder of pregnancy. Preeclampsia occurs after 20 weeks of pregnancy and the risk of developing it increases as a mother approaches term. Your obstetrical provider will screen you for preeclampsia at prenatal visits by checking your blood pressure and testing your urine for protein. Preeclampsia can negatively affect both the mother and baby. Thus, it is of utmost importance that you be monitored closely by your obstetrician during your pregnancy for the development of preeclampsia so it can be successfully treated.

During a normal pregnancy, the obstetrical provider might order ultrasound examinations of the baby. It is common for pregnant women to have at least two ultrasound examinations during the pregnancy. Of course, more ultrasounds may be done during the pregnancy as needed. The first ultrasound is typically done during the first trimester of pregnancy. The purpose of the ultrasound is to confirm the pregnancy, confirm the number of babies, confirm the fetal heart rate, and estimate the due date of the baby. Sometimes there is a discrepancy of the due date based on the woman’s recollection of the date of her last menstrual period and the ultrasound due date. Most obstetricians will use the ultrasound due date if the mother is unsure of the date of her last menstrual period.

The second ultrasound is done around 20 weeks gestation. The purpose of the second ultrasound is to do a critical anatomical examination of the baby looking for abnormalities. Some abnormalities in a baby can be treated before birth. Other abnormalities in the baby will be treated after birth. The second ultrasound will confirm the due date of the baby. It will assess the amount of amniotic fluid. The location of the placenta will be determined. The placenta is usually at the top of the uterus. However, in a condition call placenta previa, the placenta either totally or partially covers the cervix. Placenta previa can result in heavy vaginal bleeding. A C-section may be recommended to deliver the baby if placenta previa is diagnosed.

A normal pregnancy lasts for 40 weeks. A pregnancy that reaches 42 weeks is known as a post-term pregnancy.  Post-term pregnancies carry risks for both the mother and baby. Therefore, obstetrical providers will often do testing after 40 weeks to confirm the health of the baby. One such test is a Non-Stress Test (NST). A NST is a non-invasive test that monitors the baby’s heart rate with the use of an electronic fetal monitor. Accelerations (increases) in the heart rate are a good sign of fetal health. If two heart rate accelerations are seen on the monitor in 20 minutes, the test is deemed Reactive (normal). Another test is known as a Biophysical Profile (BPP). It uses an electronic fetal monitor and an ultrasound. The BPP measures the baby’s heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid. A perfect score is a 10. A score of 6 or below may indicate problems with the baby requiring delivery.

During prenatal care, an obstetrical provider can be negligent in many ways. The obstetrical provider may fail to conduct proper monitoring and testing during the prenatal period. The obstetrical provider may fail to diagnose a condition during pregnancy. He or she may fail to appropriately treat a condition that develops during the pregnancy. Thus, it is vitally important to get regular and competent care during your pregnancy because negligent prenatal care can harm both the mother and baby.

Every expecting mother has the right to proper health care during her pregnancy. If you or your child suffered an injury that you believe stems from negligent prenatal care, it is important to do a review of the care rendered. 

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