ANTENATAL CARE

Ante-Natal Care is a combination of diagnostic and screening tests, counseling about health-
related behaviors, social support, and physiologic monitoring (Siddique, 2012).

Picture 1. Focused antenatal care (ANC): The four-visit ANC model outlined in WHO clinical guidelines.

(Source : WHO, 2017. link : http://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf)

1. Urine Culture
A urine culture is used to screen for asymptomatic bacteriuria, treatment for which reduces
symptomatic infections and low birthweight births. For this reason, the USPSTF gave an A grade
(highly recommended) to prenatal screening with urine culture and recommend that such
screening occur once, early in the pregnancy (Siddique, 2012).

2. Anemia Screening
Anemia screening occurs via a blood test and measures hemotocrit and hemoglobin in the
blood. Anemia in pregnant women has been associated with increased risk for low birth weight,
preterm delivery, and perinatal mortality. The USPTF recommendation for anemia screening was
graded "B," meaning that the service was recommended although the evidence of beneficial
effects of supplementation on either mother or infant was weak (Siddique, 2012).

3. Oral Glucose Tolerance Test (OGTT)

OGTT is used to screen for gestational diabetes which, if untreated, is associated with
adverse perinatal outcomes, including birth weight above the 90th percentile, clinical neonatal
hypoglycemia, premature delivery, shoulder dystocia or birth injury, intensive neonatal care
admission, hyperbilirubinemia, and preeclampsia. There is ongoing debate about the best method
of screening for gestational diabetes. The USPTF considers the evidence of benefits versus
harms for routine screening - using either urinalysis or OGTT, to be insufficient ("I") to
recommend for or against it (Siddique, 2012).

4. Urinalysis
Urinalysis can be used to screen for infection, proteinuria, and glycosuria. The routine use
of urinalysis in pregnancy is controversial, in part because the evidence for or against each of the
three screenings using routine urinalysis is controversial. The USPSTF is currently revising the
recommendations for preeclampsia screening; the 1996 recommendation was to screen by
measuring blood pressure at the first prenatal visit and to repeat periodically; urinalysis to check
for proteinuria was dismissed as being insensitive and unreliable. Routine urinalysis has been
shown to be an unreliable screening test for urinary tract infection. While there was no explicit
grade recommendation for urinalysis, the implication was clearly that it was not recommended
(Siddique, 2012).
 Therefore, these four prenatal screening tests: urine culture, anemia screening, OGTT, and
urinalysis have widely different evidence-based recommendations from the USPSTF (Siddique,
2012).
We do not have good data that describe what actually happens during prenatal visits for
women in the U.S. To better understand the content of prenatal care as it is practiced in the
United States today, we analyzed data from two surveys carried out by the National Center for
Health Statistics that represent national probability samples of physician-patient encounters: the
National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory
Medical Care Survey (NHAMCS). Using these data, we estimate the proportion of prenatal visits
at which urine culture, anemia screening, OGTT, and urinalysis occur and the average number of
times a woman will receive each of these four procedures during a pregnancy. We also estimate
the odds that a woman will receive these procedures during a prenatal visit. These analyses allow
us to ask how closely screening procedures carried out during prenatal care visits conform to
evidence of effectiveness. They also allow us to examine whether the number of procedures
varies by maternal age, race/ethnicity, insurance status, region of the country, and pregnancy risk
group. Were the evidence being followed, we would hope to see an average of one or more urine
cultures and anemia screenings per pregnancy, an average of less than one OGTT screening per
pregnancy, and infrequent urinalysis (Siddique, 2012).

DAPUS :

Siddique, Juned. 2012. Screening Tests During Prenatal Care. Medscape : Matern Child Health
J. 2012;16(1):51-59. Link : (https://www.medscape.com/viewarticle/756599_1)

WHO. 2017. The Four-Visit ANC Model Outlined In WHO Clinical Guidelines. Link :
(http://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf)