Prenatal Assessment & Routine Care

A pregnant client at 28 weeks has her fundal height measured at 34 cm. Before you assume twins, you need to know what's normal at each visit — and what triggers further workup.

Routine prenatal assessment follows a predictable visit schedule: every 4 weeks through 28 weeks, every 2 weeks from 28–36 weeks, then weekly until delivery. Each visit includes weight, blood pressure, urine dipstick (protein and glucose), fundal height, fetal heart tones (FHTs), and fetal presentation (after 36 weeks via Leopold maneuvers). Fundal height in centimeters should approximate gestational age in weeks (±2 cm) between 20 and 36 weeks — a discrepancy of more than 2 cm warrants ultrasound to evaluate for growth restriction, macrosomia, polyhydramnios, or dating error. FHTs are auscultated with a Doppler starting at 10–12 weeks; normal range is 110–160 bpm. Quickening (maternal perception of fetal movement) typically occurs at 16–20 weeks for primigravidas, 14–16 weeks for multigravidas. Edema of the hands and face is abnormal and warrants blood pressure and proteinuria evaluation, while dependent ankle edema alone is a common physiologic finding. Each visit is an opportunity to assess for warning signs: vaginal bleeding, persistent headache, visual changes, epigastric pain, decreased fetal movement, and signs of preterm labor.

Key Distinctions

Don't confuse fundal height discrepancy (>2 cm off from gestational age) with normal variation — it always requires follow-up imaging. Students mix up when FHTs are first heard by Doppler (10–12 weeks) versus fetoscope (18–20 weeks). Ankle edema is physiologic; hand or facial edema is a red flag requiring preeclampsia workup — don't normalize all swelling in pregnancy.

Clinical Pearl

Fundal height = gestational age ± 2 cm. Think of it as a built-in ruler — when the ruler is off, the picture (ultrasound) comes next.