What To expect From First Ob/Gyn Appointment
Your first prenatal visit may be one of the longest you'll have during your pregnancy — and definitely the most comprehensive. Not only will there be tests and information-gathering, there will be lots of time spent on questions and answers. Your health care provider will give you plenty of advice, from what to eat, what prenatal vitamins to take, and how much to exercise.
During the first trimester, you will most likely have just one appointment with your doctor, unless your pregnancy is considered a high risk pregnancy or you have other medical conditions. Expect to have the first appointment between 6 and 8 weeks of pregnancy, and sooner if you are considered high-risk.
Tests and screenings
The bulk of your first appointment will be going through tests and screenings, as well as questioning you about your medical history and that of your spouse or significant other’s. A personal medical history will be assessed, including any medical conditions you have, what medications you take and if you have had surgery before.
Your visit will most likely begin with a physical exam. Your healthcare provider will weigh you and determine your blood pressure. Your heart, lungs, and breasts are going to be checked as well.
There will also be a pelvic exam, during which a pap smear is taken to screen for cervical cancer, and cultures are taken to detect STD's, such as gonorrhea and chlamydia. In addition, a bimanual internal exam will be performed to determine the size of your uterus and pelvis. This exam will also check for any abnormalities of the uterus, ovaries, or fallopian tubes.
A series of lab tests, that will be performed during your first prenatal visit will include a complete blood count, blood typing, a screen to look for the rubella virus, hepatitis panel, syphilis test, urine analysis, and an HIV test.
Your first prenatal visit will also include an ultrasound, which is done internally with a wand that uses sound waves to look at your uterus. This helps determine the position, size, and age of the fetus. Many women don’t hear the heartbeat at the 8-week ultrasound, so don’t be concerned if you aren’t able to hear it by this point.
The benefits to ultrasound evaluation include:
- detection of abnormal pregnancies that are destined to miscarry
- enabling scheduled intervention, if desired by the patient - enabling collection of pregnancy tissue for chromosomal analysis
RH antibodies test
Finally, an Rh antibodies test will be done during your first-trimester appointment. This looks for incompatible blood types between you and your fetus. It can be a problem during delivery, or even during miscarriage because your body may produce antibodies to protect itself from this "foreign" substance. This phenomenon is called Rh incompatibility.
If your partner's blood is Rh+ (and yours is Rh-), you will be given an injection of Rh immune globulin during the 28th week of your pregnancy to prevent the development of antibodies that could be harmful to your baby. You will also receive this injection during invasive procedures and if you have any significant bleeding during your pregnancy. Additionally, an injection of Rh immune globulin is given after delivery if your baby has Rh+ blood.
Depending on your ethnic background and medical history, you may also be tested for sickle-cell anemia, Tay-Sachs disease, and thalassemia. Some groups of people are more at risk for these illnesses. All of these diseases can be passed onto the baby because of defective genes that the parents may carry, even if they don't have the disease. Your provider may offer you a test for cystic fibrosis, an inherited disease that can affect breathing and digestion in your baby if you and your partner are carriers.
A nuchal translucency screening, or NT screening, is a specialized routine ultrasound performed between week 11 and week 13 of pregnancy. Fetuses with increased fluid at the base of their necks — a spot known as the nuchal fold — may have a chromosomal problem such as Down syndrome. An NT screen is often part of routine prenatal testing during the first trimester and is recommended for all women. NT focuses on a small, clear space at the back of a growing baby's neck called the nuchal fold. Experts have found that this spot tends to accumulate fluid and, as a result, expands in size in babies who have genetic abnormalities like Down syndrome.
The results from the blood tests and the ultrasound, along with the mother’s age, are then combined to determine risk factors for certain chromosomal conditions such as Trisomy 21 (Down syndrome), Trisomy 18 (Edward syndrome), and Trisomy 13 (Patau syndrome).
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