Current prenatal care with reference to state of the art knowledge

: Every physician taking care of pregnant women believes to be well acquainted with the state-of-the-art requirements. However, changes imposed by the new Swiss health insurance legislation (KVG) and by the pressure of Evidence Based Medicine brought these into a new scope. In Switzerland there is no general agreement on optimal pregnancy-care. We propose a care-standard, based on rational and efficient clinical, laboratory and sonographic checks, which allow a timely diagnosis of pregnancy-at-risk. Targeted laboratory investigations as well as the anti-D-immunoprophylaxis, and screening for diabetes mellitus efficiently help to avoid long-term sequelae for mother and child. Screening for toxoplasmosis, HIV, and hepatitis B are compulsory. A vaginal pH below 4.5 prevents premature birth. Diagnosis and treatment of vaginal chlamydial and candida infection are also very important in this respect. The number of sonographies to be performed during pregnancy is a highly political issue, and we have to comply with our dirigistic governmental regulations. However, sonography including search for increased nuchal translucency done early in pregnancy is a key procedure for quality assurance. Supplementation of folic acid started before conception, almost entirely prevents neural tube defects. Hence women need appropriate advice before conception. A new information brochure is available for future parents in Switzerland, and makes all former self-made guidelines unnecessary. UNICEF declared 1998 as the year of safe motherhood. Worldwide still too many women die from pregnancy and delivery. Care for normal pregnancy, and not only for at-risk-pregnancy will therefore continue to make sense.