Design Prenatal Visit Schedule

---
name: design-prenatal-visit-schedule
description: Use when planning OB/midwife visit cadence during pregnancy — e.g., "how often should I see my doctor", "what happens at each prenatal appointment", "setting up my prenatal care timeline"
source: WHO ANC Recommendations 2016; ACOG Committee Opinion 2021; NICE Antenatal Care Guideline NG201 2021
tags: [pregnancy, prenatal-care, antenatal, obstetrics, health]
verified: true
---

# 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, not medical advice. Individual care plans must be established with a licensed healthcare provider (OB-GYN, midwife, or maternal-fetal medicine specialist). Clinical decisions depend on personal medical history, gestational age, and risk factors.