Congratulations on your new pregnancy! We realize what an exciting time this is for you and look forward to working with you to make this a joyous event. Thank you for choosing our practice. At your first or second obstetrical visit, we will give you a pregnancy education packet. Much of this information is also here on the website. Please feel free to call the office if you have any questions or concerns not addressed below.
Schedule of Prenatal Visits
The first step is to confirm you are pregnant, this office visit should be scheduled six weeks after your last menstrual period (or two weeks after a missed period) and may include an ultrasound. After the confirmation visit, an initial pregnancy visit is scheduled. This visit takes longer than usual because it includes a thorough review of your history and blood tests, a full physical exam, and discussing a wide variety of topics to get the pregnancy off to a good start.
Subsequent prenatal visits are generally every four weeks until you are 28 weeks pregnant, every two weeks from 28-36 weeks, and then weekly until 41 weeks, which is one week after your due date. These visits will involve checking your weight, urine for protein and sugar, blood pressure, monitoring the growth of your baby, listening to the heartbeat, reviewing your diet, and discussing any questions or concerns you have.
Prenatal visits may be more frequent if needed, based on your specific pregnancy course and needs.
Initial Blood Tests
The initial prenatal labs include a blood count, a blood type and RH status, a test for unusual red blood cell antibodies, a test for hemoglobin disorders, a test to see if you are immune to rubella (German measles), and tests for syphilis, HIV and hepatitis B.
We generally perform two medically indicated ultrasounds in our office:
- First trimester: This helps confirm your due date or evaluate bleeding.
- Second trimester: Occurring around 20 weeks, this ultrasound is used to assess the anatomy and growth of your baby. Often the sex of the baby can be determined at this time, if you want to know.
Additional ultrasounds are done if medically necessary to monitor the health or growth of your baby. Occasionally we refer patients to the Yale Maternal-Fetal Medicine group for an ultrasound.
Although there appears to be minimal risk with ultrasound, we do not schedule these tests “just to take a look,” but if you have any specific concerns about your baby’s growth or development, please discuss this with us and we will schedule more tests if necessary.
Optional Testing of Pregnant Women
Some diseases are passed from mother to baby by genes. Blood from a pregnant woman can be tested to find out the risk of specific genes being passed to the baby. Even if you are healthy and have no family history of these diseases, you may have a single gene or be a ‘carrier’ of a disease.
Your genes never change. Therefore, these tests do not need to be repeated in future pregnancies. Testing is typically done early in pregnancy, but may be done at any time.
The most common genetic disease tests are offered to everyone. Additional tests may be offered based on your family history or ethnic background. Knowing if your baby has a chance of inheriting a disease may change the way you plan for your baby or how you manage your pregnancy. The midwife or doctor will review these testing options at a prenatal visit in the first trimester.
Optional Testing for the Baby
There are two groups of problems that can be screened for without any risk to your pregnancy or baby:
- Down Syndrome or chromosomal problems: The risk for chromosomal problems can be determined using tests of a pregnant woman’s blood and may include an ultrasound of the baby’s neck. Having this information may change the way your plan for your baby or how you manage your pregnancy. The midwife or doctor will review the type of testing that is most appropriate for you at a prenatal visit in the first trimester.
- Spina Bifida or neural tube defects: A test of the pregnant woman’s blood can be done to determine the risk for problems with the development of the spine, spinal cord, or brain. We recommend this testing to everyone; it can be done in the early part of the second trimester (15-21 weeks).
If there is a higher-than-normal chance your baby has a problem, other types of tests to determine the health of the baby may be performed. These usually involve extensive counseling and procedures (chorionic villus sampling or amniocentesis) by Maternal Fetal Medicine at Yale. The midwife or doctor will discuss these tests with you if they are indicated.
Between 26 and 28 weeks, we will check your blood count, offer an HIV test, check again for syphilis (as required by Connecticut state law), and do a glucose screening test for gestational diabetes. Because of a hormone put out by the placenta, some women cannot metabolize glucose as well during pregnancy. If the mother’s blood sugar is too high throughout the end of her pregnancy, the baby can grow too big, and can have problems maintaining its blood sugar following birth. Babies with very low blood sugar can have problems with seizures, maintaining their temperatures, and adapting to life outside the uterus. Many women with gestational diabetes are able to maintain a normal blood sugar range with diet modifications, and the baby generally does very well.
Gestational diabetes screening is done by a 1-hour glucose challenge test. Fasting is not required for this test. At the lab you will be given a sweet sugar solution to drink; one hour later a sample of blood is drawn to check your glucose level. If the glucose level is normal after one hour, no further testing is done. If the glucose level is high, we will ask you to have a fasting 3-hour glucose tolerance test (GTT). If two of the values (one, two and three hours after drinking the glucose solution) OR the fasting glucose on the three-hour test are elevated, we will consider that you have gestational diabetes.
Group B Strep
We test all pregnant women at 36 weeks for Group B streptococcus (GBS) using a vaginal swab. It is a very common bacteria. It resides in the gastrointestinal tract of up to 40% of men and women. In women, it can grow in the urinary tract or vagina as well. People who have these bacteria are said to be “colonized” and are called “carriers.” There is no way to get rid of GBS permanently. It tends to come and go, and rarely causes symptoms in adults.
Why is this important during pregnancy? 15-40% of women are colonized with GBS during their pregnancies. There are no symptoms, and colonization may come and go. GBS is not treated during pregnancy unless it is present in high amounts in the urinary tract.
In rare circumstances, GBS can cause a serious illness in the newborn if the mother is colonized. Almost all GBS illness in newborns can be prevented with universal screening. That means that each pregnant woman is tested for GBS at the end of pregnancy. If the culture is positive, the mother is given IV antibiotics in labor. Approximately 99% of babies exposed to GBS do not become infected.
More information is available at these websites:
When to Call – Warning Signs During Pregnancy
At any time during pregnancy you should call us if you have:
- persistent pain or pain that comes and goes at regular intervals
- fever (over 100.4 F)
- painful urination
- vomiting that lasts more than 24 hours
- severe headache that is not relieved by Tylenol (acetaminophen)
- blurry vision or flashing lights in front of your eyes
- leaking fluid from the vagina
- contractions that do not stop right away when you get off your feet and drink water (unless you are more than 36 weeks – contractions are normal then)
- decreased fetal movement
- you are concerned that “something isn’t right”