Prenatal Visits

First Trimester
Normal Care

During your first prenatal visits you should expect to have your pregnancy confirmed by your doctor or nurse midwife, find out your baby’s due date, and complete a health and family history questionnaire. You will also have some lab work done either in the office, or at another outpatient setting. Blood work may include the following tests:

• Complete blood count (CBC) to check for anemia/low iron.
• Blood type, Rh factor, and antibody screen.
• RPR to check for certain sexually transmitted diseases.
• Rubella titer to check your immunity (ability to fight infections) to German measles.
• Hepatitis screen to test for Hepatitis B.
• HIV test for AIDS. (Optional)

At one of your first visits you will have a complete physical exam. When the doctor or nurse midwife comes in, he or she will review your medical history and lab results and then do your physical. Your physical exam may include the following:

• A breast exam.
• A pap smear and cultures.
• A pelvic exam to check your pelvic size and shape.
• A measurement of your fundal height (the size of your uterus).

At each visit from now on the nurse will weigh you, check your blood pressure, and check your urine for glucose (sugar) and protein.

Be sure to ask questions and discuss any concerns you have with your doctor or nurse midwife during your appointment and schedule your next appointment before you leave.

Other Tests

Your doctor or nurse midwife may order other tests during your first trimester. If you are scheduled for any of the following tests or if you have any questions or concerns, talk with your health care provider.

Amniocentesis

This test is usually done around the 15th week of pregnancy and involves taking a small amount of fluid from the bag of waters (amniotic sac) that surrounds the baby.  An ultrasound examination is done to determine your baby’s position and the location of the placenta and pockets of amniotic fluid. During an ultrasound, a machine uses sound waves to take a picture of your baby. This is not painful and will not harm your baby. The amniotic fluid is then removed from the amniotic sac by inserting a needle through the abdomen. This feels similar to having blood work drawn.

The entire procedure takes about 30 minutes including the time spent doing the ultrasound. Laboratory tests can be done on the amniotic fluid to gather more information about your baby. Results are usually available from your health care provider in two or three weeks.

Tests for Metabolic Disorders

When there is a known metabolic disorder in the family, or if you are of a certain ethnic background including Asian, Italian, Mediterranean, African American, French Canadian, or Jewish; you may wish to find out if a specific test is available to you. Some examples are:

• Tay Sachs
• Hemophilia
• Sickle cell anemia
• Thalassemia
• Cystic fibrosis
• Duchenne muscular dystrophy

Second Trimester
Normal Care

The second trimester is considered by many women to be a very comfortable and pleasant time. Your visits to your health care provider during this trimester are generally scheduled every 4 weeks. At each visit you will:

• Be weighed, and your blood pressure will be checked.
• Have a urine specimen checked for sugar and protein.
• Have your fundal height (size of your uterus) measured with a tape measure. This helps to determine how your
• baby is growing. For example, at 20 weeks of pregnancy, your uterus will generally measure 20cm.
• Have your baby’s heartbeat checked with a small device called a Doppler. Your baby’s heart rate will normally be very fast, between 120-160 beats per minute.
• Have a chance to ask about your questions or concerns.

Routine Tests That May Be Done

Triple Test

This blood test may be done somewhere between 15-20 weeks. This screening test helps to detect your risk for certain types of birth defects. However, this is only a screening test. Results do not necessarily mean that a problem exists. Further testing, such as a repeat test, an ultrasound, or an amniocentesis, may be recommended. Also, as with any screening test, it is important to remember that screening cannot guarantee a normal baby, since there are other kinds of problems that the test does not detect.

Ultrasound

An ultrasound is usually done between 18-20 weeks of pregnancy. This test screens for abnormalities and helps to determine the age of your baby, and confirm your due date. Your baby is completely formed by this point, so ultrasound will also provide an opportunity to check for bone or organ defects, and for the location of the placenta (afterbirth), which supplies your baby with the necessary oxygen and nutrients. This ultrasound may also be able to identify the sex of your baby, which the technician will share with you if you choose to know. 

Glucose Tolerance Test and Complete Blood Count (CBC)

A Glucose Tolerance Test is done between 24-28 weeks of pregnancy to check for diabetes. You will be asked to drink a special liquid. Your blood will be drawn one hour later. Blood for a CBC may be drawn at the same time. The CBC is a check for anemia (low iron).

Third Trimester
Normal Care

During the last trimester of your pregnancy, visits to your doctor or nurse midwife will be scheduled closer together. You’ll generally have a visit around the 28th week, and again at 32 weeks. After 32 weeks, your visits may be scheduled every two weeks. Beginning at 36 weeks of pregnancy, you’ll see your health care provider every week until you deliver. At each visit you will:

• Be weighed, and your blood pressure and urine will be checked
  The doctor/nurse midwife will continue to measure the top of your uterus with a tape measure
  Listen for your baby’s heartbeat
  Have a chance to ask about your questions or concerns
  Have a chance to talk about labor and pain management options.

Towards the end of the pregnancy, the doctor or nurse midwife will attempt to determine the position of your baby. And, during the last few visits, he/she may do an internal exam to check for thinning (effacement) and opening (dilatation) of your cervix (the opening to your uterus.) 

Routine Tests That You May Experience. . .

Vaginal Cultures

Between the 32nd and 36th week of pregnancy, your doctor or nurse midwife may do a pelvic exam so that cultures can be done to check for infection in the birth canal. Any necessary treatment will be discussed with you.

Non-Stress Testing (NST)

Your doctor or nurse midwife may order a Non-Stress Test be done. This painless test is done either in your doctor’s office or at the hospital.

During an NST two sensors are strapped to your tummy with belts. One sensor monitors the baby’s heartbeat (which you will be able to hear). The other monitors for any contractions. You will be asked to push a button whenever you feel the baby move. Normally the baby’s heart rate increases when he/she moves. When the doctor or nurse midwife sees this response, they are reassured that the baby is continuing to do well.

Non-Stress Testing may be done for a number of reasons:

• If you have high blood pressure or diabetes
• If your baby is moving less than usual
• If your baby is overdue
• If there has been a problem during this pregnancy or an earlier pregnancy
• To provide reassurance to you and your doctor/nurse midwife that your baby is doing well.

Contraction Stress Test (CST)

If the results of an NST show a need for further evaluation of your baby, a Contraction Stress Test (CST) and/or a Biophysical Profile (BPP) may be ordered. 

During a CST, two sensors are strapped to your tummy. One monitors baby’s heart rate and the other monitors for uterine contractions. An IV is placed in your hand or arm. Oxytocin (Pitocin) is carefully given through the IV, causing a few contractions. (Sometimes nipple stimulation rather than Oxytocin is used to cause contractions).  The nurse doing the CST will evaluate the baby’s heartbeat during this test. A steady heartbeat means that the baby is able to tolerate the stress of contractions. This is reassurance that he/she is well.

This test is done in the Labor and Delivery Unit at the hospital. 

Biophysical Profile (BPP)

A BPP is done during an ultrasound. The ultrasound technician will evaluate your baby’s breathing movements, muscle tone, body movements, and the amount of amniotic fluid surrounding your baby. The results of this test will be reported to your doctor or nurse midwife, who will decide whether any additional testing or procedures are necessary