Everything To Expect at First Trimester Prenatal Appointments

by | Jan 30, 2020

You’re going to get to know your OB/GYN or midwife very well over the next 35 weeks or so. You’ll have many appointments for the progression of your pregnancy. 

These prenatal appointments are on a set schedule, however, if you ever have any worries or concerns, do not hesitate to give your provider a call. They are there to answer all of your questions and give you reassurance if needed. 

The prenatal appointment schedule for a normal, low-risk pregnancy goes as follows:

  • Weeks 4 to 28: 1 visit a month 
  • Weeks 28 to 36: 1 visit every 2 weeks
  • Weeks 36 to birth: 1 visit every week

In a high-risk pregnancy, your provider may change the schedule based on your situation. 

WHAT TO KNOW ABOUT YOUR PRENATAL VISITS

For a first time expecting mom, you may feel anxious about what’s to come. Here are a few things to know and remember about each important visit with your provider:

1.  COME IN WITH A LIST OF QUESTIONS

This whole pregnancy journey is very new and you will probably be thinking of so many questions in the weeks between appointments. 

Don’t expect your provider to give you all the information that you need at each visit. They have these appointments day in and day out with women at various stages of their pregnancies. They may not know exactly what’s going on inside your head unless you ask.

That’s why it’s important to jot down those concerns or issues because it’s so easy to forget when you’re sitting in the doctor’s office.

2. DON’T URINATE JUST PRIOR TO YOUR APPOINTMENT

You will always have to provide a urine sample at every appointment to check for abnormal protein in your urine. You also may need to have a full bladder for some of the first ultrasounds in order for them to see the baby well. Therefore, make sure that you don’t empty your bladder immediately prior to the visit!

3.  YOU DON’T GET TO SEE YOUR BABY AT EVERY VISIT

I know there’s nothing you’d love more than to see your sweet baby’s face on the screen every single day, but unfortunately, routine ultrasounds are not done that often.

The idea is not to expose the fetus to any more radiation than needed because it can potentially cause more harm than good. However, if you had any complications during pregnancy, are at high-risk, or are over 35, you may get ultrasounds more frequently.

Although you won’t see your baby, you’ll still get to hear their heartbeat through the doppler at every appointment. 

4.  YOUR BLOOD PRESSURE MAY BE VERY LOW

It is normal for a pregnant woman’s blood pressure to be lower than normal, so don’t be alarmed. 

WHAT HAPPENS AT EACH PRENATAL VISIT?

At your first prenatal visit, your provider will calculate your due date, schedule blood tests, may perform a pelvic and breast exam if you are not up-to-date, measure your height and weight, listen to your heart and lungs, and touch and push lightly on your stomach.

At each subsequent prenatal visit, your practitioner will perform these routine tests:

  • Take a urine sample: This will screen for proteins and sugars in your urine, both of which can show an increased risk for the health of mom and baby.
  • Weight check: Your provider will chart your weight throughout pregnancy to ensure that there are issues in relation to weight gain or gestational diabetes. 
  • Check your blood pressure: This is to check for high blood pressure which in a pregnant woman, can lead to a dangerous condition called preeclampsia.
  • Check baby’s heart rate via doppler: To listen for any abnormalities in the heart beat and ensure that the baby’s heart is healthy.
  • Measurement of uterus (fundal height) via tape measure: To track your growing uterus against what is typical at that stage of pregnancy.

Prenatal tests will be done to check the health of a pregnant woman and her baby. They can detect conditions that would put your baby at risk for problems if not treated. 

Some prenatal tests are screening tests that only reveal the possibility of a problem. Others are diagnostic tests that can accurately find whether a fetus has a specific problem.

These prenatal tests can offer expecting parents the peace of mind that their pregnancy and baby are progressing in a healthy manner. You can talk to your provider about the risks and benefits of a particular test and ultimately it’s your choice to accept or decline it.

In addition to the standard health checks given at every prenatal appointment, there are a few tests that can detect any serious issues with the baby.

FIRST TRIMESTER SCREENING

The first-trimester screening includes a blood test and urinalysis. This will most likely be done after your first appointment with your provider when your pregnancy is confirmed between 6-9 weeks).

Blood Test:

  • Complete blood count (CBC)- red and white blood cell and platelet count
  • Blood type
  • Rh factor– determines whether you are Rh positive or negative. Rh factor is a protein marker on your red blood cells. If you are Rh negative and the baby is Rh positive, your body can make antibodies against Rh factor. This can cause problems with subsequent pregnancies. To prevent antibody production, you will receive a shot around 27 weeks.
  • Previous immunizations– Rubella, Hepatitis B and C, Varicella, STI’s

Urinalysis:

  • Checks for urinary tract infections, glucose (an early indicator of gestational diabetes), and protein to compare to later protein tests for preeclampsia.

NUCHAL TRANSLUCENCY COMBINED SCREEN

This test is a detailed ultrasound given between 11 and 13 weeks that measures the amount of fluid behind the baby’s neck. This measurement combined with other factors provides a risk estimate of how likely your baby is to have the chromosomal disorders Trisomy 21 (Down Syndrome), Trisomy 18, or Trisomy 13.

The risk estimate is based on: your age, your baby’s fetal nuchal translucency (NT) score, and levels of two pregnancy hormones in your blood. You’ll get the results typically within a week and contain a risk estimate and whether that estimate is considered “positive” or “negative” for any of the three trisomies. 

This test is a screening which means that the results don’t tell you for sure whether your child has the disorder, but the likelihood of having it.

NON-INVASIVE PRENATAL TESTING (NIPT)

Non-invasive prenatal testing (NIPT) is an option for genetic screening that can be done as early as 10 weeks. It only requires a blood draw and has a higher detection rate for the three most common genetic abnormalities (Trisomy 21, 13, and 18). However, it is still only a screening, therefore it’s not 100% accurate.

In addition to testing for genetic disorders, the NIPT can tell you your baby’s sex with over 99% accuracy. 

Since this is typically an optional test, unless you have a high-risk pregnancy or are over 35, it is sometimes not covered by health insurance. Be sure to check with your policyholder beforehand to determine whether it is covered and if there will be any out-of-pocket costs.

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If either of these tests come back with a questionable result, more testing may be offered. 

Both the Amniocentesis and Chronic Villus Sampling (CVS) are invasive tests that take samples from the amniotic fluid or placenta. They can give you a more definite result of a possible genetic condition, however, they do carry some risk for you and the baby.

These tests are always optional so it’s important to talk about the benefits and risks with your physician. 

Genetic Carrier Screen

Carrier screening is an optional test done on parents (or those thinking about becoming parents) using a blood or tissue sample. These tests are used to find out whether a person carries a gene for certain inherited disorders.

Carrier screening can be done before or during pregnancy to assess risk or give you peace of mind for your child having a certain genetic disorder.

The sample is taken from the mother and father. If both parents have the recessive gene for a disorder, you may speak to a genetic counselor regarding the risks. However, if only one parent has a gene for a disorder or neither does, you have no worries that your child will have the disorders.

Here is what happens at your prenatal appointments with your doctor or midwife during your first trimester of pregnancy including routine & special tests.

Hi I’m Marissa!

A mom of two little ones, here to provide some relatable experiences, tips, and tricks to the joys and challenges of pregnancy and childbirth through raising babies and toddlers.  Read more about me here.