The Initial Visit
Prenatal care involves a series of regular examinations and tests by your physician. In an uncomplicated pregnancy, most women will be seen once a month until the 30th week of pregnancy. At this point, you will be seen every two weeks and in the final month of pregnancy (36 weeks until delivery) your visits will be increased to weekly.
The prenatal period not only gives the expectant mom time to get ready for the baby’s arrival, but it is also an opportunity for the expectant parents to get to know the person or persons who will be directly involved in your care during labor and delivery. The initial prenatal visit is often the longest. During this first visit, a complete physical examination, along with a detailed family history and blood and lab work will be performed. Your doctor will calculate your baby’s due date and that date will serve as a reference point in future visits when the baby’s growth is assessed.
During the first prenatal visit the physical examination involves an overall assessment of the mother. This includes an assessment of the heart, lungs, and thyroid function, along with an examination to rule out any other infection. Next, your doctor will perform an obstetrical exam, which includes a look at the mother’s abdomen and measurement of the height of the uterus, along with an internal pelvic exam. We will also perform a brief ultrasound study to confirm your dates, determine the number and location of fetuses present and help ensure that the pregnancy is developing normally.
A series of blood tests are also performed during the initial prenatal visit. The blood and laboratory tests that are recommended during the first visit include:
Hemoglobin - This test checks the mother’s blood to determine if she is anemic. Women usually become slightly anemic as the pregnancy progresses, but very low levels will need to be treated.
Blood type and RH with antibody screening - This test determines the mother’s blood and RH type and antibody factor. If the mother’s blood type is RH negative and her partner’s is RH positive, special monitoring of the fetus is necessary to check for RH incompatibility.
Rubella titer - This test checks the level of antibodies to the German measles virus that are present in your blood. If a woman becomes infected with German measles (Rubella) during her pregnancy there are known risks to the developing fetus.
Syphilis screen - This test checks for the presence of syphilis infection. If present, treatment can be initiated so that the fetus is not harmed.
Hepatitis B and C screen - This test checks for infection with the Hepatitis B or C virus, which can be passed to an unborn child. If present, the mother can be treated during the prenatal period and the baby at birth.
HIV screen - This tests checks for the AIDS virus. If a woman is found to have HIV infection she can be treated during pregnancy, which will reduce the chances of her passing the virus to her unborn child.
PAP smear - This test checks for abnormal cervical cells, which could indicate cervical cancer.
Gonorrhea and Chlamydia cultures - Both of these infections, if present in the mother, must be treated to prevent infection of the baby at birth.
Urinalysis - This test examines the urine for the presence of bacteria, sugar or protein. It is usually performed at each prenatal visit
During following visits we recommend other testing for your pregnancy to asses your and your baby's health, These tests will include the following:
Ultrasonography - At approximately 18-20 weeks, our physicians recommend all patients to undergo a detailed ultrasound study to evaluate the internal structures of the fetus. This study looks for structural and congenital abnormalities that may affect the pregnancy, delivery, or neonatal period. Sometimes, follow-up examinations are recommended to evaluate fetal growth, fluid levels and presentation of the fetal parts.
Glucose Testing - During the 24th-28th week of pregnancy a glucose tolerance test is usually performed. Following ingestion of a sugar drink, a woman’s blood sugar level is measured to check for a condition of pregnancy called gestational diabetes. If gestational diabetes is present, special efforts will be necessary to maintain the mother’s blood sugar at a normal level. This can often be accomplished with dietary restrictions, but may at times require the mother to take insulin. In the vast majority of cases, gestational diabetes resolves following delivery, although women who develop diabetes during pregnancy should be monitored later in life for the development of diabetes.
Hemoglobin - Your doctor usually will recommend a repeat screening to check a woman again for evidence of anemia somewhere around the 26th-28th week of pregnancy. If present, we will evaluate further and prescribe iron supplementation if necessary.
Group B Streptococcus Swab - This test involves a culture of the vagina to check for the presence of group B strep bacteria. This bacteria lives within the intestines and may occasionally colonize in the vagina. It is not transmitted from person to person. This test is usually performed toward the end of pregnancy, around the 36th week. If the bacteria are present, the mother must be treated when your water breaks or during early labor, to prevent infection of the baby during the birthing process.
Repeat Urine Culture, HIV, and Syphilis – Florida State Law recommends that these tests are offered to be repeated at 28 weeks to ensure no infection during pregnancy. You may sign a waiver to refuse these tests, but they add an extra level of safety to ensure that your pregnancy remains safe and healthy.