During your first prenatal visit, you will be screened for potential medical issues or other concerns that could affect your pregnancy. Ideally, you will make an appointment for your first prenatal visit as soon as your pregnancy has been confirmed. Your doctor will likely schedule the appointment during your eighth week of pregnancy. However, they may see you sooner if you:
- have an existing medical condition
- have had prior problems with pregnancy
- have certain symptoms, such as vaginal bleeding, abdominal pain, and severe nausea or vomiting
Your first visit will probably be the longest one during pregnancy. At your first visit, your doctor will check your vital signs and take your medical history. They will also perform certain examinations and tests, including blood and urine tests. It’s important to ask your doctor questions and to address any concerns you may have about your pregnancy.
Your vital signs indicate the status of essential body functions, such as heartbeat, breathing rate, and blood pressure. These signs will be closely monitored throughout pregnancy for any changes that could indicate underlying problems.
While taking your vital signs, your doctor will ask you for the date of your last menstrual period. This will help them calculate your due date. Your doctor will also want to know about your menstrual history. They may ask you for details regarding the types of birth control methods you’ve recently used, the length and regularity of your menstrual periods, and the severity of your premenstrual symptoms.
Your doctor will also need to know about any previous pregnancies, including miscarriages and abortions. Important details include:
- the length of pregnancy, including the number of weeks at which the baby was delivered
- the method of delivery
- the birth weight of the baby
- the type of anesthesia or analgesia used
- the occurrence of any infections, blood pressure problems, or bleeding complications
Past reproductive experiences may help predict future pregnancy outcomes. They can also assist your doctor in developing a pregnancy or birth plan tailored to your particular circumstances.
Your gynecologic history is particularly important. Your doctor needs to be aware of any current or past gynecological problems that could potentially lead to birth defects or complications in your baby. You must tell your doctor if you currently have or have ever had sexually transmitted infections, such as:
- herpes simplex
- bacterial vaginosis
- genital warts
It’s also important to tell your doctor if you have ever had abnormal Pap smear results.
Your doctor should also know about any and all diseases that have affected you. Many conditions can potentially lead to complications during pregnancy, threating the health of you and your baby. These include:
If you currently have any of these conditions, your doctor will monitor you very closely throughout your pregnancy to make sure your particular condition doesn’t get worse. They may also run certain tests to evaluate the severity of your condition.
It’s also vital to tell your doctor if you have a history of:
- psychiatric disorders
- trauma or violence
- blood transfusions
- allergic reactions to certain medications
Family History and Risk Assessment
Once you and your doctor have thoroughly covered your medical history, they will ask about your family history and ethnic heritage, as well as that of your partner. This can help them evaluate your risk for certain genetic, or inherited, conditions.
Ethnic heritage is important because some medical conditions occur more frequently among certain populations. It’s also critical for your doctor to know if you have a family history of diabetes or high blood pressure.
A family history of diabetes puts you at an increased risk of developing the condition during pregnancy or at some other point in your life. If are at risk for diabetes, your doctor may want to perform a screening test sooner rather than later. Diabetes that occurs during pregnancy is known as gestational diabetes, and it can potentially lead to complications at delivery. These complications include low blood sugar, breathing difficulties, and excessive birth weight.
Similarly, if you have a family history of high blood pressure, you have a greater chance of developing high blood pressure during pregnancy. This condition is called preeclampsia, and it can be life threatening when left untreated. If you are at risk for high blood pressure, your doctor will monitor your blood pressure very closely throughout your pregnancy.
Your family's obstetrical history is also important. Your doctor might ask you if you have a family history of twins, recurrent miscarriages, and stillbirths.
What If You Have a High Risk for Certain Genetic Diseases?
Genetic counseling can be beneficial if you are at risk for certain genetic disease. This type of counseling involves taking an extensive medical history and assessing the health of you, your partner, and your respective families. After this information has been evaluated, you may receive counseling regarding certain genetic risks. Your counselor may recommend that you, your partner, or certain family members undergo blood testing for inheritable diseases. You may also be offered early pregnancy screening tests, such as ultrasound and amniocentesis, to assess your pregnancy for the presence of a genetic disease.
