During your first prenatal visit, you will be screened for potential medical 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. If you are not taking any medications that may need to be discontinued, you may wait as long as a month to see your provider.
At your first visit, your provider may collect blood and urine samples, you will be weighed, and your vital signs will be checked.
If you experience any symptoms of high fever, severe lower abdominal pain, cramping, bleeding, or persistent nausea and vomiting, call your provider. He or she may see you in the office or refer you to the hospital, if necessary.
Your vital signs will be closely monitored throughout pregnancy for any changes that could indicate underlying problems. For example, elevation of your blood pressure during the third trimester could be the first sign of preeclampsia or underlying hypertension.
Your doctor or nurse-midwife will ask about your last period in order to determine your due date. He or she will also want to know about your menstrual history, including details of recent birth control methods you have used, the length and regularity of your periods, and the severity of your premenstrual symptoms.
What to Expect
By the time you have your first prenatal visit, your vital signs will have changed. Your blood pressure will be lower and your pulse may be faster.
After you and your provider have talked about your expected due date, he or she will ask about details of previous pregnancies, including miscarriages and abortions. Important information includes the length of your pregnancy (the number of weeks at which you delivered), the method of delivery (vaginal versus forceps or cesarean delivery), the birth weight of the baby, type of anesthesia or analgesia used, and the occurrence of any infections, blood pressure problems, or bleeding complications.
All of these details are important to your provider because past reproductive experiences may help predict future outcomes and can enable your provider to develop a pregnancy or birth plan tailored to your special circumstances. For example, if you have a history of premature delivery, you are at risk for preterm delivery in the current pregnancy, and your provider may want to see you more often to evaluate you for impending preterm labor.
Your gynecologic history is especially important. This may include a history of pelvic or genital infections (such as gonorrhea, chlamydia, trichomonas, herpes simplex, syphilis, bacterial vaginosis, or genital warts), pelvic inflammatory disease, results of pap smears and treatment for abnormal pap smears, infertility treatment, surgery to the reproductive tract, birth control methods used, and a history of sexual abuse.
Your provider should also know about any and all diseases that have affected you. Many chronic diseases have profound effects during pregnancy and can threaten your health and the pregnancy. For example, a history of diabetes, high blood pressure, heart disease, or severe lung disease may place your pregnancy at high risk. If you experience any of these conditions you deserve extensive counseling and diagnostic evaluation before or during pregnancy. Lupus is another condition that can affect pregnancy. A mother's condition may be controlled, but she may produce antibodies that can cross the placenta to the baby, causing severe life-threatening heart disease.
Other relevant details of a medical history may also include psychiatric disorders, trauma or violence, blood transfusion, allergies to medications, surgeries, or hospitalizations.
What If You Have Risk Factors for Genetic Diseases?
If you have risk factors for genetic disease, prenatal diagnosis and genetic counseling should include extensive history and assessment of you, your partner, and your respective families. After this information has been evaluated, you may receive counseling regarding certain genetic risks and be offered further evaluation. Your provider (or counselor) may recommend that you, your spouse, or certain family members undergo blood testing for inheritable diseases. In addition, you may be offered early pregnancy ultrasound, amniocentesis, or chorionic villous sampling to assess your pregnancy for the presence of genetic disease.
Family History and Risk Assessment
After you and your provider have thoroughly covered your medical history, he or she may screen you for genetic risk. Your provider will ask about your and your spouse's ethnic heritage and family histories.
Ethnic heritage is important because some medical conditions occur more frequently among certain populations. For example, sickle cell disease occurs most commonly in women of African descent; Tay-Sachs disease occurs predominantly in individuals of Ashkenazi Jewish heritage; and thalassemia occurs mainly in peoples of Italian, Greek, Chinese, or Southeast Asian decent.
In addition to the genetic history, your doctor will want to know about any family history of diabetes or hypertension. A family history of diabetes is a significant risk factor for development of diabetes at some point during your life or during pregnancy. If you are at risk for developing gestational diabetes, your physician may want to screen you earlier rather than later.
Similarly, if you have a family history of high blood pressure, you have a greater chance of developing high blood pressure and may manifest signs of hypertension during pregnancy. Your doctor may also ask if you have a family history of clotting disorders because pregnancy causes blood to clot more easily, and it is important to identify a woman who may be at risk.
Your family's obstetrical history is also important. Things your doctor might ask you about include family history of twins, preeclampsia (hypertension during pregnancy), eclampsia (hypertension with convulsions during pregnancy), recurrent miscarriages, and stillbirths.
