That at least is how it would be in a perfect world. Sadly, despite today’s medical marvels and discoveries, that is far from the case. Though motherhood should be a positive and rewarding experience, it is associated by far too many women with suffering, ill-health and even death. Every year, approximately 600,000 women die of pregnancy-related causes, and 98% of these deaths occur in developing countries.  Speaking of the risk factor, 1 in 3600 women has a risk of dying due to pregnancy linked causes in the developed world. In the developing countries that ratio is 1 in 40. (Source: International Journal of Gynecology & Obstetrics Volume 70, Issue 1, 2000)

In Pakistan an estimated 30,000 women die each year due to pregnancy related causes, placing it as a country with one of the highest maternal mortality rates. WHO & UNICEF approximate it around 270 deaths per 100,000 live births but that figure may be significantly higher due to under registration and absence of cause of death information.

The main reasons for the high rates of maternal mortality is lack of prenatal care, dearth of properly trained birth attendants and medical facilities, as well as a rural culture where there is no concept of antenatal visits. Most people do not visit a hospital until they feel it is a life or death situation. Almost 80 percent of births in the country take place at home.

To ensure a safe and healthy pregnancy, antenatal care with medical professionals cannot be stressed enough. A woman should have at least 3 visits to a medical facility to be labeled as a booked case. In a low-risk pregnancy 7 visits are considered ideal and in a high-risk case the required number can go up to 9-12 visits. Even though the number of visits maybe reduced due to unavoidable reasons, there are critical junctures during a pregnancy that a visit is vital and should not be missed. The first crucial stage in a pregnancy is during 5-9 weeks where an ultra sound is taken to ensure it is an intrauterine pregnancy and a cardiac flicker is done as well. The next essential period is 20-24 weeks where ultra sound is used to monitor for congenital malformation, if any, in the baby. Between 32-36 weeks the third visit is used to check placenta localization.

The table here provides details of the medical examination carried out at various stages of the pregnancy.

1 (0-4 Weeks)

• Confirmation of pregnancy
• Medical history and previous obstetrical history, if one
• A general physical exam
• Blood tests: hemoglobin and hematocrit, blood typing, rubella titer, hepatitis B screen
• Possible blood test for genetic diseases if history warrants
• Urinalysis to test for infection, sugar, and protein
• Weight and blood pressure check
• Counseling on proper nutrition and avoiding environmental hazards
• An opportunity to discuss other relevant concerns

2 (5-9 Weeks)

• Check-up for intra uterine pregnancy and cardiac flicker
• Ultrasound
• Nutritional counseling
• Weight and blood pressure check
• An opportunity to discuss other relevant concerns

3 (10-14 Weeks)

• Examination of abdomen to feel the top of the uterus
• Examination of the size and height of uterus
• Weight and blood pressure check
• Discussion of tests if needed: ultrasound, chorionic villus sampling, amniocentesis, and prenatal screening for genetic problems
• An opportunity to discuss other relevant concerns

4 (15-19 Weeks)

• Examination of the size and height of uterus
• Examination for swelling varicose veins, and rashes
• An opportunity to hear baby's heartbeat
• An Opportunity to possibly see the baby move and all the organs that are now developed on ultrasound, if indicated
•  Weight and blood pressure check (expect a more rapid weight gain over the next three months)
• Urinalysis to test for infection, sugar, and protein
• An opportunity to discuss feeling baby move
• An opportunity to discuss other relevant concerns

5 (20-24 Weeks)

• Check-up for congenital malfunction
• Examination for the size and height of uterus
• An abdominal exam
• Examination of breasts and skin
• Examination for swelling of hands, legs, and enlargement of veins
• Weight and blood pressure
• Urinalysis to test for infection, sugar, and protein
• An opportunity to hear baby's heartbeat
• An opportunity to see baby on ultrasound, if indicated
• An assessment of fetal activity
• An opportunity to discuss other relevant concerns

6 (25-28 Weeks)

• Examination of the size and height of uterus
• Weight and blood pressure check
• Urinalysis to test for infection, sugar, and protein
• Oral glucose tolerance test, screening for gestational glucose intolerance, if indicated
• Vaginal culture, screening test for beta strep infection, if indicated
• An opportunity to hear the baby's heart beat
• An opportunity to see the baby growing on ultrasound, if indicated
• An opportunity to discuss other relevant concerns

7 (28-32 Weeks)

• Examination of the size and height of uterus
• Examination of your skin for rashes, enlarging veins, and swelling
• Weight and blood pressure check
• Urinalysis to test for infection, sugar, and protein
• Hemoglobin and hematocrit, if indicated
• Review of diet, an opportunity to discuss mother’s weight, if necessary.
• An opportunity to hear baby's heartbeat
• An opportunity to see on ultrasound how baby has grown (if indicated)
• An opportunity to discuss other relevant concerns

 During the seventh and eighth month of pregnancy, healthcare provider may call the mother twice a month for check up.

8 (32-36 Weeks)

Check-up for placental localization

• Examination of the size and height of uterus
• Examination of your skin for rashes, enlarging veins, and swelling
• Weight and blood pressure check
• Urinalysis to test for infection, sugar, and protein
• Hemoglobin and hematocrit, if indicated
• Review of your diet, an opportunity to discuss mother’s weight, if necessary
• An opportunity to hear baby's heartbeat
• An opportunity to see on ultrasound how baby has grown (if indicated)
• An opportunity to discuss other relevant concerns

 
During the seventh and eighth month of pregnancy, the healthcare provider may call the mother twice in a month for check up.

9 (36-40 Weeks)

• Examination of the size and height of uterus
• Palpation of your uterus to determine position of baby
• An internal exam, if indicated
• Weight and blood pressure check
• An ultrasound exam if needed to determine the size and position of your baby
• Urinalysis to test for infection, sugar, and protein,
• An opportunity to discuss when to call your practitioner if labor begins
• An opportunity to discuss the difference between Braxton-Hicks contractions and the "real" ones
• An opportunity to discuss signs that labor has begun
• An opportunity to discuss when to go to the hospital or birth center
• An opportunity to discuss your birth plan, including labor assistants, avoiding episiotomy, or special birth requests
• An opportunity to discuss other concerns

During this month, your healthcare provider may check you weekly. If the weekly or twice-weekly visits drag any further, your healthcare provider may discuss what to do when you are "overdue". You may have weekly ultrasound examinations to assess the volume of the amniotic fluid, a biophysical profile, or discussion of possible induction of labor at some point. If you are overdue, your healthcare provider will counsel you on worrisome signs to watch for. Frequency and content of healthcare provider visits during the final month depends greatly on your particular obstetrical situation.