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Is My Pregnancy Going Well?

What Can I Expect At The Doctor's Office?

Last modified: 
18/04/2012 - 13:44

Contributing Author: Guy Slowik FRCS

Women should plan a doctor's visit early in pregnancy. A woman's health during those first weeks is crucial to normal fetal development.

Many doctors schedule prenatal visits monthly for the first 28 weeks of pregnancy, every two weeks from 28 to 36 weeks, and weekly during the last month. Prenatal visits usually include routine blood and urine tests.

The First Doctor's Visit

An initial pregnancy visit usually includes a medical history, a physical exam, and a number of prenatal tests. These tests include:

  • Urinalysis. A urine test screens for protein and glucose (sugar), which could indicate diabetes, [hyperlink to Diabetes in Pregnancy article] infection, or kidney disease. Technicians also check the urine for an elevated white blood cell count, which could signal disease or infection of the kidney or bladder.

    For more detailed information about diabetes that develops during pregnancy, go to Diabetes In Pregnancy.

  • Pap smear. A Pap smear test is a procedure for detecting and diagnosing malignant (cancerous) and premalignant (precancerous) conditions of the female genital tract. The site of the test is the cervix, which is the opening that leads to the uterus. The test is an important part of preventive care.

    For more detailed information about PAP smear, go to PAP Smear.

  • Blood tests. Physicians test blood in pregnant women for the following conditions:
    1. Anemia - Anemia is a deficiency in hemoglobin (a protein found in red blood cells). The most common symptoms of anemia are paleness and fatigue.

      For more detailed information about Anemia, go to Anemia.

    2. Infection - An elevated white-blood cell count indicates that a woman has an infection in her body.
    3. Rhesus (RH) factor - Usually first performed early in the pregnancy, and may be performed again as the pregnancy progresses. Women who lack the Rh factor (a substance found in red blood cells) are considered Rh-negative. Rh status, whether positive or negative, does not affect health before pregnancy. But during pregnancy, if an expectant mother is Rh-negative and her fetus is Rh-positive, problems can arise.
    4. Sexually transmitted diseases - Diseases such as syphilis and AIDS may be transmitted from mother to baby and can also cause birth defects and other health problems for the child.
    5. Hepatitis B - The hepatitis virus, which causes liver disease, can be transmitted to the fetus, resulting in a severe-and potentially fatal-infection of the liver.
  • Cultures. A culture is an examination of tissue to look for infection.
    1. Urine culture - A urine sample is cultured to determine if bacteria are present.
    2. Genital tract culture - The cervix is cultured for gonorrhea and chlamydia The lower vagina and rectum is cultured at 35 to 37 weeks of gestation for Group B streptococcus. If this is positive, the woman needs to be treated with antibiotics such as penicillin during labor to prevent a serious infection in the newborn.

Need To Know:

If an Rh-negative woman is carrying an Rh-positive fetus, her immune system may produce antibodies against the Rh factor in the fetus's blood. The result can be mild or severe damage or death in the fetus from Rh disease (also called hemolytic disease or erythroblastosis).

Physicians use a blood test to determine whether an Rh-negative mother is producing antibodies against red blood cells. If the test indicates that the mother had not produced these harmful antibodies, a physician can give a woman an injection of a blood product called Rh immunoglobin during and after pregnancy, and this prevents antibodies from forming.

Regular Visits During Pregnancy

During the prenatal visits, the doctor will check:

  • Blood pressure. A physician will carefully monitor a pregnant woman's blood pressure, because hypertension (high blood pressure) can be harmful to both mother and baby. Hypertension may result in preeclampsiaa potentially serious elevation of blood pressure that may occur late in pregnancy.
  • Mother's weight. Most women gain about 1 pound a week after the first trimester. Women within 20 percent of their ideal body weight should gain 25 to 35 pounds during the pregnancy. A slowing or stopping of weight gain in the mother can be an indication of poor nutrition. A rapid gain in weight could indicate excessive fluid retention (edema), which can be a sign of preeclampsia.
  • Uterine size. The growth of the uterus is checked each visit. It is determined by checking the fundal height-the distance between the top (fundus) of the uterus and the pubic bone. If the uterus is too small, it could indicate an error in the due date or that the fetus or volume of amniotic fluid is too small or the fetus is not growing normally. If uterine size is too large, it could indicate twins, excess amniotic fluid, or a large fetus.
  • Fetal heart rate. Listening to the sounds or movement of the fetal heart is the most certain method of assuring that the fetus is alive. This heart rate can be determined by two methods:
    1. Obstetricians can directly listen for the heart sounds of the fetus using a special stethoscope that is more sensitive than ones used on adults. The normal fetal heart rate is 120 to 160 beats per minute.
    2. Frequently, an ultrasonic device known as a doppler is used to detect the fetal heart rate. This device allows measurement of the fetal heart rate much earlier in pregnancy than the stethoscope and allows the mother to hear the fetal heart as well.

Nice To Know:

The doctor finds the top of a woman's uterus by gently tapping and pressing on her abdomen and measures from that point down along the front of the abdomen to her pubic bone. During the middle of pregnancy from about 18 to 34 weeks the fundal height, in centimeters, often equals the number of weeks of pregnancy.

Glucose Tolerance Test

A doctor may perform a glucose screening and testing to determine whether a pregnant woman has gestational diabetes. Diabetes involves an abnormality in the hormone insulin, which regulates levels ofblood sugar (glucose). In a person with diabetes, the body does not produce enough insulin, or it does not properly use the insulin it does produce. The result is an excess amount of glucose in the blood, which can give rise to numerous health problems.

Gestational diabetes is a form of diabetes that develops during pregnancy. It is caused by changes in a pregnant woman's metabolism and hormone production. Gestational diabetes poses many potential problems for the baby. For example, the baby may put on excess weight before birth, a condition called macrosomia.

To screen for gestational diabetes, the mother drinks a glucose solution containing 50 grams of glucose, and a blood test is done one hour later. If the glucose value in this blood test is high, a three-hour oral glucose tolerance test will need to be done. For three days prior to this test, the mother's diet should contain ample amounts of carbohydrates. On the day of the test, she must fast. Before drinking the glucose solution, and every hour for three hours afterward, the mother's blood glucose level is measured.

For more detailed information about diabetes that develops during pregnancy, go to Diabetes In Pregnancy.

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Is My Pregnancy Going Well?

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.