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# Prenatal care: the nursing visit and warning signs

- Fundamental

Prenatal care starts before week 10, follows the pregnant woman month by month and teaches the warning signs that need care right away.

Updated Nov 5, 2026

## Key points

- Early enrolment: after the first missed period and before week 10.
- At least 10 visits for a first pregnancy and 7 for a woman who has given birth before; monthly until week 36, then every 15 days until week 40.
- The visits at weeks 36, 38 and 40 are done by a doctor.
- Warning signs: headache, changes in vision or hearing, epigastric pain, swelling, bleeding, leaking fluid, contractions, fewer fetal movements, urinary symptoms and cough.
- Blood pressure of 140/90 or more on two readings at least 4 hours apart after week 20, or 160/110 on a single reading: hospital referral.

## What it is

Prenatal care monitors the pregnancy to detect risks and complications early, plan the birth and prepare the family. In Colombia, the Comprehensive Maternal and Perinatal Care Pathway (Resolution 3280 of 2018) states that low-risk visits are done by a doctor or a nurse, with immediate referral to the doctor if the nurse finds a risk factor. The visits of the last month are done by a doctor.

## Key points

- WHO recommends at least eight antenatal contacts, the first within the first 12 weeks.
- WHO recommends one ultrasound scan before 24 weeks.
- At every visit: blood pressure, weight, fundal height, fetal heart rate and, from week 36, fetal lie and presentation.
- At the first visit, ask direct questions about violence and screen for the risk of postpartum depression.
- The main causes of maternal death are bleeding, infection, high blood pressure in pregnancy, delivery complications and unsafe abortion; most are preventable.

## Components

- History: personal, gynaecological, obstetric and family history, and the current pregnancy.
- Psychosocial assessment: support networks, violence, alcohol and substance use, barriers to access.
- Full physical exam with vital signs, weight, height and body mass index.
- Tests in the pathway's protocol, vaccination per the current schedule and a birth plan.

## What it is for

- Identify pregnant women at risk early and refer them.
- Teach the woman and her companion the warning signs.
- Prepare for the birth: place, institution and what to do in an emergency.

## Step by step

- Identify the woman and confirm the gestational age — it guides what to assess at each visit.
- Ask about warning symptoms and fetal movements — detects complications between visits.
- Measure blood pressure with correct technique — hypertension in pregnancy is a leading cause of maternal death.
- Record the weight and the gain on the chart — inadequate gain needs specialised follow-up.
- Measure fundal height and listen to the fetal heart rate — tracks fetal growth and wellbeing.
- Ask about violence, mood and substance use — these risks do not show on examination.
- Review tests and vaccination, and refer if findings are abnormal — the plan depends on the risk.
- Teach the warning signs and the course of preparation for parenthood — the woman decides when to seek care.

## In nursing practice

- If the nurse finds a risk factor in the history, the exam or the tests, the woman is referred at once for medical assessment.
- A woman who arrives late is not turned away: at a late first visit, the missed activities are done too.
- Ask about language or access barriers; she may need a maternity waiting home or an intercultural interpreter.
- Vaccination in pregnancy follows the current PAI schedule.

## Common mistakes

- Measuring blood pressure with the wrong cuff or without rest.
- Not asking about fetal movements at every visit.
- Giving the warning signs only at the first visit: they are repeated at every visit.
- Not recording the referral or not confirming that the woman reached the medical assessment.

## Test yourself

Think of the answer, then tap the question to see it.

## When should a pregnant woman be enrolled in prenatal care in Colombia?

After the first missed period and before week 10 of pregnancy.

## What minimum number of prenatal visits does Resolution 3280 set for a normal pregnancy?

At least 10 in a first pregnancy and 7 otherwise, monthly until week 36 and then every 15 days until week 40.

## Which blood pressure requires referral of a pregnant woman after week 20?

140/90 or more on two readings at least 4 hours apart, or 160/110 or more on a single reading.

## How many antenatal contacts does WHO recommend?

At least eight, with the first in the first 12 weeks of pregnancy.

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## Connections

## Related 2

- [Labour and postpartum nursing: monitoring and warning signs](https://durgical.com/en/nursing/labour-and-postpartum-nursing-monitoring-and-warning-signs/)
- [Giving vaccines safely and Colombia's PAI schedule](https://durgical.com/en/nursing/giving-vaccines-safely-and-colombia-s-pai-schedule/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta Integral de Atención para la Promoción y Mantenimiento de la Salud y de la Ruta Integral de Atención en Salud para la Población Materno Perinatal](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-3280-de-2018.pdf) (Ministerio de Salud y Protección Social de Colombia, 2018); [New guidelines on antenatal care for a positive pregnancy experience](https://www.who.int/news/item/07-11-2016-new-guidelines-on-antenatal-care-for-a-positive-pregnancy-experience) (World Health Organization, 2016); [Maternal mortality (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/maternal-mortality) (World Health Organization, 2025).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/prenatal-care-the-nursing-visit-and-warning-signs/