The first prenatal physical examination is comprehensive so your doctor can evaluate any abnormalities that may be present in various parts of the body.
Head and Neck
Your healthcare provider will assess the general condition of your teeth, gums, and thyroid gland.
Severe gum disease and infection in the oral cavity have been identified as risk factors for preterm labor. When gum disease or another type of oral condition is identified, your doctor will refer you to a dentist for treatment.
Thyroid enlargement may occur as a normal part of pregnancy. In some cases, however, it can be associated with an underactive thyroid or an overactive thyroid. Either condition might increase your risk for premature birth or miscarriage. Your doctor may order certain blood tests to evaluate your thyroid gland if one of these conditions is suspected.
Lungs, Heart, Breasts, and Abdomen
Your doctor will listen to your heart and lungs with a stethoscope. They may suggest additional tests, such as an electrocardiogram or chest X-ray, if any abnormalities in breathing or heart rate are detected.
Your breasts will be examined for the presence of lumps. If a lump is found, your doctor may perform an ultrasound, mammography, or biopsy.
During an examination of the abdomen, your doctor will gently press on your liver and spleen to determine whether they are of normal size. An enlarged organ can be a sign of a serious medical condition.
Arms and Legs
Your extremities are also examined for swelling, reflex reactions, and blood flow. It isn’t uncommon for the lower legs to swell during pregnancy. However, severe swelling in the hands, face, or leg may indicate an underlying health problem. Your doctor will order certain blood tests to check for signs of abnormal conditions, such as preeclampsia and blood clots.
Throughout the physical examination, your doctor will evaluate your skin. Moles and other skin spots may get darker because of the hormones changes that take place in the body during pregnancy. Your nipples may also darken significantly. These changes generally become less prominent after pregnancy. However, if one of your moles significantly changes color or becomes larger during pregnancy, you should notify your doctor so that an appropriate evaluation can be done. You should also tell your doctor if you develop any new moles.
A thorough pelvic examination is necessary in all pregnant women. During the exam, your doctor will check your cervix for any abnormalities and signs of infection.
Testing for Infection
Your doctor will likely perform a Pap smear to obtain samples of the cells lining the uterus. These cells will be evaluated for signs of gonorrhea and chlamydia. Vaginal discharge may also be collected and examined under a microscope for the presence of bacterial vaginosis or trichomonas.
It is important to identify and treat infections of the genital tract because they are associated with preterm labor and other pregnancy complications. If you are diagnosed with a sexually transmitted infection, then you and your partner will need to receive treatment promptly.
Examining the Cervix
During a physical examination of the cervix, your doctor will place several fingers in your vagina to assess the thickness, length, and opening of the cervix. If your doctor is concerned about the opening or length of the cervix, they may order an ultrasound of the cervix for further evaluation. A prematurely dilating or thinning cervix may indicate cervical insufficiency, or weakness of the cervix. This condition can lead to serious complications, including miscarriage and premature birth, so treatment must be given right away.
Examining the Uterus
Your doctor will also evaluate the size and shape of your uterus. They will compare these findings with the estimated gestational age, or age of the baby. The uterus will also be examined for masses and tender areas.
Assessing the Shape of the Pelvis
After examining the uterus, your doctor will feel your pelvic bones to assess the shape and size of the birth canal. This information can help your doctor determine the best delivery method. Depending on the results of the pelvic exam, your doctor may suggest a vaginal delivery, cesarean delivery, or vacuum-assisted delivery.
End of Visit
At the end of your first prenatal visit, your doctor will explain any additional testing that may be needed.
They will also describe the importance of eating well, exercising, and taking certain prenatal vitamins during pregnancy. Make sure to ask your doctor about any over-the-counter medicines or supplements you might want to take while you’re pregnant. They can advise you whether they are safe to use during pregnancy.
Your doctor will also tell you about the discomforts you may experience during pregnancy and warn you about the symptoms that require immediate medical treatment.
Your second prenatal appointment will likely take place four weeks later.