Hamal (Pregnancy) in Pakistan: Antenatal Check-ups and Danger Signs

Pakistan has made real progress on maternal deaths and still loses far too many women to causes that a check-up would catch. The Pakistan Maternal Mortality Survey 2019 put the maternal mortality ratio at 186 deaths per 100,000 live births — a 33% fall since 2007. But research on the same survey found that only about one-fifth of pregnant women receive comprehensive antenatal care, defined as four or more visits to a skilled professional with at least one in the first trimester, plus lab tests and blood pressure measurement (PLOS ONE).

At a glance

• Maternal mortality ratio: 186 per 100,000 live births (PMMS 2019), down 33% from 2007
• Only ~20% of pregnant women get comprehensive antenatal care
• WHO recommends at least eight antenatal contacts, starting in the first 12 weeks
• Most maternal deaths follow causes that are detectable in advance: bleeding, high blood pressure, infection, obstructed labour
• Anaemia is extremely common here and is treatable long before delivery
• Know the danger signs below — they are the difference between a scare and a tragedy

Check-up ka schedule

WHO ab kam az kam aath antenatal contacts ki sifarish karta hai. Aam tarteeb:

• Pehla check-up: 12 haftay se pehle — jitna jaldi ho utna behtar
• Us ke baad 20, 26, 30, 34, 36, 38 aur 40 haftay par
• Agar sugar, blood pressure, jurwan bache ya koi aur masla ho to zyada baar

Har visit par: wazan, blood pressure, pait ki paimaish, bache ki dhadkan, aur peshab ka test. Yeh chand minute ka kaam hai aur yehi zyada tar khatray pakarta hai.

Tests worth insisting on

• Blood group and Rh factor — a Rh-negative mother needs anti-D; missing this endangers later pregnancies
• Haemoglobin / CBC — anaemia is very common in Pakistani pregnancy and is a direct contributor to death from bleeding
• Blood sugar / OGTT at around 24–28 weeks for gestational diabetes
• Hepatitis B and C, HIV, syphilis — all treatable or manageable, and transmission to the baby is preventable. See hepatitis
• Urine test — for protein (pre-eclampsia) and infection; see UTI, which needs treating in pregnancy even without symptoms
• Thyroid function — untreated hypothyroidism affects the baby's development
• Thalassemia screening if not already done — see our thalassemia guide
• Ultrasound — dating in the first trimester, anomaly scan at 18–22 weeks, growth scans later if indicated

Khatray ki nishaniyan — go to hospital now

In mein se koi bhi alamat ho to intezar na karen, chahe raat ka waqt ho:

• Khoon aana — hamal ke kisi bhi marhale mein
• Shadeed sar dard, aankhon ke aage dhabbay ya dhundla nazar aana — pre-eclampsia ki nishani
• Chehray, hathon ya pairon ka achanak sooj jana
• Bache ki harkat kam ho jana ya band ho jana — yeh sab se ahem nishani hai aur "kal dekhte hain" wali baat nahi
• Tez bukhar
• Pait mein shadeed ya musalsal dard
• Pani ka behna (membranes ka phatna)
• Musalsal ulti jis se kuch andar na ruk sake
• Peshab mein jalan ke sath bukhar aur kamar dard
• Dauray parna — fauri emergency

Care in pregnancy

• Folic acid — 400 mcg daily, ideally starting before conception and through the first trimester; it prevents neural tube defects. A higher dose is advised for some women — ask
• Iron and calcium as prescribed. Iron on an empty stomach with something acidic absorbs better; take calcium at a different time
• Eat regularly and well — daal, meat or eggs, dahi, fruit, green vegetables. "Eating for two" is a myth; eating properly is not
• Avoid raw or undercooked meat and eggs, unpasteurised dairy, and excess caffeine. No smoking, naswar or sheesha — including secondhand
• No medicine without asking, including painkillers and herbal preparations. Several common drugs are unsafe in pregnancy
• Tetanus vaccination as scheduled
• Keep moving — walking is safe and helpful in an uncomplicated pregnancy
• Dental care — gum disease is more common in pregnancy and is linked to preterm birth. See bleeding gums

Plan the birth before labour starts

Decide in advance: where you will deliver, how you will get there at 3 a.m., who will accompany you, who your blood donors are, and how you will pay. The "three delays" model — delay in deciding to seek care, in reaching a facility, and in receiving care once there — describes most maternal deaths, and the first two are the ones a family can plan away.

Skilled attendance at birth is the single biggest determinant of safety. A gynaecologist manages complications and surgical delivery; a trained midwife provides antenatal care, attends normal births and is often the more accessible option — you can find midwives on DoctorOS alongside doctors.

Find care: browse midwives and lady health professionals near you on DoctorOS — filter by city, distance and rating, and book without a phone call.

Frequently asked questions

Agar tabiyat bilkul theek hai to bhi check-up zaroori hai?

Ji haan — balke check-up ka maqsad hi yeh hai. Blood pressure barhna, khoon ki kami aur hamal ki sugar shuru mein koi alamat nahi dikhate. Jab tak alamat aati hain, masla barh chuka hota hai. Har visit chand minute leti hai aur yehi khamosh khatray pakarti hai.

Ghar mein delivery karwana theek hai?

Sab se ahem baat yeh hai ke delivery karwane wala tarbiyat yafta ho aur emergency mein hospital pohanchne ka mukammal intezam pehle se ho. Khoon behna aur dauray minton mein jaanleva ho sakte hain. Agar hamal mein koi bhi pechidgi hai — blood pressure, sugar, khoon ki kami, pichla C-section, jurwan bache — to hospital delivery hi mahfooz hai.

Kitni baar ultrasound karwana chahiye?

Aam hamal mein aksar do se teen ultrasound kaafi hain: shuru mein tareekh ke liye, 18–22 haftay par bache ki mukammal jaanch ke liye, aur zaroorat par aakhir mein. Har mahine bina wajah ultrasound karwana zaroori nahi — lekin agar doctor kahe to karwayen.

Is a caesarean always avoidable?

No, and treating it as a failure is harmful. A caesarean is life-saving for obstructed labour, placenta praevia, fetal distress and several other situations. What is worth asking is why one is being recommended in your specific case — a good clinician will explain the indication clearly.

Sources

• Pakistan Maternal Mortality Survey 2019, Key Indicators (DHS Program) — MMR 186 per 100,000
• "Factors associated with maternal health services utilization in Pakistan: Evidence from Pakistan maternal mortality survey, 2019," PLOS ONE
• WHO recommendations on antenatal care for a positive pregnancy experience — eight-contact model

For practitioners: if you're a gynaecologist, midwife or lady health visitor in Pakistan, list your practice free on DoctorOS and start taking bookings from patients who are searching for exactly this kind of care.

Cover image: Untitled by Emery Co Photo, licensed under CC BY-SA 2.0.