Tests at Your First Prenatal Visit

You should schedule your first visit as soon as you know you are pregnant. Generally, the first prenatal visit will be scheduled after your 8th week of pregnancy. If you have another medical condition that could affect your pregnancy or have had difficult pregnancies in the past, your provider might want to see you earlier than that.

The first step is to choose what type of provider you want to see for your prenatal care visits. Your options including the following:

• An obstetrician (OB): A doctor who specializes in caring for pregnant women and delivering babies. Obstetricians are the best choice for high-risk pregnancies.
• A family practice doctor: A doctor who cares for patients of all ages. A family practice doctor can care for you before, during, and after your pregnancy. They can also be the regular provider for your baby after birth.
• A midwife: A healthcare provider trained to care for women, especially during pregnancy. There are several different types of midwives, including certified nurse midwives (CNMs) and certified professional midwives (CPMs). If you are interested in seeing a midwife during your pregnancy, you should choose one who is certified by either the American Midwifery Certification Board (AMCB) or the North American Registry of Midwives (NARM).
• A nurse practitioner: A nurse who is trained to care for patients of all ages, including pregnant women. This can be either a family nurse practitioner (FNP) or a women’s health nurse practitioner. In most states, midwives and nurse practitioners must practice under the supervision of a physician.

No matter what type of provider you choose, you will be visiting your prenatal care provider regularly throughout your pregnancy.

There are a number of different tests that are typically given at the first prenatal visit. Because this is likely to be the first time you meet your prenatal provider, the first appointment is usually one of the longest. Some tests and questionnaires you can expect include the following:

Confirmatory pregnancy test

Even if you have already taken an at-home pregnancy test, your provider will likely request a urine sample in order to run a test to confirm that you are pregnant.

Due date

Your provider will try to determine your estimated due date (or fetal gestational age). The due date is projected based on the date of your last period. While most women don’t end up giving birth precisely on their due date, it’s still an important way to plan and monitor progress.

Medical history

You and your provider will discuss any medical or psychological problems you have had in the past. Your provider will particularly be interested in:

• if you’ve had any previous pregnancies
• what medications you are taking (prescription and over the counter)
• your family medical history
• any prior abortions or miscarriages
• your menstrual cycle

Physical exam

Your provider will also perform a comprehensive physical exam. This will include taking vital signs, like height, weight, and blood pressure, and checking your lungs, breasts, and heart. Depending how far along you are in your pregnancy, your provider may or may not do an ultrasound.

Your provider will likely also conduct a pelvic exam during your first prenatal visit if you haven’t had one recently. The pelvic exam is done for many purposes and typically involves the following:

• A standard Pap smear: This will test for cervical cancer and for certain sexually transmitted infections (STIs). During a Pap smear, a doctor gently inserts an instrument known as a speculum into your vagina to hold the vaginal walls apart. They then use a small brush to collect cells from the cervix. A Pap smear shouldn’t hurt and only takes a couple minutes.
• A bimanual internal exam: Your doctor will insert two fingers inside the vagina and one hand on the abdomen to check for any abnormalities of your uterus, ovaries, or fallopian tubes.

Blood tests

Your doctor will take a sample of blood from a vein on the inside of your elbow and send it to a laboratory for testing. There is no special preparation necessary for this test. You should only feel mild pain when the needle is inserted and removed.

The laboratory will use the blood sample to:

• Determine your blood type:Your provider will need to know what specific type of blood you have. Blood typing is particularly important during pregnancy because of the Rhesus (Rh) factor, a protein on the surface of red blood cells in some people. If you are Rh-negative and your baby is Rh-positive, it can cause a problem called Rh (rhesus) sensitization. As long as your provider is aware of this, they can take precautions to prevent any complications.
• Screen for infections: A blood sample can also be used to check whether you have any infections, including STIs. This is likely to include HIV, chlamydia, gonorrhea, syphilis, and hepatitis B. It’s important to know whether you might have any infections, as some can be transmitted to your baby during pregnancy or delivery.
  • The U.S. Preventive Services Task Force now recommends that all providers screen for an STI known as syphilis using the rapid plasma reagin (RPR) test at the first prenatal visit. The RPR is a blood test that looks for antibodies in the blood. If not treated, syphilis during pregnancy can cause stillbirth, bone deformities, and neurologic impairment.
• Check for immunity to certain infections: Unless you have well-documented proof of immunization against certain infections (like rubella and chickenpox), your blood sample is used to see whether you are immune. This is because certain diseases, like chickenpox, can be very dangerous to your baby if you contract them during pregnancy.
• Measure your hemoglobin and hematocrit to check for anemia:Hemoglobin is a protein in your red blood cells that allows them to carry oxygen throughout your body. Hematocrit is a measurement of the number of red blood cells in your blood. If either your hemoglobin or hematocrit is low, it’s an indication that you could be anemic, which means that you don’t have enough healthy blood cells. Anemia is common among pregnant women.

Since this is your first visit, you and your provider will discuss what to expect during your first trimester, answer any questions you may have, and recommend that you make some lifestyle changes in order to maximize your chances of having a healthy pregnancy.

Proper nutrition is very important for fetal development. Your provider will recommend that you start taking prenatal vitamins, and may also discuss exercise, sex, and environmental toxins to avoid. Your provider may send you home with pamphlets and a packet of educational materials.

Your provider may also go over genetic screening. Screening tests are used to diagnose genetic disorders, including Down syndrome, Tay-Sachs disease, and trisomy 18. These tests will typically be performed later on in your pregnancy — between weeks 15 and 18.

The next nine months will be filled with many more visits to your provider. If at your first prenatal visit, your provider determines that your pregnancy is high risk, they may refer you to a specialist for a more in-depth checkup. A pregnancy is considered high risk if:

• you are over the age of 35 or under the age of 20
• you have a chronic illness like diabetes or high blood pressure
• you are obese or underweight
• you are having multiples (twins, triplets, etc.)
• you have a history of pregnancy loss, cesarean delivery, or preterm birth
• your bloodwork comes back positive for an infection, anemia, or Rh (rhesus) sensitization

If your pregnancy is not considered high risk, you should expect to see your provider for future prenatal visits on a regular basis according to the following timeline:

• first trimester (conception to 12 weeks): every four weeks
• second trimester (13 to 27 weeks): every four weeks
• third trimester (28 weeks to delivery): every four weeks until week 32 then every two weeks until week 36, then once weekly until delivery