The initial physical exam is comprehensive, including a breast exam, pelvic exam, and possibly a rectal exam.
Head and Neck
- Severe gum disease and infection in the oral cavity have been identified as risk factors for preterm labor. Therefore, when significant gum or other oral disease is identified, prompt referral to a dentist is recommended.
- Thyroid enlargement may occur as a normal part of pregnancy or may be associated with an underactive or overactive thyroid. Your health care provider may ask for additional blood tests to evaluate your thyroid gland.
Lungs, Heart, Breasts, and Abdomen
Your health care provider will listen to your heart and lungs with a stethoscope.
- It is not uncommon for a woman to have a heart murmur during pregnancy. This is probably due to increased blood volume during pregnancy and is more prominent later in pregnancy. If you have symptoms related to the heart or lungs, your doctor may suggest additional tests, such as an electrocardiogram or chest x-ray.
- The breasts are examined for the presence of masses. If a breast mass is found, ultrasound, mammography, needle aspiration, biopsy, or referral to a surgeon may be indicated.
- The nipples are examined. Inverted or flat nipples may make breast-feeding difficult. This condition may be improved with the use of breast shields in the latter part of pregnancy.
- Examination of the abdomen focuses on palpation (feeling) for the liver and spleen to determine whether they are of normal size. Enlarged organs can indicate the presence of a serious medical condition. Early in pregnancy, the uterus sits inside the pelvis and is not large enough to be felt during an abdominal exam. At around 16 weeks of pregnancy, the top of the uterus can be felt midway between the pubic bone and the umbilicus.
Arms and Legs
Your extremities are examined for swelling, reflex reactions, and blood flow. It is not uncommon for the lower legs to swell significantly (edema). However, swelling in the hands or face or swelling in only one leg may indicate abnormal conditions such as toxemia or blood clots.
Throughout the examination, your provider will evaluate your skin. Moles may get darker because of the way hormones work in the body during pregnancy. The line from your pubic bone to your belly button (the linea alba) and your nipples may also darken significantly. These changes generally become less prominent after the pregnancy. If you notice a mole that changes color and grows during pregnancy, it should be brought to the attention of your provider so that an appropriate evaluation can occur. Similarly, if you develop new moles, you should notify your provider.
A thorough pelvic examination is necessary in all pregnant women. The exam usually begins with placement of a speculum into the vagina in order to view the cervix (the opening of the uterus). The cervix is examined for abnormalities and signs of infection.
Testing for Infection. Typically, your provider will obtain a Pap smear (a sampling of the cells lining the uterus) and cultures for gonorrhea and chlamydia. Vaginal discharge may 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 infection of the uterus and preterm labor. If a sexually transmitted disease is diagnosed (chlamydia, for example), your partner should be treated or you may be at risk for reinfection.
Examining the Cervix. After your provider has visually examined the cervix, he or she will remove the speculum and examine the cervix and uterus by hand. The doctor or nurse-midwife will place several fingers in the vagina in order to assess the thickness, length, and opening of the cervix. In normal circumstances, the cervix is long and closed prior to the onset of labor. If your provider is concerned about the dilation or length of the cervix, he or she 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. If this condition is not associated with infection or preterm labor, you may be a candidate for a cervical cerclage (reinforcement of the cervix with the use of a surgical suture).
Examining the Uterus. Your provider will evaluate the size and shape of your uterus and will compare these findings with the estimated gestational age of the fetus. The uterus will also be examined for masses and tender areas, and the ovaries will be felt for any abnormalities.
Assessing the Shape of the Pelvis. After examination of the uterus, your provider may feel the bones of your pelvis to assess the shape and size of the birth canal. If your provider is concerned that you might have a small pelvis, the size of the baby will be closely monitored as the time for delivery approaches. This information will be used to decide the best way to deliver your baby (vaginal versus cesarean or forceps- or vacuum-assisted delivery). However, your provider will often recommend that you attempt vaginal labor first because your pelvis may not be small in relation to the baby.
End of Visit
After the physical exam, you and your provider may talk about any additional testing that may be needed. Before leaving this first prenatal visit, you should be sure that you have an understanding of the normal symptoms of pregnancy versus the signs that could indicate something is wrong.
Your provider should also give you suggestions about which prenatal vitamins (for example, Prenate Advance) to take. It is important that you speak with your health care provider about any over-the-counter medicines or supplements (including herbs) that you want to take during pregnancy. Even though an item might be labeled ?natural? or ?intended for use during pregnancy,? it is important to inform your health care provider so that he or she can assist you in making healthy choices during pregnancy.