Pregnancy Office Visits
A. Due Dates
Due dates are set to help gauge the approximate date of conception and delivery. Only 1 in 20 babies is delivered exactly on the calculated day, although most are born within 10 days of the projected date. A full-term baby usually goes 280 days from conception to birth.
B. The First Office Visit
You can call our office to schedule your first prenatal visit anytime during the first trimester. Our doctors like to see you between 8 to 10 weeks. If you want to take a pregnancy test, you may do so anytime during regular business hours. The first office visit will take longer than your other visits. Your medical history will be taken. At your first visit, we will do some lab tests relative to pregnancy and your general health. Blood tests are especially important since they tell us much about your medical history, which could have an effect on you and your baby’s well being.
Follow-up visits are much shorter in duration than your initial visit. The growth and development of your baby is monitored and certain blood tests and other tests (ultrasound) will be performed at pre-determined intervals throughout your pregnancy (see list below).
The closer you get to your due date, the more frequently we will need to see you. Through your sixth month, we’ll set up an appointment every four weeks. Then, plan to come in every two weeks during the seventh and eighth month, and every week during the last month. These visits will take less time than your initial exam, but are just as important to make sure your pregnancy is progressing well.
C. Office Visits, Labs and Ultrasounds
Prenatal visits will be scheduled as follows:
8-10 weeks – new OB visit with your doctor includes annual exam and ultrasound
every 4 weeks until 28 weeks
every 2 weeks until 36 weeks
12-13 weeks Genetic Screening
1st Trimester – Consist of ultrasound to measure Nuchal (neck) skin on back of baby’s neck with blood drawn for two substances: PAPPA and Free B-HCG. This is then used to calculate risk for Down’s syndrome and Trisomy 18. May also detect some heart defects.
2nd Trimester – MSAFP for neural tube defects if ultra screen was done in the 1st trimester.
A follow up amniocentesis may be recommended for confi rmation if the results of the Genetic Screening indicate that you are at a higher risk.
15 – 19 weeks Quad Screen
The Serum Quad Screen is a maternal blood test, which measures serum alpha-fetoprotein, human chorionic gonadotropin, Inhibin A, and estriol. Abnormalities with these markers can indicate a fetus with a neural tube defect (abnormality of the brain or spinal cord), Down’s syndrome or Trisomy 18. Most women with an affected fetus do not have any risk factors. An abnormal result may also indicate a fetus is at an increased risk of low birth weight, low amniotic fluid and fetal death. This test is performed between 15-19 weeks gestational age. This test is not perfect. There are false positive as well as false negative results. The false positive rate is 3-5%. That is 3-5 out of 100 test results will come back positive when there is nothing wrong with the baby. A positive test result will require further investigation with a fetal ultrasound and possible retesting or amniocentesis. Also, normal results do not guarantee a perfect outcome as the test does not screen for all fetal anomalies and can miss some babies with the above abnormalities. This test identifies 60% of those with Down’s syndrome and 85% with an open neural tube defect. This test is OPTIONAL but can provide very important information that will help guide the management of your pregnancy.
20 – 24 weeks Ultrasound
An ultrasound will be given during your first and second trimester. The ultrasound uses high frequency sound waves to produce a picture of your baby.
24 – 28 weeks One-hour glucose test
The one-hour glucose test is given between 24-28 weeks to screen for gestational diabetes. You will be asked to drink approximately 10 oz. of glucose (sugar) beverage (fasting is not necessary). You will remain in our office for one hour. After one hour, blood will be drawn from a vein in your arm. The blood sample will show how your body reacts to having “glucose load”. The test results are usually back within 48 hours. If the test is abnormal, more testing will be done. Why is the test so important? Gestational diabetes occurs in up to 12% of all pregnancies in the United States and can be a concern for the health of both mother and the baby. If it is diagnosed early, complications during the pregnancy can be prevented. This is a mandatory test.
24 – 28 weeks Hemoglobin
This is a blood test for anemia (low iron) taken at the same time the one-hour glucose test is done. If your iron level is low, we will start you on iron supplements. This is a common condition in pregnancy and if you take the iron as directed, there should be no long term affects on you or your baby.
28 weeks RhoGam injenction (if Rh Negative)
If you are Rh negative (A, B, O, or AB) and the father of your baby is Rh positive, you must be screened at 28 weeks (sooner in case of miscarriage, trauma, or bleeding) for Rh “antibodies”. You should have a negative antibody screen. If your antibody screen is positive that would mean that some of the baby’s blood has gotten into your blood stream and the baby’s blood type is like the father’s type – Rh positive. Your body would recognize this blood type as foreign and make antibodies to attack the Rh positive blood cells. RhoGam is an important injection given to the mother, which protects the baby by keeping the mother’s body from making these antibodies. Once you have these antibodies, they never go away. The antibodies could affect your current pregnancy and any future pregnancies.
35 – 37 weeks Group B strep vaginal culture
Group B Streptococcus (GBS) is a type of bacteria that can be found in approximately 30% of pregnant women. In women, it is most commonly found in the vagina or rectum. A woman with GBS can pass it on to her fetus when she is pregnant or to her baby during delivery or after birth. Most babies who get GBS from their mothers do not have any problems. Only 1-2% of all babies who are exposed to GBS during pregnancy become infected. This can cause major health problems or even threaten their lives. A vaginal culture is done between 35-37 weeks to screen for GBS.