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First trimester, provider appointment #1 (week 8)

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

Out of all of the prenatal 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. Many practices will have you meet with a Nurse Practitioner (NP), Physician Assistant (PA), or Certified Nurse-Midwife (CNM) rather than your OB-GYN at your first visit. During your initial visit, you’ll go through a bit of an “interview” process, as your healthcare provider 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. At the first and all successive visits, the healthcare provider will usually check your weight, blood pressure, and have you leave a urine sample that will be tested for protein and glucose levels to make sure there are no indicators of preeclampsia, gestational diabetes, or infections.

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

  • hCG level: Human Chorionic Gonadotropin (hCG) is the hormone released by your fertilized egg early in pregnancy. Your healthcare provider will 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, imminent miscarriage, abnormally located pregnancy, or other medical condition.
  • Blood type, Rh factor: Your healthcare provider should 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 her, so your healthcare provider will have you take an injection later on in your pregnancy and after your pregnancy that will offset any ill effects.
  • Cystic fibrosis screen: You may be offered a screening test to determine if you are a carrier of cystic fibrosis (CF), a genetic disease that affects several of the babies’ organ systems, but particularly the lungs.
  • CBC: Your healthcare provider will take a CBC (complete blood count) to check your blood’s ability to transport oxygen to your unborn baby, and check your red blood cell count to determine whether or not you are anemic (not enough red blood cells).

Your healthcare provider will also perform different cultures and exams, including a pelvic exam, breast exam, Pap smear if you have not had one recently, and cultures to test for gonorrhea, chlamydia, and bacterial vaginosis or other infections such as syphylis, hepatitis and rubella.

Your healthcare provider will also probably discuss with you a general outline of how the next several months will go in terms of appointments, tests, and possible symptoms. They may begin talking to you about noninvasive prenatal testing. Noninvasive prenatal testing requires a blood test to measure the relative amount of chromosome material (abnormal number of chromosomes) in maternal blood. Chromosomes are structures inside every cell in your body and contain the genes which are inherited from your mother and father. People have 23 pairs of chromosomes – the first 22 pairs are called the autosome chromosomes and are identical in males and females; the 23rd pair is called the sex chromosomes (X and Y). Females have two X chromosomes and males have one X chromosome and one Y chromosome. Some people are born with an extra or missing chromosome, meaning they have one or three copies of a chromosome instead of two. This is known as trisomy. Noninvasive prenatal testing detects the most common fetal trisomies, including Trisomy 21 (Down syndrome), Trisomy 18 (Edwards syndrome), and Trisomy 13 (Patau syndrome). The test also detects other abnormalities called fetal sex chromosomal aneuploidies (an abnormal or incorrect number of the X or Y sex chromosomes) and other rare chromosomal conditions that your healthcare provider can discuss with you. Pregnant women who are at an increased risk to have a pregnancy with chromosomal abnormalities based on certain risk factors, such as advanced maternal age, personal or family history of chromosomal abnormalities, fetal ultrasound abnormality suggestive of chromosomal abnormalities, or an abnormal serum screening test, should be tested.


Read more
Sources
  • Sir John Dewhurst. Dewhurst’s Textbook of Obstetrics and Gynaecology. 8th ed. Keith Edmonds. John Wiley and Sons Ltd, 2012. Print.
  • “The Rh Factor: How It Can Affect Your Pregnancy: FAQ027.” ACOG. American College of Obstetricians and Gynecologists, 9/13/2015. Web.
  • “Cystic fibrosis and pregnancy.” March of Dimes. March of Dimes, 1/13/2015. Web.
  • “Cystic Fibrosis – Prenatal Screening and Diagnosis: FAQ171.” ACOG. American College of Obstetricians and Gynecologists, 8/11/2015. Web.
  • American College of Obstetricians and Gynecologists. “Routine Tests During Pregnancy: FAQ133.” ACOG. American College of Obstetricians and Gynecologists, 1/14/2015. Web.
  • “Gestational Diabetes: FAQ177.” ACOG. American College of Obstetricians and Gynecologists, 9/13/2015. Web.
  • Mayo Clinic Staff. “First trimester pregnancy: what to expect.” Mayo Clinic. Mayo Clinic, 4/22/2014. Web.
  • “ACOG’s Screening Guidelines on Chromosomal Abnormalities.” ACOG. American College of Obstetricians and Gynecologists, 5/7/2007. Web.

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