Initial Prenatal Visit:
Prenatal care (the care you get during pregnancy) should start as soon as possible after you find out you are pregnant. We prefer to see patients before 10 weeks of pregnancy, so call us to make an appointment right after your first positive pregnancy test. Establishing an accurate due date or estimated date of delivery is very important and is best determined by performing an ultrasound in the first trimester. An accurate due date allows us to monitor your baby’s growth and the progress of your pregnancy, as well as schedule certain tests or procedures at the most appropriate time. The ultrasound is also very reassuring for you because most of the time you will actually see the baby inside the uterus, see the heart beating and confirm that there is only one baby (or more)!
Your initial visit will be the most time consuming and will consist of:
- A complete history and physical examination including pap smear and cultures
- Weight, blood pressure and urine screening
- Initial prenatal blood work
- Prenatal education and counseling
- Ultrasound (if you are within the first trimester)
Your future visits will be scheduled as follows:
- From 6-28 weeks = every 4 weeks
- From 29-35 weeks = every 2 weeks
- From 36 weeks to delivery = every week
- This may vary depending on the health needs of each individual
- Cervical checks will usually be done starting at 35 weeks until delivery
At each follow-up visit we will check:
- Weight, blood pressure, urine screening (check for glucose and protein)
- Listen to fetal heart tones and evaluate growth
- Answer any questions regarding your pregnancy
The following is an overview of some of the special tests and procedures that we offer during your pregnancy.
Cystic Fibrosis (CF) screening- CF is a genetic life long illness causing problems with digestion and breathing. CF carrier testing is to see if a couple is at increased risk of having a child with CF. The test is done on a sample of blood or saliva. It does not detect all CF carriers. If the test is positive on the mother, additional testing is done on the father to determine if the child will be at risk of having CF. If one parent is a carrier and the other parent is not a carrier, there is still a small chance the child could have CF.
Noninvasive Prenatal Screening tests- these are newer screening tests that analyze fragments of your baby’s DNA in your blood to assess the risk of Down’s syndrome and other genetic conditions more accurately than traditional tests. Traditional screening tests fail to identify over 20% of Down’s syndrome cases in addition to the 5% false positive rate. These newer screening tests identify 99% of Down’s syndrome cases with false positive results of less than 0.1% reportedly. These tests are optional for all pregnant women and are covered by most insurance. Women who are at higher risk for an infant with Down’s syndrome or other birth defects should definitely consider this option. You also have the option to obtain information about the sex of your baby and can have an accurate assessment of this as early as 10 weeks.
Alpha Fetoprotein test- the Prenatal Screening Program in California provides pregnant women with the traditional risk assessment for birth defects including Down’s syndrome through one or two blood tests drawn during the time period stated above. The screening test indicates risk but does not diagnose birth defects. A positive or abnormal AFP screen does not mean that there is a problem with the baby. However, women with positive screening results will be referred for a free consultation with a specialist called a perinatologist for further evaluation. The decision to have the AFP test done is voluntary, and if you decide not to do it, you will sign a form documenting that you were offered the test but declined.
Ultrasound- We perform an ultrasound during this time because we can generally determine if the infant appears normal and also if it is a boy or girl. Unfortunately, the technology of ultrasound is not perfect, and everyone has heard of parents who were told to expect the opposite sex of the infant that actually delivered. You must remember, that even though ultrasounds can generally detect major fetal anomalies, the presence of subtle anatomical and/or functional anomalies cannot be definitively ruled out. The fetus is usually not visualized appropriately earlier in pregnancy, but for those of you who just can’t wait to possibly see if it is a baby boy or girl, you can ask the receptionist for the details on how to schedule a limited “sex sono.”
Gestational Diabetes screen- this is a blood test that is drawn one hour after you finish a glucose drink that you will ask the receptionist for when you arrive for your appointment. It is recommended that you do not eat any concentrated sugars for eight hours before this test. This is not a fasting test. You may eat and drink before the test, but avoid anything with a lot of sugar in it. Gestational Diabetes is a form of diabetes that may develop during pregnancy without any symptoms. If this screen is elevated, you will need to do a fasting blood sugar followed by a 3-hour glucose tolerance test which is the definitive test for gestational diabetes.
During pregnancy, some women develop anemia which means the iron level in your blood is low. Iron carries the oxygen around your body so you may feel more tired if your iron level is low. When we draw your blood for the diabetes test, we also check your iron level again. If it is low, we will prescribe extra iron to take with your daily prenatal vitamins.
If your blood type is RH negative, you will be given an injection of Rhogam after the results of these tests are returned from the lab. This injection protects the baby (and future babies) if the baby’s blood type is RH positive. After delivery, you will also need to receive another Rhogam injection at the hospital if the baby’s blood type is found to be RH positive.
Non-stress test (NST)- this test is used to check the well-being of the baby by monitoring it’s heart rate in Labor & Delivery. This is not a routine test. It is done in the latter part of pregnancy when there is a suspected fetal or maternal problem. For instance, a woman complaining that she hasn’t felt her baby move enough, or she has developed hypertension or diabetes during pregnancy. NST’s may be continued twice weekly until delivery.
Group B Strep screening- this is a vaginal culture performed on the mother to detect if she has group B strep bacteria present. These bacteria are harmless to the mother but can cause a life-threatening infection to the infant. If group B strep is detected, the mother will be given antibiotics during labor. She will need to inform the nurse taking care of her in L & D if she is GBS positive that she requires antibiotics from the time of admission to delivery. Antibiotics are given to decrease the chance that the baby will develop a group B infection. This treatment does not guarantee that the baby will not develop this infection. If your baby develops a fever during the first few weeks of life, you must notify your pediatrician immediately.
Follow up Ultrasound- this is generally ordered around this time to verify fetal position, placenta location, assess the amniotic fluid adequacy and to estimate the weight of the baby. Again, based on limitations inherent to ultrasound technology, this is only an estimate based on sometimes imprecise measurements of the baby. While this is safe and the most accurate way to assess weight, there is no method available that can accurately predict the weight of a baby prior to birth.