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What to Expect at Your First Prenatal Visit


Congratulations! You’re pregnant and about to see the doctor to know how far along you are. Pregnancy duration is defined in weeks, and 40 weeks of pregnancy must pass from your last menses before you are technically ‘due’, hence ‘due date’ or, in obstetrical jargon, “Estimated Day of Confinement” or EDC. Most women do not deliver on their EDC; any pregnancy beyond 37 weeks is considered full term or normal. While any deliveries before 37 weeks are preterm. That’s why it is essential to see your doctor early in the pregnancy so that your EDC can be calculated from either the first day of your last menstrual period or an ultrasound in the first trimester.

Medical history and tests

So, what can you expect at your first prenatal visit? The first thing that occurs is a check-in with the nurse, who will take your vital signs, collect a urine sample, and assign you an exam room. The urine will be analyzed in the office for human chorionic gonadotropin (HCG) presence. HCG levels can be detected in the urine about the time of your missed menses—the one that led you to believe you might be pregnant. The urine will be sent to the lab to determine if you have a urinary tract infection since these are more common in pregnancy. Your urine will be collected and checked for protein, infection, and ketones at each visit. Blood pressure and weight will be performed at all visits.

Exam and more tests

Once inside the exam room, your doctor will ask questions about your past and current medical problems, the nature of your periods, whether they are regular, and the duration. The first day of your last normal period is asked, which is the basis for estimating your due date or EDC. The doctor will assess your family history, especially any history of congenital malformations or hereditary conditions. The doctor will ask about prior pregnancies and deliveries to assess your current risk factors. Gravid women have had a least one prior pregnancy, while parous means the number of babies delivered either vaginally or by cesarean section. Thus, if you are pregnant for the second time and have had a child, you would be designated as G2P1. Those will also be noted if you have had a miscarriage, ectopic, or abortion.

Because the breasts may be sore, that exam may be deferred until the second trimester. Then, you will have a pelvic exam that consists of a speculum so that samples can be taken from your cervix to detect certain infections such as gonorrhea or chlamydia. If it is the appropriate time, a pap smear will also be done. Then, a bimanual exam will be performed to estimate the size of your uterus and to rule out ovarian masses. As the uterus grows beyond the pelvis, fundal height (in centimeters) will be measured as it corresponds with gestational age starting at 20 weeks, when the top of the uterus will reach the umbilicus. This assesses for proper fetal growth.

Ultrasound

After the exam, some doctors elect to do a transvaginal ultrasound if you are still in your first trimester. Otherwise, they may do one on your abdomen if you are further along. Around five weeks of pregnancy, the ultrasound will likely see a gestational sac with or without a fetal pole. If the fetal pole is large enough, a heartbeat may be seen on ultrasound, but it’s too early to hear one externally. Around six weeks and beyond, the tiny embryo can be measured from the head to the rear end—called the ‘crown-rump length.’ This length is the most accurate in determining your due date if you are unsure of your last menstrual period.

There will be blood work drawn at one of your early visits, and many times that will be postponed until around thirteen to sixteen weeks so that prenatal tests for genetic or chromosomal problems can be detected. Blood tests determine your blood type and RH status, syphilis, rubella, varicella, HIV, hepatitis B status, and hemoglobin to look for anemia. Blood work will be repeated around 28 weeks to assess for diabetes.

Education and counseling

Your doctor will counsel you about the next steps such as frequency of visits, diet, exercise, weight gain, whether you may be at risk for complications, smoking cessation, and what to call the doctor for. Educational material will be given, or you will be directed towards online sites for continual learning. You will be given a prescription for prenatal vitamins if you don’t yet have them. Counseling about the common symptoms of early pregnancy will occur, and morning sickness is the most common, besides breast tenderness. You will be given tips on how to manage those early symptoms. It’s best to avoid greasy and spicy foods, drink plenty of water, and have crackers handy at all times. Nausea can strike at any time, so small frequent meals are recommended. Healthcare practitioners recommend visits every four weeks until 28 weeks, then every two weeks until 36 weeks, and then weekly. During the last 4-5 visits, your cervix will be checked to see if you are dilating. Dilation is the process of the cervix opening up to allow passage of the baby. Effacement is the amount of softening or thickness of the cervix and can signify that dilation will follow.

Key takeaways

  • Depending on your province or territory, you might be provided with an optional first-trimester screening to ascertain your risk of having a child with trisomy 18 or Down syndrome.
  • The majority of prenatal healthcare professionals will inquire about your mental health, both now and in the past.
  • All healthcare professionals must give pregnant patients the same level of care. You will schedule an appointment every four weeks from the start of your pregnancy until 28 weeks.
  • Even though your first session could seem frightening and overwhelming, you'll leave with plenty of knowledge that will help you make the best choices for both you and your unborn child.

Conclusion

Your entire world changes the instant you urinate on that stick, and the pregnancy test comes back positive. You likely sense anticipatory anxiety, excitement, and perhaps even a little confusion about what to do next. What types of testing are required? When will you be able to view that first ultrasound or hear your baby's heartbeat? Well, take it easy. Scheduling an appointment with a medical expert is the first step. Hopefully, this article has given you a comprehensive insight into what you should expect at your first prenatal visit.

Resources

  1. The American College of Obstetricians and Gynecologists (ACOG). Guidelines for Perinatal Care.
  2. Alabama Perinatal Excellence Collaborative (APEC). Guidelines for Routine Prenatal Care.
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