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Abstract：
The coronavirus disease 2019 pandemic led to some of the most drastic changes in clinical care delivery ever seen in the United States. Almost overnight, providers of prenatal care adopted virtual visits and reduced visit schedules. These changes stood in stark contrast to the 12 to 14 in-person prenatal visit schedule that had been previously recommended for almost a century. As maternity care providers consider what prenatal care delivery changes we should maintain following the acute pandemic, we may gain insight from understanding the evolution of prenatal care delivery guidelines. In this paper, we start by sketching out the relatively unstructured beginnings of prenatal care in the 19th century. Most medical care fell within the domain of laypeople, and childbirth was a central feature of female domestic culture. We explore how early discoveries about \"toxemia\" created the groundwork for future prenatal care interventions, including screening of urine and blood pressure-which in turn created a need for routine prenatal care visits. We then discuss the organization of the medical profession, including the field of obstetrics and gynecology. In the early 20th century, new data increasingly revealed high rates of both infant and maternal mortalities, leading to a greater emphasis on prenatal care. These discoveries culminated in the first codification of a prenatal visit schedule in 1930 by the Children\'s Bureau. Surprisingly, this schedule remained essentially unchanged for almost a century. Through the founding of the American College of Obstetricians and Gynecologists, significant technological advancements in laboratory testing and ultrasonography, and calls of the National Institutes of Health Task Force for changes in prenatal care delivery in 1989, prenatal care recommendations continued to be the same as they had been in 1930-monthly visits until 28 weeks\' gestation, bimonthly visits until 36 weeks\' gestation, and weekly visits until delivery. However, coronavirus disease 2019 forced us to change, to reconsider both the need for in-person visits and frequency of visits. Currently, as we transition from the acute pandemic, we should consider how to use what we have learned in this unprecedented time to shape future prenatal care. Lessons from a century of prenatal care provide valuable insights to inform the next generation of prenatal care delivery.
摘要：
2019年冠状病毒病的大流行导致了美国有史以来最剧烈的临床护理服务变化。几乎一夜之间，产前护理提供者采用虚拟访问和减少访问时间表。这些变化与以前建议近一个世纪的12至14人的产前检查时间表形成鲜明对比。随着产妇护理提供者考虑在急性大流行后我们应该保持的产前护理分娩变化，我们可以从了解产前护理分娩指南的演变过程中获得洞察力.在本文中,我们首先勾勒出19世纪产前护理的相对非结构化的开端。大多数医疗保健属于外行人的范畴，分娩是女性家庭文化的主要特征。我们探讨了关于“毒血症”的早期发现如何为未来的产前护理干预奠定基础，包括尿液和血压的筛查，这反过来又需要进行常规的产前护理。然后我们讨论医疗行业的组织，包括妇产科。在20世纪初,新数据越来越多地显示婴儿和产妇死亡率高，导致更加重视产前护理。这些发现最终导致儿童局在1930年首次编纂了产前检查时间表。令人惊讶的是,这一时间表在近一个世纪里基本保持不变。通过美国妇产科学院的成立，实验室测试和超声检查的重大技术进步，1989年，美国国立卫生研究院特别工作组呼吁改变产前护理，产前护理建议继续与1930年每月一次的访问相同，直到妊娠28周，每两个月一次，直到妊娠36周，和每周访问，直到交付。然而,2019年冠状病毒病迫使我们改变，重新考虑面对面访问的必要性和访问频率。目前,当我们从急性大流行过渡时，我们应该考虑如何利用我们在这个前所未有的时代学到的东西来塑造未来的产前护理。一个世纪的产前护理经验为下一代的产前护理提供了宝贵的见解。
