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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Antepartum care.

Shahd A. Karrar ; Peter L. Hong .

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Last Update: August 8, 2023 .

Continuing Education Activity

Antepartum care comprises a significant percentage of health maintenance visits in the United States. Also referred to as prenatal care, antepartum management is essential to the progression of healthy pregnancies, identifying potential abnormal pregnancies, and ensuring safe and timely management of prenatal issues and deliveries for patients and neonates. This activity outlines antepartum care and reviews the role of the interprofessional team in evaluating, managing, and improving the care for patients during pregnancy.

Describe the significance of adequate antepartum care for pregnant patients.
Review the typical antepartum course for pregnant patients.
Identify possible risk factors and health issues that may arise during antepartum care.
Summarize the importance of interprofessional communication and healthcare coordination in antepartum care.
Introduction

Antepartum care, also referred to as prenatal care, consists of the all-encompassing management of patients throughout their pregnancy course. Antepartum care has become the most frequently utilized healthcare service within the United States, averaging greater than 50 million visits annually. After the first positive pregnancy test, care is typically sought by patients and begun after confirmed sonographic intrauterine pregnancy. The average number of visits ranges between twelve to seventeen visits, depending on the complexity of the pregnancy course.

The prenatal course is typically separated into trimesters, for which each of the three trimesters serves a specific purpose for maternal/fetal monitoring, gestation-specific examinations and laboratory work, and screening for potential pregnancy abnormalities. Traditionally, prenatal visit frequencies are typically scheduled at 4-week intervals until 28 weeks of gestation, at which time visits are scheduled every 2 weeks until 36 weeks of gestation, followed by weekly visits until delivery. Visits may be adjusted to more frequent follow-ups when high-risk pregnancy complications are present, when pertinent lab values must be reviewed, or if patients require closer monitoring for risk factors. [1] [2] [3]

With the increasing focus beginning in the early 1990s on preventing maternal and fetal morbidity and mortality, great efforts have been made to improve access to quality antepartum care to low socio-economic and minority populations. Although still prevalent despite efforts, the growing disparities between minority populations (specifically among Hispanics and African Americans) are rooted in lack of access and complex obstetric and medical risk factors leading to poor obstetric outcomes. Thus, an adequate evaluation of a patient’s medical history, related risk factors, and potential obstacles to healthcare must be attained, followed by a patient-centered discussion regarding the potential prenatal plan of care. [1] [2] [3]

First Trimester Antepartum Care (0-14 6/7 weeks)

First trimester antepartum care most commonly begins with an initial prenatal visit, after the development of symptoms, a positive pregnancy test, and confirmed intrauterine gestation via sonography. Patients with early pregnancies may present with any combination of signs and symptoms or might be completely asymptomatic. The most common presenting complaint of patients is an abrupt cessation of the menstrual cycle in previously healthy women of reproductive age with regular menstrual cycles. Although this is a common presenting complaint, menstrual cycle variation among women of varying ages or underlying gynecologic conditions also means amenorrhea cannot reliably be utilized as the only method of diagnosis of pregnancy. Patients may also present with complaints of breast pain or swelling, often less commonly reported by multiparous patients.

Sonography, specifically transvaginal sonography, plays an essential role in identifying and establishing gestational age and confirms the location of the pregnancy. Intrauterine pregnancies are confirmed by the presence of a gestation sac within the endometrial cavity, typically identified at 4 to 5 weeks gestation, along with a visualization of a yolk sac, typically seen by 5 weeks gestation. With this confirmation, and at about 6 weeks gestation, cardiac activity may be noted.

Several major tasks must be accomplished during this initial visit, including establishing the baseline medical condition of the patient and fetus, proper gestational age and dating, and planning the intended course of obstetric care with the patient. Within the first visit, a complete history should be taken, including a detailed history of past medical problems that may be of concern during pregnancy, previous surgeries, and detailed past obstetric and gynecologic history for foreseeable complications. Current issues and complaints should also be addressed.

A complete physical examination should also be performed, including complete vital signs, maternal weight, and pelvic/cervical examination, fundal height, and fetal heart rate. Laboratory tests should also be collected and completed during this first visit. These include a complete blood count (CBC), complete metabolic panel (CMP), blood type and Rh factor testing with antibody screen, urine analysis, urine culture, pap smear screening, rubella serology, syphilis serology, gonorrhea, and chlamydia screening, Hepatitis B serology, and HIV serology. These results should be followed up promptly so as to begin necessary adjustments to prenatal care, repeat laboratory testing, or initiate treatment or a higher level of care. During the first trimester, fetal nuchal translucency sonography and fetal aneuploidy screening may be performed between 11 and 14 weeks gestation and again during the second trimester depending on the modality of fetal aneuploidy testing utilized. [4] [5] [6] [7] [8]

Second Trimester Antepartum Care (15 0/7 - 28 6/7 weeks)

In the second trimester, antepartum care consists of updated histories with each visit, including reviewing current pregnancy-related issues and a review of newly occurring issues. This includes assessing possible symptoms such as headaches, altered vision, abdominal pain, nausea or vomiting, vaginal bleeding, leakage of fluid, or dysuria. During early second trimester gestations, patients may begin to endorse the perception of fetal movement. This is typically found at around 16 to 18 weeks gestation, or even up to 20 weeks gestation, in primigravida patients and varies in the detection based on maternal factors such as body habitus.

Care also includes repeat blood pressure recordings, maternal weight, fundal height, and fetal heart rate. Fetal heart rates can be detected via Doppler ultrasound, in nonobese patients, at as early as 10 weeks gestation. Because the second trimester encompasses a vast majority of the rapid fetal growth period, several essential screening and laboratory tests are collected during this trimester. Earlier in the second trimester, the second portion of combined-trimester fetal aneuploidy testing or single-test quadruple maternal screening is collected between 16 to 20 weeks gestation. In addition to this, fetal sonography for the anatomic survey is performed during 18 to 20 weeks gestation.

Gestational diabetic screening is also an essential component of second-trimester testing via a 50-gram glucose tolerance test. This is typically collected between 24 to 28 weeks of gestation. Tdap vaccinations are also routinely administered during this timeframe. If patients have a known Rh-negative status, Rhogam is administered at 28 weeks. Patients during this trimester are also counseled at around 28 weeks gestation to begin self-monitoring of fetal movements equating to 10 movements within 2 hours, also known as “fetal kick counts.” [9] [10] [11]

Third Trimester Antepartum Care (29 0/7- 41 6/7 weeks)

The third trimester of antepartum care consists of the final preparations, screenings, necessary treatments, and counseling to facilitate safe and timely delivery and improved maternal and fetal outcomes. As with second-trimester visits, antepartum care in the third trimester consists of updated histories with each visit, reviewing current pregnancy-related issues and reviewing newly occurring issues. Review of new symptoms such as headaches, altered vision, abdominal pain, nausea or vomiting, vaginal bleeding, leakage of fluid, or dysuria should be discussed. If present, appropriate physical examination or laboratory testing should be completed. And, as performed in other visits, blood pressure recordings, maternal weight, fundal height, and fetal heart rate should be obtained.

Between 36 to 37 weeks gestation, third-trimester laboratory testing is typically collected in uncomplicated prenatal care. These include repeat complete blood count to address and correct anemia or thrombocytopenia prior to delivery, Hepatitis B surface antigen testing, gonorrhea and chlamydia screening, HIV screening, and Group B Streptococcal screening. During late third trimester visits, patients typically return for weekly visits to assess for signs of early labor, fetal distress, or maternal complaints.

Patients may also require a physical examination, including cervical examination, sonography to assess for estimated fetal weight and amniotic fluid index, or nonstress tests to examine fetal status. If there are abnormalities, other pregnancy-related, or maternal-related medical conditions present, patients may require induction of labor or imminent delivery depending on the circumstance and severity. [12] [13]

Issues of Concern

Several issues of concern may arise during the course of antepartum care. While serious medical conditions pose a risk and concern to prenatal management (discussed in other articles), most areas of concern in day-to-day pregnancy issues also comprise a significant amount of patient complaints. Therefore, recognition of these concerns and timely intervention is an essential contributor to adequate antepartum care.

Nausea and Vomiting

Nausea and vomiting are among the most common complaints of pregnant patients within the first trimester of pregnancy, and is thought to be multifactorial and more directly caused by rapidly increasing level of pregnancy-related hormones such as beta HCG, estrogen, progesterone, placental growth hormone, leptin, and several others. Patients may experience varying degrees of nausea or vomiting throughout the antepartum course. Severe cases may require hospitalization and workup for more serious causes, such as hyperemesis gravidarum, identified by severe dehydration, accompanied by acid-base and electrolyte abnormalities. Patients typically state symptoms present prominently after the first missed menstrual cycle and may continue up to 16 weeks of gestation and up to 22 weeks gestation in rare cases. Symptoms are typically perceived to be more severe during early waking hours. Patients experiencing these issues may receive relief from several different interventions. First, patients may attempt to portion smaller, more frequent meals, ginger into their diets, or supplement medications. Patients may require Vitamin B6 supplementation with Doxylamine or antiemetics such as H1-receptor antagonists. [14] [15]

Musculoskeletal Back Pain

Patients during the antepartum course may also have significant complaints of back and lower lumbar pain, most commonly in the third trimester of pregnancy and caused by the increasing size of the gravid uterus and alignment distortion. This is typically worsened by walking significant distances, intense bending forward, or lifting moderately weighted objects. Severe cases of back pain may warrant orthopedic evaluation. Management of back pain includes rest, heating pads, back braces, and analgesics. [16] [17] [18]

Weight Gain

Weight gain during pregnancy should be discussed with patients and assessed based on pre-pregnancy BMI and individual risk factors, with an increased focus on obesity. Obesity’s association with fetal macrosomia, gestational diabetes, gestational hypertension, preeclampsia, rate of cesarean sections, and other pregnancy complications requires early intervention and counseling of patients beginning in early antepartum care. Pre-pregnancy BMI categories allow for stratification of the total weight gain throughout pregnancy recommendation for underweight patients (BMI <18.5) to be a 28 to 40 lb (12.7 18.1 kg) to total weight gain, normal weight (BMI: 18.5 to 24.9) to be a 25 to 35 lb (11.3 to 15.9 kg) total weight gain, overweight (BMI: 25.0 to 29.9) to be a 15 to 25 lb (6.8 to 11.3 kg) total weight gain, and obese (BMI great or equal to 30.0) to be an 11 to 20 lb (5 to 9 kg) total weight gain. The emphasis during antepartum care and weight gain is currently focused on the obese population, given the significantly increased risk for gestational diabetes, macrosomia, gestational hypertension, preeclampsia, and cesarean delivery, and other antepartum and intrapartum complications. [19] [20] [21]

Smoking, Alcohol, and Illicit Drugs Use

Although the overall prevalence of cigarette smoking during pregnancy has decreased significantly throughout the United States, there continues to be a prevalence of twelve to thirteen percent of women who endorse cigarette use during the antepartum period. These patients typically tend to be younger in age, have completed fewer years of education, and are of lower socioeconomic status. During the antepartum course, it is essential to identify patients who endorse smoking, counsel patients extensively regarding risk factors associated with cigarette use during pregnancy, and implement a quitting plan with the identification of foreseeable roadblocks and obstacles to doing so. Cigarette smoke is fetotoxic due to the vasoactive effects leading to its substances leading to a marked reduction in oxygen levels. Effects of decreased oxygen levels may lead to cardiac anomalies, gastroschisis, hydrocephaly, microcephaly, omphalocele, cleft lip, and palate, or limb anomalies. These effects are noted to be dose-dependent. Risks associated with cigarette smoke use and exposure in the antepartum period also include spontaneous abortions, fetal growth reduction, preterm delivery, and placental abnormalities, like placental abruption or placenta previa. [22]

Like tobacco, alcohol use during pregnancy, while decreasing in prevalence, is still prevalent amongst eight to thirty percent of pregnancies in the United States. Alcohol exposure in-utero has been established as the leading cause of non-genetically linked mental retardation, along with a constellation of presenting defects that together are referred to as Fetal Alcohol Syndrome. These include notable central nervous system abnormalities (neurologic, functional, and structural dysfunction), growth restriction, notable dysmorphic facial features (short palpebral fissures, smooth philtrum, and thinned vermilion border), and other anomalies (cardiac, skeletal, renal, auditory, ophthalmologic, etc.). While the dose-effect correlation between alcohol use in pregnancy and fetal defects is unknown, several studies show an increased risk among those exposed to excessive binge-drinking behavior. [23] [24]

Illicit drug use during pregnancy is also of major concern to both maternal and fetal outcomes. With exposure rates as high as ten percent, assessing patients using recreational drugs must be completed in all pregnant patients. The use of drugs poses a unique risk when considering outcomes and fetal effects, given the multiple variables typically associated with those using drugs. These include younger patient populations, low socioeconomic status, polysubstance abuse, mental health issues, infectious diseases, and other social issues, which may complicate the picture of diagnosis and management. The greatest risk of illicit drug use in pregnancy also lies with the toxic and teratogenic effects of additives and impurities found in several street drugs. Effects of recreational drug use include, but are not limited to, fetal growth restriction, facial defects, cardiovascular, renal, and urinary abnormalities, behavioral abnormalities, and complications of fetal withdrawal (i.e., seizures, central nervous system defects). [25] [26]

Work & Employment

With more than half of pregnant women working from conception until delivery, employment during the antepartum course is another common area of concern for patients. According to the Family and Medical Leave Act, pregnant employees must be granted at least twelve weeks of unpaid leave from employment for delivery and newborn care. As per the American College of Obstetrics and Gynecology, pregnant women may continue employment until labor begins in the absence of obstetric complications.

Despite these recommendations, some work may increase the risk of complications to pregnant patients, including employment that requires strenuous heavy lifting and long work hours. These demanding conditions may place additional stress on the patient as well as the pregnancy course, leading to complications such as gestational hypertension with an increased risk of the development of preeclampsia, preterm premature rupture of membranes, preterm labor and delivery, and fetal growth restrictions. It is acceptable to counsel patients with significant obstetric histories of these complications on the added risk of strenuous workplaces on the antepartum course. [27] [28] [29]

With the emphasis on promoting healthy lifestyles during antepartum care, patients may have specific concerns regarding exercise safety during pregnancy. The American College of Obstetrics and Gynecology recommends that after thorough clinical evaluation and with no contraindications, pregnant women should be encouraged to participate in regular, moderate-intensity physical activity in regular, moderate-intensity physical activity for at least thirty minutes or greater per day. Relative contraindications are noted as follows: heavy smoking, poorly controlled disorders such as seizure disorder, hyperthyroidism, Type 1 diabetes, or hypertension, extreme weights including morbid obesity or underweight, intrauterine growth restriction, chronic bronchitis, unevaluated maternal cardiac arrhythmia, history of severely sedentary lifestyle, symptomatic or severe anemia, or heavy smoking.

Absolute contraindications as as follows: incompetent cervix or cerclage, multifetal gestation pregnancy with risk of preterm labor, persistent second or third trimester vaginal bleeding, preterm labor during in the pregnancy, placenta previa present after 26 weeks of gestation, rupture of membranes, preeclampsia or pregnancy-induced hypertension, significant heart disease, or restrictive lung disease. Specific physical activities and intensity of those activities should be reviewed. Those activities in which the risk of trauma to the abdomen or falls are increased should be discouraged. [30] [31] [32]

The American College of Obstetrics and Gynecology states that pregnant women may safely travel until 36 weeks of gestation provided there are no complications. Modern, adequately pressurized aircraft pose no harm to pregnant patients or fetuses. Patients are advised to ambulate every hour while on long flights to prevent thromboembolism and wear seat belts throughout the flight. Seat belt safety in regards to automobile travel should be discussed with all pregnant patients during antepartum care. Specifically, correct placement of seatbelts via three-point restraints where the shoulder portion of the strap should be firmly positioned between the breasts and bottom portion should safely be positioning under the abdomen and across the upper portion of the thigh. Both should be positioned across the body tightly, and airbags should always be present in vehicles and utilized in the event of a high-impact accident. [33] [34] [35]

Clinical Significance

The totality of antepartum care is an intricate balance of maternal and fetal management aimed to prevent significant maternal and fetal morbidity and mortality and provide support throughout the prenatal course. Close follow-up with timely review of new complaints or issues, significant physical exam, sonography, and laboratory findings facilitate the necessary interventions. These may include escalation of care to more frequent antepartum care visits, close follow-up by maternal-fetal medicine specialists, or potential early delivery depending on the gestational age, clinical picture, and potential improvement of outcomes.

While all of these interventions can be implemented with relative ease, major obstacles do exist to achieving this. The main concern for practitioners is patient compliance with visits, specifically in low socioeconomic or minority populations. Obstacles, such as access to prenatal facilities, transportation, or proper understanding of risk factors, all play a role in delayed intervention. Because of this, it is essential for the antepartum care team to identify these obstacles early in the prenatal course so as to preemptively find solutions to potential obstacles. [1] [2] [3]

Enhancing Healthcare Team Outcomes

During the antepartum course, the care and management of patients serve significant challenges and obstacles, given the complexity of caring for both the patient and fetus. Because of this dual perspective, a team-directed approach of care by physicians, nurses, pharmacists, and healthcare aids is essential for improving maternal and fetal outcomes. This begins with adequate antepartum or prenatal care to ensure patients feel supported and informed. This also includes early detection and acknowledgments of patient complaints, signs, and symptoms of early disease processes, vital signs, laboratory values, and antepartum and prenatal care goals.

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Disclosure: Shahd Karrar declares no relevant financial relationships with ineligible companies.

Disclosure: Peter Hong declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Karrar SA, Hong PL. Antepartum Care. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Antepartum Care: Importance, Components, and Benefits

Introduction:.

Antepartum care, also known as prenatal care, is an essential aspect of healthcare for pregnant individuals. Regular prenatal care can help promote a healthy pregnancy and reduce the risk of complications for both the mother and the baby. In this article, we will discuss the importance, components, and benefits of antepartum care.

Importance:

Antepartum care is important for several reasons, including:

Monitoring the health of the mother and the baby throughout the pregnancy
Identifying and managing any pregnancy-related complications, such as gestational diabetes or preeclampsia
Providing education and support to promote a healthy pregnancy and prepare for childbirth
Identifying any potential problems or risks that may require additional interventions or specialized care

Components:

Antepartum care typically involves several components, including:

Regular prenatal check-ups with a healthcare provider to monitor the health of the mother and the baby
Screening tests and diagnostic tests to identify any potential complications or risks, such as ultrasound or blood tests
Education and counseling on healthy pregnancy behaviors, such as nutrition, exercise, and stress management
Preparation for childbirth, including classes and discussions on labor and delivery, pain management, and postpartum care
Referrals for specialized care or additional interventions, if necessary

Antepartum care has several benefits, including:

Reducing the risk of pregnancy-related complications, such as preterm birth or low birth weight
Improving the health outcomes for both the mother and the baby
Identifying and addressing any potential problems or risks before they become more serious
Providing education and support to help parents feel more confident and prepared for childbirth and parenting

Conclusion:

Antepartum care is an essential aspect of healthcare for pregnant individuals. Regular prenatal care can help promote a healthy pregnancy and reduce the risk of complications for both the mother and the baby. By providing monitoring, education, and support, antepartum care can help parents feel more confident and prepared for childbirth and parenting.

Hashtags: #antepartumcare #prenatalcare #pregnancy #complications #monitoring #education #preparation #outcomes #benefits

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Antepartum Care

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First Trimester Antepartum Care (0-14 6/7 weeks)

Second Trimester Antepartum Care (15 0/7 - 28 6/7 weeks)

Third Trimester Antepartum Care (29 0/7- 41 6/7 weeks)

Issues of Concern

Nausea and Vomiting

Musculoskeletal Back Pain

Weight Gain

Smoking, Alcohol, and Illicit Drugs Use

Work & Employment

Clinical Significance

Enhancing Healthcare Team Outcomes

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Duncombe D, Skouteris H, Wertheim EH, Kelly L, Fraser V, Paxton SJ. Vigorous exercise and birth outcomes in a sample of recreational exercisers: a prospective study across pregnancy. The Australian & New Zealand journal of obstetrics & gynaecology. 2006 Aug:46(4):288-92 [PubMed PMID: 16866788]

. ACOG Committee Opinion No. 746: Air Travel During Pregnancy. Obstetrics and gynecology. 2018 Aug:132(2):e64-e66. doi: 10.1097/AOG.0000000000002757. Epub [PubMed PMID: 30045212]

. ACOG Committee Opinion No. 443: Air travel during pregnancy. Obstetrics and gynecology. 2009 Oct:114(4):954. doi: 10.1097/AOG.0b013e3181bd1325. Epub [PubMed PMID: 19888065]

. ACOG educational bulletin. Obstetric aspects of trauma management. Number 251, September 1998 (replaces Number 151, January 1991, and Number 161, November 1991). American College of Obstetricians and Gynecologists. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 1999 Jan:64(1):87-94 [PubMed PMID: 10190681]

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Pregnancy week by week

Prenatal care: 1st trimester visits

Pregnancy and prenatal care go hand in hand. During the first trimester, prenatal care includes blood tests, a physical exam, conversations about lifestyle and more.

Prenatal care is an important part of a healthy pregnancy. Whether you choose a family physician, obstetrician, midwife or group prenatal care, here's what to expect during the first few prenatal appointments.

The 1st visit

When you find out you're pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.

Medical history

Your health care provider might ask about:

Your menstrual cycle, gynecological history and any past pregnancies
Your personal and family medical history
Exposure to anything that could be toxic
Medications you take, including prescription and over-the-counter medications, vitamins or supplements
Your lifestyle, including your use of tobacco, alcohol, caffeine and recreational drugs
Travel to areas where malaria, tuberculosis, Zika virus, mpox — also called monkeypox — or other infectious diseases are common

Share information about sensitive issues, such as domestic abuse or past drug use, too. This will help your health care provider take the best care of you — and your baby.

Your due date is not a prediction of when you will have your baby. It's simply the date that you will be 40 weeks pregnant. Few people give birth on their due dates. Still, establishing your due date — or estimated date of delivery — is important. It allows your health care provider to monitor your baby's growth and the progress of your pregnancy. Your due date also helps with scheduling tests and procedures, so they are done at the right time.

To estimate your due date, your health care provider will use the date your last period started, add seven days and count back three months. The due date will be about 40 weeks from the first day of your last period. Your health care provider can use a fetal ultrasound to help confirm the date. Typically, if the due date calculated with your last period and the due date calculated with an early ultrasound differ by more than seven days, the ultrasound is used to set the due date.

Physical exam

To find out how much weight you need to gain for a healthy pregnancy, your health care provider will measure your weight and height and calculate your body mass index.

Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it's been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

At your first prenatal visit, blood tests might be done to:

Check your blood type. This includes your Rh status. Rh factor is an inherited trait that refers to a protein found on the surface of red blood cells. Your pregnancy might need special care if you're Rh negative and your baby's father is Rh positive.
Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that allows the cells to carry oxygen from your lungs to other parts of your body. Hemoglobin also carries carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low hemoglobin or a low level of red blood cells is a sign of anemia. Anemia can make you feel very tired, and it may affect your pregnancy.
Check immunity to certain infections. This typically includes rubella and chickenpox (varicella) — unless proof of vaccination or natural immunity is documented in your medical history.
Detect exposure to other infections. Your health care provider will suggest blood tests to detect infections such as hepatitis B, syphilis, gonorrhea, chlamydia and HIV , the virus that causes AIDS . A urine sample might also be tested for signs of a bladder or urinary tract infection.

Tests for fetal concerns

Prenatal tests can provide valuable information about your baby's health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome.

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Other 1st trimester visits

Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby's heartbeat with a small device, called a Doppler, that bounces sound waves off your baby's heart. Your health care provider may offer a first trimester ultrasound, too.

Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind.

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Lockwood CJ, et al. Prenatal care: Initial assessment. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
Prenatal care and tests. Office on Women's Health. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests. Accessed July 9, 2018.
Cunningham FG, et al., eds. Prenatal care. In: Williams Obstetrics. 25th ed. New York, N.Y.: McGraw-Hill Education; 2018. https://www.accessmedicine.mhmedical.com. Accessed July 9, 2018.
Lockwood CJ, et al. Prenatal care: Second and third trimesters. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/. Accessed July 9, 2018.
Bastian LA, et al. Clinical manifestations and early diagnosis of pregnancy. https://www.uptodate.com/contents/search. Accessed July 9, 2018.

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Medical Definition of antepartum

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Labor and Delivery

Inpatient Antepartum and Postpartum Care

Women with high-risk pregnancies who require inpatient care before or after delivery receive specialized evaluation and treatment services at our modern Connors Center for Women and Newborns facility. The space and specialists are exclusively dedicated to caring for women with high-risk pregnancies before and after delivery.

Our multidisciplinary team provides expert, compassionate, and comprehensive antepartum (pre-delivery) and postpartum (after delivery) care. Every morning and throughout the day, the team addresses each patient’s medical, nursing, social, nutritional, and subspecialty needs in a private environment.

The team specializes in treating women with preterm labor , diabetes , bleeding in late pregnancy, preeclampsia (characterized by high blood pressure), and other antepartum (pre-delivery) and postpartum medical conditions. Inpatient care may also be undertaken for monitoring of pregnancies with fetal or placental concerns such as congenital anomalies , altered fetal growth and placenta accreta .

Placenta Accreta Video

Sophia, a patient of Daniela Carusi, MD, describes her antepartum care for placenta accreta.

Twin Pregnancy Video

Carolina Bibbo, MD, discusses twin pregnancy. Women expecting twins or triplets may need closer monitoring by the inpatient team either before or after birth.

Care is led by our high-risk pregnancy physicians , who are recognized for their expertise in infectious diseases, genetics, diagnostic sonography, medical complications of pregnancy, emergency obstetric care, and abnormalities of labor.

We provide both short-term and long-term inpatient care. Some patients may stay for days, while others may stay for weeks. Many patients stay right up to delivery. Individualized care plans including the important considerations of home and work adjustments for an unexpected hospitalization, assistance with home health care and visiting nurses are highlighted. In other cases, we are able to stabilize the condition of a patient before delivery and facilitate the transfer of their care back to the referring physician.

Our specialized services include:

A daily morning visit from nutrition, nursing, social, and physician specialists
Private room for each patient, with accommodations for an overnight guest
24/7 availability for monitoring of fetal conditions
24/7 visiting hours
Same-day consultations from other physician teams with expertise in medical or surgical concerns

NICU Collaboration

Following delivery, babies of high-risk mothers may end up spending time in our state-of-the-art Newborn Intensive Care Unit (NICU) . Our internationally-recognized neonatologists and their expert nursing and other NICU colleagues are dedicated to providing the most advanced care possible to newborns with critical and unique health challenges. Learn more about our NICU .

Also at times additional pediatric subspecialty care is necessary and an extended team of support from Boston Children’s Hospital is always immediately available. If the newborn infant requires hospitalization at Boston Children’s Hospital, parents can easily continue their close contact and involvement in their newborn’s care with Boston Children’s Hospital accessed by a convenient walkway connecting the two hospitals. Ongoing continued involvement of the parents and their family is available through real-time digital technology providing easy access to the intensive care units, their newborn and the care team involved.

In addition to our dedication to delivering the best antepartum care possible, we are equally committed to seeking ways to make that care even better. We continually collect patient outcome data that is used in regional and national studies.

Learn more about Brigham and Women's Hospital

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an·te·par·tum

acid-base monitoring
Amniotic fluid
antepartum haemorrhage
antepartum hemorrhage
Antepartum Testing
anxiety reduction
biological monitoring
bleeding reduction
bleeding reduction: antepartum uterus
bleeding reduction: gastrointestinal
bleeding reduction: nasal
bleeding reduction: postpartum uterus
bleeding reduction: wound
certified nurse midwife
Cervical Insufficiency
closed reduction
deceleration
antegrade cystography
antegrade pyelography
antegrade urography
antegrade, anterograde
antelocation
antemortem clot
antemortem thromboembolus
antemortem thrombus
antenatal care
antenatal diagnosis
antenatal screening
antenatal services
antenatal surgery
Antenatal Testing
antennal gland
antennapedia complex
antepartal care
antephialtic
antepituitary
anteposition
antepyretic
anterior (bronchopulmonary) segment S III
anterior abdominal cutaneous branch of intercostal nerve
anterior acoustic stria
anterior ampullar nerve
anterior ampullary nerve
anterior amygdaloid area
anterior and lateral thoracic regions
anterior and posterior radicular arteries
anterior and posterior superior pancreaticoduodenal artery
anterior apprehension test
anterior arch of atlas
anterior articular surface of dens
anterior asynclitism
anterior atlantoaxial ligament
anterior atlantooccipital ligament
anterior atlantooccipital membrane
antenuptial
Antenuptial (prenuptial) agreement
Antenuptial agreement
antenuptial marriage contract
antenuptially
Anteorbital
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Antepagmenta
antepartal paralysis
antepartal recumbency
Antepartum Fetal Heart Rate Testing
Antepartum haemorrhage
Antepartum hemorrhage
antepartum hemorrhage of unknown origin
antepartum paralysis
antepartum/postpartum
antepartumly
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antependium
antepenultima
antepenultimate
antepenultimately
antepenults
Antephialtic
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MONICA PREBOTH

Am Fam Physician. 2000;62(5):1184-1188

The Committee on Practice Bulletins–Obstetrics of the American College of Obstetricians and Gynecologists (ACOG) has developed clinical management guidelines on antepartum fetal surveillance. According to the committee, the goal of antepartum fetal surveillance is to prevent fetal death. The techniques of antepartum fetal surveillance, which are based on the assessment of fetal heart rate patterns, have been in clinical use for nearly 30 years. These guidelines, which replace Technical Bulletin No. 188 issued in January 1994, appear in the October 1999 issue of Obstetrics and Gynecology .

Techniques of Antepartum Fetal Surveillance

Several techniques for antepartum fetal surveillance currently in use are discussed in the ACOG bulletin. These include fetal movement assessment, nonstress test, contraction stress test, fetal biophysical profile, modified biophysical profile and umbilical artery Doppler velocimetry.

FETAL MOVEMENT ASSESSMENT

Fetal movement assessment occurs when the mother perceives a diminution in fetal movement. The mother counts fetal “kicks” as a means of antepartum fetal surveillance. The optimal number of movements and the ideal duration for counting movements have not been determined; however, numerous protocols have been reported and appear to be acceptable.

CONTRACTION STRESS TEST

The contraction stress test is based on the response of the fetal heart rate to uterine contractions. It is believed that fetal oxygenation will be transiently worsened by uterine contractions. In the fetus with suboptimal oxygenation, the resulting intermittent worsening in oxygenation will, in turn, lead to the fetal heart rate pattern of late decelerations. Uterine contractions also may provoke or accentuate a pattern of variable decelerations caused by fetal umbilical cord compression, which in some cases is associated with oligohydramnios.

The contraction stress test is interpreted by the presence or absence of late fetal heart rate decelerations, which are defined as decelerations that reach their nadir after the peak of the contraction and that usually persist beyond the end of the contraction. The results of the contraction stress test are categorized in the ACOG bulletin as follows:

Negative . No late or significant variable decelerations.

Positive . Late decelerations following 50 percent or more of contractions (even if the contraction frequency is fewer than three in 10 minutes).

Equivocal - suspicious . Intermittent late decelerations or significant variable decelerations.

Equivocal - hyperstimulatory . Fetal heart rate decelerations that occur in the presence of contractions that are more frequent than every two minutes or last longer than 90 seconds.

Unsatisfactory . Fewer than three contractions in 10 minutes or a tracing that is not interpretable.

Relative contraindications to the contraction stress test usually include conditions that are associated with an increased risk of preterm labor and delivery, uterine rupture or uterine bleeding. According to ACOG, these conditions include the following:

Preterm labor or certain patients at high risk of preterm labor.

Preterm membrane rupture.

History of extensive uterine surgery or classic cesarean delivery.

Known placenta previa.

NONSTRESS TEST

In the nonstress test, the heart rate of the fetus that is not acidotic or neurologically depressed will temporarily accelerate with fetal movement. Heart rate reactivity is believed to be a good indicator of normal fetal autonomic function. Loss of reactivity is commonly associated with a fetal sleep cycle but may result from any cause of central nervous system depression, including fetal acidosis.

Results of nonstress tests are classified as reactive or nonreactive. Various definitions of reactivity have been used. Most commonly, the nonstress test is considered reactive, or normal, if there are two or more fetal heart rate accelerations within a 20-minute period, with or without fetal movement discernible by the woman, according to ACOG. The nonreactive stress test lacks sufficient fetal heart rate accelerations over a 40-minute period. The nonstress test of the neurologically healthy preterm fetus is frequently nonreactive—from 24 to 28 weeks of gestation, up to 50 percent of nonstress tests may not be reactive, and from 28 to 32 weeks of gestation, 15 percent of nonstress tests are not reactive.

BIOPHYSICAL PROFILE

The biophysical profile discussed in the ACOG bulletin is a nonstress test plus four observations made by real-time ultrasonography. The five components of the biophysical profile are as follows: (1) nonstress test; (2) fetal breathing movements (one or more episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes); (3) fetal movement (three or more discrete body or limb movements within 30 minutes); (4) fetal tone (one or more episodes of extension of a fetal extremity with return to flexion, or opening or closing of a hand; and (5) determination of the amniotic fluid volume (a single vertical pocket of amniotic fluid exceeding 2 cm is considered evidence of adequate amniotic fluid).

Each of the components is given a score of 2 (normal or present as defined previously) or 0 (abnormal, absent or insufficient). A composite score of 8 or 10 is normal, a score of 6 is equivocal and a score of 4 or less is abnormal. In the presence of oligohydramnios, further evaluation is warranted regardless of the composite score.

MODIFIED BIOPHYSICAL PROFILE

During the late second or third trimester, amniotic fluid reflects fetal urine production. Placental dysfunction may cause diminished fetal renal perfusion, which can lead to oligohydramnios. Therefore, assessment of amniotic fluid volume can be used to evaluate long-term uteroplacental function. This led to the development of the modified biophysical profile.

The modified biophysical profile combines the non-stress test with the amniotic fluid index, which is the sum of measurements of the deepest cord-free amniotic fluid pocket in each of the abdominal quadrants, as an indicator of long-term function of the placenta. An amniotic fluid index of more than 5 cm is thought to be an adequate volume of amniotic fluid. The modified biophysical profile is considered normal if the nonstress test is reactive and the amniotic fluid index is greater than 5 cm and abnormal if the nonstress test is nonreactive or the amniotic fluid index is 5 cm or less.

UMBILICAL ARTERY DOPPLER VELOCIMETRY

Doppler ultrasonography is used to assess the hemodynamic components of vascular impedence. Umbilical artery Doppler flow velocimetry has been adapted as a fetal surveillance technique because it is believed that flow velocity waveforms in the umbilical artery of fetuses with normal growth differ from those of fetuses with growth restriction. The umbilical flow velocity waveform of a normally growing fetus has high-velocity diastolic flow, while in cases of intrauterine growth restriction, the umbilical artery diastolic flow is diminished. With extreme intrauterine growth restriction, the flow may be absent or even reversed. There is a high perinatal mortality rate among such pregnancies.

Indications for Antepartum Fetal Surveillance

The results of antepartum fetal surveillance have not definitively demonstrated improved perinatal outcome. Therefore, all indications for antepartum testing should be considered somewhat relative. Usually, antepartum fetal surveillance is used in pregnancies with a high risk of antepartum fetal death. Some of the conditions in which testing is appropriate include the following:

Maternal conditions: antiphospholipid syndrome, poorly controlled hyperthyroidism, hemoglobinopathies such as hemoglobin SS, SC or S-thalassemia, cyanotic heart disease, systemic lupus erythematosus, chronic renal disease, type 1 diabetes mellitus and hypertensive disorders.

Pregnancy-related conditions : pregnancy-induced hypertension, decreased fetal movement, oligohydramnios, polyhydramnios, intrauterine growth restriction, post-term pregnancy, moderate to severe isoimmunization, previous fetal demise (unexplained or recurrent risk) and multiple gestation with significant growth discrepancy.

Recommendations

The following ACOG recommendations are based on limited or inconsistent scientific evidence (Level B):

Women at high risk for stillbirth should undergo antepartum fetal surveillance using the nonstress test, contraction stress test, biophysical profile or modified biophysical profile.

Initiation of testing at 32 to 34 weeks of gestation is appropriate for most pregnancies that are at increased risk of stillbirth. In pregnancies with multiple or particularly worrisome high-risk conditions, testing may be initiated as early as 26 to 28 weeks of gestation.

When the clinical condition that prompted testing persists, a reassuring test should be repeated weekly or, depending on the test used and the presence of certain high-risk conditions, twice weekly until delivery. Any significant deterioration in fetal activity requires fetal reevaluation, regardless of the amount of time that has elapsed since the last test.

An abnormal nonstress test or modified biophysical profile usually should be further evaluated by a contraction stress test or a full biophysical profile. Subsequent management should then be predicated on the results of the contraction stress test or biophysical profile, the gestational age, the degree of oligohydramnios (if assessed) and the maternal condition.

Oligohydramnios, defined as no ultrasonographically measurable vertical pocket of amniotic fluid greater than 2 cm or an amniotic fluid index of 5 cm or less, requires (depending on the degree of oligohydramnios, the gestational age and the maternal clinical condition) delivery, or close maternal or fetal surveillance.

In the absence of obstetric contraindications, delivery of the fetus with an abnormal test result often may be attempted by induction of labor with continuous monitoring of the fetal heart rate and contractions. If repetitive late decelerations are observed, cesarean delivery generally is indicated.

Recent, normal antepartum fetal test results should not preclude the use of intrapartum fetal monitoring.

Umbilical artery Doppler velocimetry seems to benefit only pregnancies complicated by intrauterine growth restriction. If used in this setting, decisions regarding timing of delivery should be made using a combination of information from the Doppler ultrasonography and other tests of fetal well-being, along with careful monitoring of maternal status.

Middle cerebral artery Doppler velocimetry should be considered an investigational approach to antepartum fetal surveillance.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide .

Continue Reading

Pregnancy Stages: What to Know about Antenatal, Intrapartum & Postpartum

As a leading birth trauma lawyer in Ontario, Sommers, Roth, and Elmaleh work with clients across the province, ensuring medical professionals are held accountable during the pregnancy and delivery. Our job is to ensure that any malpractice cases , especially those resulting in the harm of a child, be brought to justice.

Throughout pregnancy, there are various aspects of medical care put to the test. Each stage is essential to guarantee a safe and healthy delivery when the time comes and protect the mother and child after the delivery. These stages of pregnancy are known as:

This is the care you receive before giving birth to your baby. It includes pregnancy exams, tests, and other pregnancy-related healthcare.

Intrapartum

Intrapartum is the portion of pregnancy that occurs during labour. It begins as labour begins and ends following the third stage of labour.

As the name suggests, postpartum occurs after the birth of the baby. This stage of pregnancy is just as important as the others, despite the heavy ordeal of giving birth being completed.

Here, we will delve deeper into each of these categories and what they mean for healthcare professionals, smothers, and children.

What is the Role of Your OB/GYN During Antenatal Pregnancy?

Within the realm of pregnancy and birth, it is crucial to understand the stages you go through and your physician’s role or OB/GYN throughout each process. This helps your doctor maintain control and develop alterations to your birth plan as needed.

During the antepartum phase of pregnancy, you will require many regular tests to monitor your child’s development, as well as your health. Checking temperature, heart rate, blood pressure, blood sugar levels, and weight at each appointment is common practice. Along with these standard protocols, your OB/GYN should perform additional antenatal testing, such as:

Antepartum fetal testing, also known as a biophysical profile or BPP test, occurs after 20-weeks of pregnancy. It involves checking the baby’s heart rate, breathing, and muscle tone through electronic monitoring and ultrasound.

A Chorionic Villus Sampling is taken around 10-12 weeks of pregnancy to check for genetic abnormalities and chromosomal defects in the fetus.

An ultrasound allows your physician to see your baby through the power of sonography. The high-frequency sounds are not audible by humans but provide a picture of your uterus through an echo. Most Canadian women will have a pregnancy ultrasound performed at 11-14 weeks for dating purposes and 18-20 weeks to check anatomy.

Between 15-20 weeks, your doctor may perform an amniocentesis. This test removes some amniotic fluid through a large syringe from inside your uterus. The fluid tells your doctor more information about your child’s development, including in-depth data regarding genetic defects and abnormalities. There are higher risks with amniocentesis testing than with other forms of antenatal testing because the uterus is breached, and there is a chance of leakage and infection.

Percutaneous Umbilical Cord Blood Sampling, also known as Cordocentesis, or a PUBS test, is another antenatal test performed to identify potential abnormalities or health concerns in a fetus . The test requires a blood sample from the umbilical cord.

What is the role of your OB/GYN during intrapartum pregnancy?

The intrapartum portion of pregnancy can be daunting for most women as it requires a great deal of physical effort, discomfort, and pain. It is also a dangerous time for both mother and child if an OB/GYN and attending nursing staff are not prepared and diligent. Some of the duties required of a doctor during Intrapartum pregnancy are:

Labour induction

Not all women will be induced into labour, but sometimes, delivery requires a helping hand due to late delivery, gestational diabetes, child growth rates, and other reasons. Induction involves stimulating the uterus into contractions by pressure against the cervix, opening the amniotic sac, or hormonal enhancement. This causes labour to begin when it does not start naturally.

Continuous monitoring

No two pregnancies are exactly alike. A woman giving birth to her second child, for example, may have a completely different experience than she did with her first. Therefore, medical professionals must monitor intrapartum pregnancy for signs of concern.

Episiotomy and stitching

During birth, the vaginal tissue sometimes tears to allow the baby to leave the birth canal. Not all women tear; some need a cut to widen the vagina and avoid rupture during birth. Whether by cut or tear, your doctor then stitches the wound to ensure the tissue’s safe and healthy healing following childbirth.

Along with these procedures, your doctor may also be required to deliver your baby through a method other than natural delivery. These methods include:

Cesarean delivery

Cesarean delivery or a C-section is used both as a method of planned delivery and emergency delivery. It requires incisions to be made in the lower abdomen and uterus to remove the baby surgically rather than vaginally.

Breech delivery

Babies are naturally born head first. In some cases where a baby will not be born head first, a Cesarean may be used for safe delivery. In other cases, the baby may be born breech, which means the feet or bottom are delivered first. This is not a safe position for the baby and has a higher risk of complications.

What is the role of Your OB/GYN during postpartum pregnancy?

Following a natural vagina birth or a cesarean delivery, your doctor should monitor you for postpartum complications. This includes any abnormal bleeding, infection, pain, and psychological issues.

Your physician may prescribe medicine for pain and swelling and hospitalize you for a day or more to ensure you are well enough to care for your child. If you have undergone surgery, your hospital stay will be longer, and your follow-up care stricter.

Your baby should also be monitored for breathing, heart rate, passing waste, eating, and drinking. Your baby will also require cleaning, weighing, and a series of vaccinations and bloodwork. If breastfeeding, a lactation specialist may visit, and a nurse may check-in to ensure you can feed your baby as needed, whether on schedule or by demand.

Contacting a Birth Trauma Lawyer

If you feel that any of the care you have received in these pregnancy stages has been sub-par, negligent, or resulted in health issues for you or your child, you should contact a birth trauma lawyer as soon as possible. A birth trauma lawyer will work closely with you and your family to help you heal and cover costs caused by medical negligence during birth.

For more information about the different pregnancy states, call Sommers, Roth and Elmaleh at 1-844-777-7372 or contact us here .

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Packers Host ‘Monster’ Receiver for NFL Predraft Visit

The Green Bay Packers are loaded at receiver. That doesn’t mean they aren’t looking to upgrade even further.

Author: Bill Huber

In this story:

GREEN BAY, Wis. – The Green Bay Packers have one of the youngest, deepest and best receiver corps in the NFL. On any list of NFL Draft needs, receiver would rank toward the bottom.

That doesn’t mean the Packers aren’t looking to get even stronger. According to The Draft Network’s Justin Melo , they hosted South Carolina star Xavier Legette on a predraft visit.

Who Is Xavier Legette?

Legette was one of the nation’s breakout stars in 2023. After catching 42 passes during his first four seasons, Legette dominated with 71 receptions for 1,255 yards and seven touchdowns in 2023.

In the transfer-portal era, Clemson coach Dabo Swinney hated going against Legette but appreciated his story.

“Seventeen, he's a superstar,” Swinney said.

“The intensity of recruiting, and everybody knows everything, and talks about everything, and evaluates and scrutinizes everything – if kids aren't great players as freshmen, they stink. It’s such a bad mindset. … You get so scrutinized in today's world, it's a lot of pressure on these kids. A lot of them, they hit a wall and it stunts their development, I think. Or, ‘Oh, I gotta go, I gotta leave,’ and the mirror goes with them. It's really the man in the mirror. So I think (Legette is) a great example of development. … Here’s this senior that’s a monster.”

Legette averaged a robust 17.7 yards per catch, due in large part to his run-after-catch prowess. Plus, Pro Football Focus charged him with only two drops.

“I put in a lot of work during the summer,” he told The Draft Network during the season. “After every catch, before I finish every workout, I finish the play by running into the end zone. Every ball that I catch during a workout gets taken into the end zone. I burst in for a touchdown.

“All I want is touchdowns (laughs). I don’t have as many of them this season as I’d like to (laughs). I don’t have as many as I should. I’m always trying to score a touchdown. If I can get that YAC [yards after catch], I’m getting that YAC.”

How Would Xavier Legette Fit With Packers?

At 6-foot-1 and 221 pounds – those are running back dimensions – Legette would add a new dynamic to the receiver corps. And yet, he’s got 4.39 speed. So, he’s got the power to run through tackles and the speed to run away from defenders.

As Daniel Jeremiah said at NFL.com : “Legette is a thick, muscled-up receiver with impressive top speed and toughness. … He has reliable hands, and he has a nice blend of speed and toughness after the catch. He plays much faster with the ball in his hands. Overall, Legette doesn’t offer a full complement of routes, but he can do damage with his select few.”

The Packers’ passing game emerged as one of the best in the league last season but Jordan Love ranked only 19th in yards after the catch per catch. Legette could change that dynamic.

“I’ve had that mentality ever since I was a little kid,” he told Melo recently . “Ever since I’ve been playing football, I’ve been the same way and had the same approach. Growing up playing the way we did in South Carolina, you had to be tough and physical from a young age. The first man can’t tackle you. You need to have that mentality. I’ve carried that with me throughout my career.”

What Is Xavier Legette’s NFL Draft Projection?

Legette is viewed as a borderline Top 50 pick. The Packers have made a living with their second-round receivers, dating to Greg Jennings, Jordy Nelson and Randall Cobb and continuing with Jayden Reed in last year’s draft.

“My name has continued to buzz, I don’t know how the draft is going to go,” he told Panthers Wire . “They had me going late third round, now they’re telling me I could go No. 15 to 32, or even early second round.”

He added: “I look to be a big-time, big-name player in the league,” Legette said. “I can run with anybody. The big names that they’re already screaming. I want them to be screaming my name just like that.”

Xavier Legette

Jeff Blake-USA TODAY Sports

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Rep. Marjorie Taylor Greene says Speaker Mike Johnson should resign as Democrats signal potential support

Rep. Marjorie Taylor Greene maintained Sunday that she plans to follow through with an effort to oust House Speaker Mike Johnson if he doesn’t resign after the House passed a $95 billion package that includes foreign aid for Ukraine.

“Mike Johnson’s leadership is over. He needs to do the right thing to resign and allow us to move forward in a controlled process,” Greene, R-Ga., said in an interview on Fox News’ "Sunday Morning Futures." “If he doesn’t do so, he will be vacated.”

Asked whether she plans to move forward with her motion to vacate Johnson’s speakership, she said, “It’s coming regardless of what Mike Johnson decides to do."

Reached for comment about the House's changing posture toward a motion to vacate, office directed NBC News to recent remarks from Johnson, R-La., which included his saying Saturday that he doesn't walk around the Capitol "being worried about a motion to vacate."

"I have to do my job. We did. I’ve done here what I believe to be the right thing, and that is to allow the House to work its will," he t old reporters Saturday. "And as I’ve said, you do the right thing and you let the chips fall where they may, and I’ll continue to do that.”

Johnson faces backlash from hard-right members of his party after he joined Democrats on Saturday to pass a critical foreign aid package that included $60.8 billion of aid for Ukraine. Republican Reps. Paul Gosar of Arizona and Thomas Massie of Kentucky have signed on to the motion to vacate, which Greene authored but hasn't yet brought to the floor as a privileged resolution.

If the motion is brought to the floor, the three Republican votes supporting it could be enough for passage if they are joined by all Democrats in the chamber. But some House Democrats have signaled that they plan to vote to save Johnson.

Rep. Jared Moskowitz, D-Fla., a moderate who is on the Foreign Affairs Committee, blasted Greene’s effort to oust Johnson on Sunday when he was asked about her criticism of the foreign aid package.

“What Marjorie Taylor Greene and what Thomas Massie and what Paul Gosar are trying to accomplish by removing the speaker of the House in this very moment after Oct. 7 would only embolden China, it would only embolden Russia, [and] it would only embolden Iran,” Moskowitz said on "Fox News Sunday."

Rep. Ro Khanna, D-Calif., a progressive who is a member of the Armed Services Committee, said Sunday he would protect Johnson’s job if members of his far-right flank go through with their threat to oust him.

“I’m a progressive Democrat, and I think you would have a few progressive Democrats doing that. And I disagree with Speaker Johnson on many issues, and I’ve been very critical of him, but he did the right thing here,” Khanna said in an interview on ABC News’ “This Week,” referring to Johnson’s bringing the foreign aid package to the floor. “And he deserves to keep his job till the end of this term.”

The shift from Democrats is noteworthy given their lockstep support of the motion to vacate that led to the ouster of Speaker Kevin McCarthy, R-Calif., in October, which ultimately resulted in Johnson’s getting the gavel. Members tried to remove speakers in previous congressional terms, but no motion ever reached the floor for a vote.

Summer Concepcion is a politics reporter for NBC News.

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Antepartum Care
Antepartum care, also referred to as prenatal care, consists of the all-encompassing management of patients throughout their pregnancy course. Antepartum care has become the most frequently utilized healthcare service within the United States, averaging greater than 50 million visits annually. After the first positive pregnancy test, care is typically sought by patients and begun after ...
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Antepartum care, also known as prenatal care, is an essential aspect of healthcare for pregnant individuals. Regular prenatal care can help promote a healthy pregnancy and reduce the risk of complications for both the mother and the baby. In this article, we will discuss the importance, components, and benefits of antepartum care. Importance:
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When assessing a patient presenting for an initial first trimester antepartum care visit, meaning an initial visit through 13 and 6/7 weeks gestation, your first step is to obtain a focused history and physical exam. History may reveal common first trimester symptoms, such as nausea, vomiting, breast pain, fatigue, cramping, and bleeding.
Antepartum Care
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antepartum: [ an″te-pahr´tum ] occurring before childbirth , with reference to the mother. Spelled also ante partum. Called also antepartal and prepartal . antepartum/postpartum before or after childbirth ; in the problem classification scheme of the omaha system this is defined as a client problem in the physiologic domain .
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