Your regular prenatal visits are designed to help maximize your health and the health of your baby, as well as deal with any problems that come up and answer any questions that you may have. Here’s what to expect:
Confirmation of Pregnancy Visit
This is usually the first visit you will have, shortly after you find out that you are pregnant. We will confirm that you are pregnant and try to establish a final due date, often with an ultrasound. Usually, we will order your prenatal labs and deal with any current or pre-existing issues, like medicines you might be taking or symptoms you may be experiencing.
Your prenatal labs consist of:
- A CBC (complete blood count) to check for anemia and other blood disorders;
- A blood test for syphilis, HIV, hepatitis B, and hepatitis C;
- Your blood type and whether you have any unusual antibodies in your blood;
- Your rubella titer to see if you are immune;
- A urine drug screen and/or a urine culture.
Depending on risk factors, we may add other tests, such as screening for diabetes or sickle cell anemia; and depending on your family history, you may also need screening for genetic diseases like cystic fibrosis or other familial conditions like bleeding or clotting disorders.
We will ask you a series of questions relating to your pregnancy history, medical and surgical history, family history, etc. These detailed series of questions are helpful to screen for any risk factors you may have for your pregnancy.
New OB Visit
At this visit, we will do a physical exam, including a pelvic exam with a Pap smear and cultures for chlamydia and gonorrhea, if these things have not already been done. Not every woman will need a Pap smear, so in some cases the pelvic exam may be unnecessary and we can check for chlamydia and gonorrhea in your urine. We will review your prenatal lab test results as well as the results go over any issues identified from your history, as well as other pregnancy concerns you may have.
Subsequent Visits
At the first visit and every visit thereafter, we will check your weight, blood pressure, and, if possible, listen to the baby’s heartbeat. This isn’t always possible before 12 weeks of pregnancy without an ultrasound. We check your urine at several visits for signs of infection and for protein, which is sometimes associated with the development of preeclampsia. You should always tell us if you are having any symptoms of a urinary tract infection. We will talk about any problems that you are having and talk about things you should be looking for, etc.
Pregnancy is 40 weeks total. We will see you about once a month until 28 weeks, then every 2-3 weeks until about 36 weeks, then weekly until you deliver. Sometimes a pelvic exam may be required, particularly if you are bleeding, leaking fluid, or have been having a lot of contractions. If you are pregnant during Flu season, you should have a Flu Shot.
Some additional things about a few visits are listed below:
10-12 Weeks. Some women may want an optional test that we call First Trimester Screening. This is a combination of an ultrasound that looks at the thickness of the back of the baby’s neck and a blood test for two markers called PAPP-A and HCG. It is used to screen for Down Syndrome and Edward Syndrome, both of which are related to carrying an extra copy of a chromosome. The test also may indicate certain types of heart defects. The test is performed between the 11-13th week of pregnancy and needs to be ordered in advance. Not every woman does the test. Of those who do, about 5% will have a positive result; this positive result indicates an actual problem less than 1% of the time, so most positive results are false positive. About 15% of cases of Down and Edward Syndrome are missed by this test. Further testing would be needed to confirm any positive result.
Another choice for early testing is called Noninvasive Prenatal Screening or NIPS. NIPS is a blood test that can be performed any time after 10 weeks and it also screens for Down and Edward Syndrome, as well as conditions related to abnormal numbers of sex chromosomes and can determine the baby’s gender. Currently, this test is only recommended for women who have an increased risk for things like Down Syndrome; so, if you’re over 35 for example, it may be a great choice.
16-20 Weeks. In this timeframe, usually closer to 20 weeks, all women will receive a detailed Anatomic Ultrasound looking at many specific parts of the baby’s anatomy. This helps to screen for many birth defects or other problems. Optionally, many women will choose to also have a test known as the Quad Screen. This is a blood test (AFP, HCG, Estriol, and Inhibin-A) which screens for Down and Edward Syndrome, neural tube defects like spina bifida, abdominal wall defects like gastroschisis, and a few other problems. It is merely a screening test and gives the patient a specific risk (like 1 in 500) for one of those conditions being present. Further testing is required to provide a definitive diagnosis, such as an Amniocentesis.
28 Weeks. At this visit, all women whose blood type is Rh Negative, such as A Neg, B Neg, O Neg, or AB Neg, will receive an injection of Anti-D antibody, commonly known as Rhogam or Rhophylac. This injection helps to prevent mothers from forming antibodies against their babies’ blood, which might be different from their own. Also between 24 and 28 weeks, we will discuss screening for Gestational Diabetes and decide if you have risk that requires a screening test.
This visit is a good time to discuss what you might like to do for birth control after you deliver. If you are planning on have your tubes tied, it is important to let us know at this visit so that we can discuss all of your options.
36 Weeks. Every woman will have a swab taken of the vagina, perineum, and anus for Group B Streptococcus or GBS. Around one third of women carry this bacteria as part of their normal genital flora and it causes no problems for them; but, it can rarely cause serious problems for newborns. If your test is positive, you will need to receive antibiotics in your IV when you are in labor to reduce the risk that your baby will be affected. You will start weekly visits after this check-up and we will be discussing plans for your delivery.
41 Weeks. If you’ve made it a week past your due date, it’s almost always time to be induced. For most women, the risks of continuing the pregnancy are greater than the risks of being induced.