Pregnancy - Evaluation by Physician Health Article

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.

Vital Signs

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. For more information on determining your due date, go to Figuring Your Due Date.

Reproductive History

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.

Gynecologic History

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.

Medical History

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.

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 , 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 easi