Urmila* was 31-years-old when she conceived through in vitro fertilisation (IVF) procedure. She was regular for her antenatal checkups till 24 weeks of pregnancy and everything was fine. However, she started to miss her regular checkups after she went to stay with her mother in another state. Things took a dramatic turn during the 34th week of pregnancy as she was rushed to the hospital with convulsions, high blood pressure and swollen legs. To save the mother and the baby, the doctors had to perform an emergency caesarean and the mother gave birth to two babies.
“It was a preterm delivery. As it was an emergency, we didn’t have any other choice but to do a caesarean. Soon, her blood pressure normalised, the swelling in the legs reduced and the convulsion was managed. The mother and the babies were discharged after ensuring they are doing okay,” said Dr P M Gopinath, director of reproductive medicine, Kauvery Hospital Group, Chennai.
Regular antenatal checkups are very important as around 90% of issues can be caught early and corrected, while in 10% of the cases, the disease progression can be stalled, thus ensuring the wellbeing of the mother and the baby.
According to the National Family Health Survey-6 (NFHS-6), released by the Union Health Ministry at the end of May, around 4% of women in the country did not visit a hospital even once during pregnancy. Also around 35% of women did not complete a minimum of four antenatal visits. However it has slightly improved from 58.5% in NFHS- 5 (2019-21) to 65.2% NFHS-6 (2023-24). Notably, urban women recorded higher compliance at 75.8% compared to 61.4% in rural areas.
Any planned pregnancy should start with preconception counselling for the couple. “Many people come after a positive urine pregnancy test. By that time, the early week which is crucial for foetus development is missed. That is already four weeks of pregnancy,” said Dr K Thendral, clinical lead and senior consultant, obstetrics & gynaecology, Kauvery Hospital.
During preconception counselling, the women’s general health condition is assessed — if she has any health problems like diabetes, hyperthyroidism and blood pressure — and how to keep issues under control. “During antenatal checkups, not only the physical health of the mother and foetus is assessed, but also emotional and mental health of the mother. She is counselled accordingly,” said Dr Thendral.
During the first antenatal visit, a physical examination of the mother is conducted to confirm whether the pregnancy is viable or not, and also ascertain any possible complications. The mother’s height, weight gain, abdominal circumference and blood pressure are usually checked and urinary tests are prescribed during the first visit. “Pregnant mothers are screened for anaemia periodically. If there are any variations, corrective measures are taken immediately. Anaemia, antepartum haemorrhage and infections are the three most common causes of maternal mortality and morbidity. These can be kept under check during antenatal checkups,” says Dr Gopinath.
According to doctors, expectant mothers are advised to visit the doctor at least once a month till the seventh month of pregnancy. “All mothers should go for antenatal checkups monthly once up to 7th month, twice a month in the 7th and 8th month, and weekly checkups in the 9th month. Regular checkups will help in categorising whether it is a high or low risk pregnancy. If placenta abnormality is diagnosed, then delivery will be planned at a hospital with a blood bank, an expert who can control the bleeding and facilities to handle any emergency,” added Dr Gopinath.
Ultrasonography (or ultrasound) scan, a safe and non-invasive imaging technique that uses sound waves to assess the health of the mother, foetus, placenta and uterus, for antenatal mothers is done during each trimester. It is an essential component of quality antenatal care, enabling early detection of complications, appropriate referral, and timely interventions to improve maternal and newborn outcomes.
The scan in the first trimester (6-8) weeks of pregnancy is done to confirm intrauterine pregnancy, cardiac activity of the foetus and number of foetuses among other things. The second trimester (18-22 weeks) scan assesses various parameters including head circumference, femur length, placental location, umbilical cord vessels. In the third trimester (28-32 weeks), it is done to assess foetal growth, amniotic fluid index, placental location and maturity, and foetal growth restriction or macrosomia.
“Foetal anomaly scan, a comprehensive foetal anomaly scan is performed between 18 and 22 weeks (second trimester) to detect major structural foetal anomalies and identify pregnancies requiring referral and specialised obstetric care. This is the scan done for detecting major congenital anomalies. Foetal anatomy, like brain, face, spine, heart chambers, lungs, kidneys and other organs can be assessed in the scan,” said Dr A Somasundaram, Director of Public Health and Preventive Medicine, Tamil Nadu said.
The scan in the third trimester will be helpful to know whether it can be a normal delivery (spontaneous vaginal birth) or if c-section should be planned, added Dr Shanthi K Elango, superintendent, Government RSRM Lying In Hospital, Chennai.
(*Name changed)