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Pregnancy | Prenatal Care

What to Expect from Prenatal Appointments

Throughout the nine months of your pregnancy you will have quite a few prenatal appointments to attend – the number depending on whether or not it’s the first time you are having a baby. It’s always a good idea to discuss general health issues and any concerns you might be having with your gynaecologist or midwife, and your prenatal appointments present the perfect opportunity to do this. There are also several pregnancy blood tests and scans to get through – some of them compulsory, and some still optional. Let’s take a closer look at what to expect from prenatal appointments - from your very first check-up right through till the birth of your new bundle of joy.

As soon as you have a positive pregnancy test you can make and appointment to see your gynae or midwife. Typically you should be seen every four weeks in the first and second trimester, and every two weeks in your third trimester. If your baby hasn’t arrived by week 40, however, you’ll start seeing your gynae or midwife once a week or more often. And should you have any pregnancy complications, the number of appointments will naturally be noticeably higher.

Women that are pregnant for the first time will on average have ten prenatal appointments throughout a normal, healthy pregnancy. If you’ve been pregnant before, on the other hand, the number of appointments goes down to about seven.

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Your first prenatal appointment
Your very first prenatal appointment should take place between the eight and twelfth week of your pregnancy; most women schedule it for around week 10. During this appointment, which will probably be the longest out of all of your prenatal appointments, you gynae or midwife will ask you a few questions related to your lifestyle, previous births/miscarriages/abortions, family history of diseases and the date of your last period – in order to calculate your due date. Your blood pressure will be checked and you’ll have a pregnancy blood test and a urine test. An ultrasound pregnancy scan can also be done to measure the size of the fetus – which means that you might be able to see your baby for the first time! You won’t need an internal examination, but your gynae or midwife might feel your abdomen, and your height and weight will be measured. At your first prenatal appointment it’s also very important that you ask all the questions that are buzzing around in your head, as your gynae or midwife will be able to answer anything and give you advice that will put your mind at rest.

Pregnancy tests
There are quite a few pregnancy blood tests to get through during your pregnancy. While screening tests can asses the risk of abnormalities, a diagnostic test can be offered if the screening tests shows any abnormalities. Early pregnancy blood tests taken by your gynae or midwife will be checked for a number of things – such as immunity to rubella (German measles), anaemia (iron levels) and your rhesus status. Most people are RhD positive, but if you are RhD negative and your baby RhD positive, you might get very ill if your baby’s blood enters your bloodstream. You can also screen your blood for HIV, syphilis and hepatitis B – unless you opt not to. And at around 28 weeks your blood can be tested for the level of glucose – in order to determine if you suffer from gestational diabetes or glucose intolerance.
Chorionic Villus Sampling
(CVS) can determine if your baby has a chromosomal disorder, and can be done as early as eight weeks. A small needle/catheter is placed either through the abdomen or through the vagina near the uterus to collect a small sample of villi. Ultrasound is then used to guide the needle/catheter away from the baby and the placenta. The amniocentesis test is done in a similar way, and collects a sample of amniotic fluid. This test can also determine whether your baby has a chromosomal disorder – from as early as 11 weeks. The same test can check fetal lung maturity after week 34 of your pregnancy. AlphaFetoProtein (AFP) testing is done to help provide a screening for Neural Tube Defects (NTD) like spina bifida and anencephaly. This test is most effective between 15 and 17 weeks of gestation. Screening your blood for your baby’s risk of Down’s syndrome is done along with a Nuchal scan – explained later in this article.
Urine tests will check for protein in your urine in order to detect early signs of preeclampsia – a high blood pressure disease that can occur during pregnancy. You can also check the urine for bacteria to rule out the possibility of a urinary tract infection.
Apart from these tests you can also listen to your baby’s heartbeat during any of your prenatal appointments, should you wish to. This is typically done with a stethoscope or a Doppler – which uses ultrasound. Palpation is another routine test offered – and sees your gynae or midwife feeling your abdomen manually to check your uterus’s height and the position of your baby.

Pregnancy scans
A few ultrasound pregnancy scans will be available and scheduled throughout your pregnancy. When getting ready to have an external scan, it’s important to remember to drink lots of water in order to make your bladder push your uterus upwards for a better picture. During your scan you will lie down and the operator will spread a gel on your tummy before rolling a transducer across your abdomen. Apart from being offered a routine pregnancy scan at your first prenatal appointment, you can also have one done at around 14 weeks to determine the baby’s due date and to check whether you are having twins. You also have the option of having a nuchal scan to assess the risk of Down’s Syndrome or other chromosomal conditions. The nuchal scan measures the nuchal translucency – a fluid located at the back of the baby’s neck. This scan must be done before you are 14 weeks pregnant, as after this the fluid may drain or resolve itself. At around 20 weeks, if you choose to, a fetal anomaly scan can be done to detect other abnormalities. This scan is detailed and looks at your baby’s major organs and skeleton – checking for conditions such as spina bifida. Any scans available later in the pregnancy are simply routine scans and will check your baby’s growth, as well as the position of the placenta and the position of your baby. Apart from being able to detect abnormalities, ultrasound pregnancy scans also allow you to tell the sex of your baby – that is if you want to know, and if your baby cooperates at that specific time.

Routine prenatal appointments
Let’s lastly look at what to expect from the rest of your routine prenatal appointments – apart from the tests and scans mentioned above. If you are pregnant for the first time, these prenatal appointments will typically be scheduled for week 16, 25, 28, 31, 34, 36, 38, 40 and also for week 41 – if you haven’t had your baby by then. If it’s not your first pregnancy, however, prenatal appointments will typically be scheduled for week 16, 28, 34, 36, 38 and 41.
At these routine appointments your gynae or midwife will check your blood pressure and urine. At 25 weeks your gynae or midwife can also start measuring the size of your bump – from the pubic bone to the top of your bump. This centimetre measurement is normally close to the number of weeks that you are pregnant. And at 31 weeks your gynae or midwife can take another pregnancy blood test in order to rule out anaemia – as this is more common later in pregnancy.
Appointments will be bi-weekly in your third trimester – just to be on the safe side and to monitor closely how you and your baby are progressing. And if you still haven’t given birth by week 41, your gynae or midwife might talk to you about having an induction.

Now that you know what to expect from prenatal appointments, you shouldn’t have much to worry about. If you find that you do worry, however, don’t be afraid or hesitate to contact your gynae or midwife. They are there to help you, and will without doubt be able put your mind at rest!

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