First trimester provider appointments

You’ll only need to visit with your healthcare provider a couple times during the first trimester, but he or she can act as an invaluable resource for you from the start.

1st Trimester, 1st Appointment (Week 8)

Out of all of the pre-natal visits you will make (about fourteen regularly scheduled visits, not including any further testing or ultrasounds), your first one will probably be the longest at about 45 minutes, and will also be the only one in which you may meet with a Nurse Practitioner (NP) or Physician Assistant (PA) rather than your OB/GYN if you have one. During your initial visit, you’ll go through a bit of an “interview” process, as your medical professional tries to better understand your personal and family medical history, information that will help them guide you through your pregnancy, and recommend certain tests and screens that you should take. At the first visit, like all visits after it, will also check your weight, blood pressure, and have you leave a urine sample that they will test for protein and glucose levels to make sure there are no indicators of preeclampsia, gestational diabetes, or certain infections.

The healthcare provider will also send you to the lab for blood work, where they will test for the following:

  • hCG level: Human Chorionic Gonadotropin is the hormone released by your fertilized egg early in pregnancy. Healthcare providers want to make sure that your hCG level is within the recommended range, as excess hCG levels can indicate a possibility of a chromosomal disorder or imminent miscarriage.
  • Blood type, Rh Factor: Technicians will determine whether or not a protein called Rhesus (Rh) is present in your blood. If you are Rh-negative (Rh not present) and your baby is Rh-positive, you could build antibodies that might be dangerous for him, so your healthcare provider will likely have you take a injection later on in your pregnancy that will offset any ill effects.
  • CF Screen: Your blood may be screened to detect Cystic Fibrosis, a genetic disease that affects the lungs, as well as other organs. You may also choose to be screened for other conditions.
  • CBC: Your provider will take a CBC (Complete Blood Count) to check your blood’s ability to transport oxygen to the womb, and check your red blood cell count to determine whether or not you are anemic (not enough red blood cells).
  • Other tests: You may also be tested for other conditions like syphilis, Hepatitis, RPR, HIV, and rubella.

Your Nurse Practitioner, Physician Assistant, or other medical professional will also perform different cultures and exams, including a pelvic exam, breast exam, Pap smear if needed based upon the current guidelines, and cultures to test for gonorrhea, chlamydia, and bacterial vaginosis.

He or she will also probably discuss with you a general outline of how the next several months will go in terms of appointments, tests, and possibly symptoms, and they may begin talking to you about non-invasive prenatal testing, a popular new diagnostic tool that is safer in practice than an amniocentesis or chorionic villus sampling.

1st Trimester, 2nd Appointment (Week 12)

The second prenatal visit might be your first appointment with your OB/GYN if you elect to use one, so it may also run a bit longer than the ones to come. As in the first appointment, your healthcare provider will ask you some questions about your medical history and current health, just to more fully understand the individual specifics of your pregnancy.

As always, the provider will take your weight, blood pressure, and have you leave a urine sample, which they will check for sugar and protein levels, as elevated quantities of these can indicate preeclampsia and gestational diabetes respectively. And if you did not undergo a physical examination at your first appointment, you will almost certainly have one done now. Your doctor, NP, PA or midwife will probably also offer two other forms of testing at this appointment:

  • Fetal doppler: Using a fetal doppler, a hand-held ultrasound device, your provider will check the baby’s heart rate to make sure all is going smoothly.
  • First Trimester Combined Screening: Although this screening process cannot diagnose chromosomal abnormalities, medical professionals can use the information obtained to determine whether further testing is necessary. The screening is basically divided into two parts:
    • Using an ultrasound, your provider will measure the amount of fluid behind your baby’s neck, which can be a sign of Down Syndrome or other abnormalities when the amount is too high. This is known as Nuchal Translucency Screening.
    • You will have blood drawn, which your healthcare providers will check for levels of Pregnancy-associated plasma protein A (PAPPA) and human chorionic gonadotrophin (hCG), as lower or higher than normal amounts, respectively, can indicate chromosomal abnormalities.

There is an increased age-related risk of fetal anomalies, so it’s especially important that older moms get screened. Although these screening tests can identify about 85% of abnormalities, they also have an approximately 5% false positive rate. And because the amount of babies with abnormalities is so much smaller than the amount of healthy babies, the 5% of false positives represent a significant portion of those whose tests raised red flags. This means that only about 1 out of every 200 First Trimester Screening positives are actually cases of chromosomal abnormalities. So although all babies who screen positive will be referred to further, more conclusive diagnostic testing like amniocentesis or chorionic villus sampling, a positive result on the First Trimester Screening is not a sure-fire indicator of a risk.


Read more
Sources
  • Mayo Clinic Staff. “Prenatal care: 1st trimester visits.” Mayo Clinic. Mayo Clinic, 7/31/2015. Web.
  • “Prenatal care in your first trimester.” U.S National Library of Medicine. MedlinePlus, 6/11/2014. Web.
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