Prenatal care: what each visit checks and which signs can't wait
NCLEX-RN topic: Ante-, intra-, postpartum and newborn care
- Visits: monthly to 28 weeks, every 2 weeks to 36, then weekly.
- The expected fetal heart rate is 110–160/min.
- Due date: LMP minus 3 months, plus 7 days, then adjust the year.
- Screen for gestational diabetes at 24–28 weeks, group B strep at 36–38.
- Face or hand swelling, lasting headache, vision changes or bleeding: get care now.
Key facts
- Expected fetal heart rate at prenatal visits is 110 to 160 beats per minute.
- Naegele's rule: first day of the last menstrual period minus 3 months, plus 7 days, then adjust the year.
- From about 16–18 weeks until 36 weeks, fundal height in centimeters roughly equals the weeks of gestation; at 20 weeks the fundus is at or just below the umbilicus.
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- All pregnant clients are screened for gestational diabetes at 24–28 weeks; the 1-hour glucose challenge test does not require fasting.
- An Rh-negative client with a negative antibody screen receives Rho(D) immune globulin at about 28 weeks, after any bleeding episode and after birth.
- Group B strep is screened at 36–38 weeks; a positive client gets IV antibiotics during labor, not before.
- Kick counts: at least 10 fetal movements within 2 hours; fewer, or a sudden drop in activity, means calling the provider right away.
Quick check1 question · 2 more at the end
At her first prenatal visit, a client reports that the first day of her last menstrual period was June 24, 2026. Her cycles are regular, every 28 days. Using Naegele's rule, which date will the nurse record as the estimated date of delivery?
Correct answer: C.
Naegele's rule has three steps: subtract 3 months from the first day of the last menstrual period, add 7 days, then adjust the year. June 24 minus 3 months is March 24; adding 7 days gives March 31; because the date has moved into the next calendar year, the EDD is March 31, 2027. The rule assumes a 28-day cycle and the date is plus or minus 2 weeks.
A This applies the month and day steps correctly but skips the final step of adjusting the year.
B This subtracts 7 days instead of adding them.
C Correct: June 24 minus 3 months is March 24, plus 7 days is March 31, and the year advances to 2027.
D This subtracts 3 months and adjusts the year but leaves out the 7 days.
Full lesson
Each part starts with its main idea. Open a part when you want the details.
The short answer: Prenatal visits check weight, blood pressure, urine protein and glucose, fetal heart rate (110–160/min) and fundal height. Visits are monthly until about 28 weeks, every 2 weeks until 36 weeks, then weekly. Teach the client to get care immediately for a headache that won't go away, vision changes, face or hand swelling, bleeding, leaking fluid, fever or less fetal movement.
1 What happens at a routine prenatal visit?Every prenatal visit repeats the same short set of checks so small changes stand out early. 1 min
Every prenatal visit repeats the same short set of checks so small changes stand out early. The nurse weighs the client, takes the blood pressure and dipsticks a urine sample for protein, glucose, ketones, blood and nitrites. The nurse also listens to the fetal heart rate (expected 110–160/min), asks about fetal movement and, from about 12 weeks, checks the height of the uterus.
A healthy pregnancy is seen monthly until about 28 weeks, every 2 weeks until 36 weeks, then weekly. The first visit is typically scheduled at about 8 weeks.
2 How do you calculate the due date with Naegele's rule?Naegele's rule turns the first day of the last menstrual period (LMP) into an estimated date of delivery (EDD) in three steps. 1 min
Naegele's rule turns the first day of the last menstrual period (LMP) into an estimated date of delivery (EDD) in three steps. Subtract 3 months, add 7 days, then adjust the year. It assumes a 28-day cycle, and the EDD is plus or minus 2 weeks.
Example: LMP March 10, 2026, minus 3 months is December 10, plus 7 days is December 17, so the EDD is December 17, 2026.
3 How do you read fundal height?Fundal height is a tape-measure check of fetal growth from the symphysis pubis to the top of the uterus (the fundus). 1 min
Fundal height is a tape-measure check of fetal growth from the symphysis pubis to the top of the uterus (the fundus). The fundus is near the symphysis at 12 weeks, halfway to the umbilicus at 16 weeks, and at or just below the umbilicus at 20 weeks.
From about 16–18 weeks until 36 weeks, centimeters roughly equal weeks of gestation. After 36 weeks this stops matching as the fetus descends into the pelvis.
4 Which screenings happen at which week?Routine tests are timed so their results arrive while they can still change care. 1 min
Routine tests are timed so their results arrive while they can still change care.
- First visit: blood type, Rh and antibody screen, complete blood count, urine testing.
- 24–28 weeks: gestational diabetes screen, usually a 1-hour glucose challenge test (50 g drink, no fasting needed).
- About 28 weeks, Rh-negative clients: repeat antibody screen; if negative, give Rho(D) immune globulin. It is also given after any bleeding episode and after birth.
- 36 to 38 weeks: vaginal-rectal swab for group B strep (older texts say 35–37 weeks); a positive client gets IV antibiotics during labor.
5 Which warning signs need care right away?" The CDC urges immediate medical care for these signs. 1 min
Teach every pregnant client that some symptoms mean "get care now," not "mention it at the next visit." The CDC urges immediate medical care for these signs.
| Sign the client reports | What it may point to |
|---|---|
| Headache that won't go away, vision changes, swelling of face or hands | Hypertensive disorder such as preeclampsia |
| Vaginal bleeding | Miscarriage, placenta previa or placental abruption |
| Fluid leaking from the vagina | Rupture of membranes |
| Baby moving less or not at all | Fetal stress |
| Fever of 100.4°F (38°C) or higher | Infection |
| Ongoing epigastric pain | Preeclampsia, HELLP syndrome, liver or gallbladder disease |
Some swelling of the feet and ankles is normal in pregnancy. A blood pressure of 140/90 mm Hg or higher before 20 weeks suggests preexisting hypertension. A raised pressure or protein in the urine after 20 weeks suggests possible preeclampsia.
6 How should a client do kick counts?Daily fetal movement counts in the third trimester are a simple home check of fetal well-being. 1 min
Daily fetal movement counts in the third trimester are a simple home check of fetal well-being. The client counts when the baby is usually active, or after a meal, lying on her side or sitting comfortably. She should feel at least 10 movements within 2 hours.
If there is no movement within an hour, she eats or drinks something, lies on her left side or walks for 5 minutes, then keeps counting. Fewer than 10 movements in 2 hours, or a sudden drop in activity, means calling the provider right away.
7 What the nurse doesThe nurse compares every visit with the client's own baseline and acts on change. 1 min
The nurse compares every visit with the client's own baseline and acts on change.
- Assess: blood pressure against baseline, urine protein, fetal heart rate, fundal height and symptoms.
- Act: report a raised blood pressure, new warning symptoms or a fetal heart rate outside 110–160/min right away.
- Teach: warning signs, kick counts and when each screening is due.
Common mistakes
The traps students fall into most. Read these before you practice.
Watch out: Swelling of the face, hands or around the eyes is a warning sign, not the normal end-of-day ankle swelling of pregnancy.
Watch out: A blood pressure of 140/90 or higher found before 20 weeks points to preexisting hypertension, not preeclampsia.
Watch out: Cramping with bleeding before 20 weeks suggests possible miscarriage; after 20 weeks the same signs suggest preterm labor.
Watch out: Group B strep found at 36 weeks is treated in labor, not right away, because the bacteria can come back before birth.
Watch out: After 36 weeks fundal height no longer matches the weeks of gestation, because the fetus is descending into the pelvis.
How to remember it
One rhyme and one body map cover this lesson. Memory hook: "Monthly, then every two, then every week until baby's due." For warning signs, think head, eyes, hands, belly, bleeding, baby.
Self-check:
- Calculate the EDD for an LMP of August 20.
- Name the week range for the gestational diabetes screen and for the group B strep swab.
- Explain why face swelling at 32 weeks is a concern but ankle swelling at the end of the day usually is not.
Show answers
- May 27 of the next year.
- Start with the first day of the LMP: August 20.
- Subtract 3 months: May 20.
- Add 7 days: May 27.
- Adjust the year: the EDD falls in the next calendar year. An LMP of August 20, 2026 gives an EDD of May 27, 2027.
- 24–28 weeks and 36–38 weeks.
- The gestational diabetes screen is done at 24–28 weeks.
- The group B strep swab is done at 36 to 38 weeks.
- Face swelling can be a sign of preeclampsia; end-of-day ankle swelling is common.
- Swelling of the face or hands is on the list of signs that need care right away.
- At 32 weeks the client is past 20 weeks, when preeclampsia becomes the concern.
- Some swelling of the feet and ankles is normal in pregnancy.