Prenatal Calendar

Your pregnancy test is positive and you should come in for your first visit around this stage in pregnancy.

What to expect at your visit:

Your first visit is the most involved. We discuss our practice, take a full medical history, and do a full physical exam, including a pap smear.  We will also give you some literature on pregnancy and samples of prenatal vitamins at this visit.

Normal symptoms at this stage of pregnancy:

The most common complaint in early pregnancy is fatigue. It is very common at this stage to sleep long hours but have no energy. Breast tenderness and some early nausea are also common. Although most bleeding is benign in early pregnancy, if you have any bleeding you should call us immediately.

What to expect at your visit:

At every visit the baby's growth and heartbeat are assessed. At this stage in the pregnancy, the baby is very small and these two tasks are difficult. The best way to evaluate the baby early in pregnancy is with ultrasound. Since the embryo is very tiny, the ultrasound is usually done vaginally. This allows us to make important checks, such as the number of embryos, the position of the embryo, whether it is in the uterus and not in the tubes or elsewhere, and sometimes even see a heart beat. The heart beat is the most reassuring sign that you're not going to have a miscarriage. We also perform the ultrasound to measure the size of the baby and the baby's heartbeat. You can usually hear the heartbeat during this visit. A baby's heartbeat is about twice as fast as an adult, normally 110 to 160 beats per minute, and at this early stage can be even faster.  Before you leave your this visit, we draw a small sample of blood. For this visit you should plan on being at our office for up to two hours.

Normal symptoms:

The biggest hurdle at this point in your pregnancy is nausea, usually referred to as morning sickness. This term is not wholly accurate since the nausea can occur at any time of the day or night, and in some pregnancies, all the time. You may also feel some mild menstrual type cramps as the uterus begins to stretch and grow.

What to expect at your visit:

At this point in your pregnancy, we should be able to hear the baby's heartbeat by placing a small listening device, called a Doppler, on your abdomen. We also measure your abdomen to make sure the uterus is growing appropriately. At this point in the pregnancy (11-14 weeks), there is a blood test done to check for Down Syndrome and spina bifida. This test , which has become standard practice for many years, checks 4 different chemicals in your blood. These results and other information, such as age, weight, and race, are input into the lab's computer and a risk assessment for Down Syndrome (DS) and neural tube defects, also known as spina bifida, is given. We consider a risk for DS greater than 1 in 270 to be positive. The only sure way to rule out DS is with amniocentesis and this may be recommended as the next step. If you will be 35 years of age or older when the baby is born, we may discuss skipping this blood test and proceeding directly with amniocentesis.

Normal symptoms:

While your baby has been moving since as early as 8 weeks, you should now be able to feel its movements.

What to expect at your visit:

At this stage in the pregnancy we do a full ultrasound to look at the baby's anatomy and check for growth. At this visit we can find out the sex of the baby, if our little patient is cooperative. Many birth defects can be seen using ultrasound, but the smaller the problem, the harder it is to see and some issues can't be seen at all. Issues that are genetic or metabolic, like Down Syndrome or Sickle cell anemia, can't be seen using ultrasound.

Normal symptoms:

Headaches are very common at this point in pregnancy and are similar to migraine headaches. Unfortunately, most medicines used to treat migraines are not safe to use during pregnancy.  Tylenol is safe to use during pregnancy
 

What to expect at your visit:

At this point in your pregnancy, the baby is growing quickly. As with previous visits, we will take a urine specimen to check protein, ketones, and glucose levels. We will also weigh you, check your blood pressure, measure your uterus, and listen to the baby's heart with a Doppler. When measuring the baby's growth, we measure from the pubic sympysis to the top or "fundus" of the uterus. This should roughly be the same number of centimeters as weeks in your pregnancy. For example, at 24 weeks, your fundal height should be 24cm. At this visit, we will give you your registration packet from the hospital. Inside the packet, you will find all the information you need to sign up for classes on everything from baby CPR to childbirth to breast feeding.

Normal symptoms:

A very common symptom during this point of the pregnancy is "round ligament pain." The round ligaments are two very small ligaments that go from each side of the uterus to the pelvic floor. They are about the size and length of your little finger, and as the uterus grows, they get stretched. This stretching usually presents itself as a sharp pain on one side or the other and gets worse with various movements such as walking or rolling over in bed. Near the end of this stage, you may also experience  uterine cramping, also referred to as "Braxton-Hicks contractions."

What to expect at your visit:

During this stage of your pregnancy we perform a test for gestational diabetes. Diabetes is a condition characterized by high blood sugar. Gestational diabetes occurs only during pregnancy. The test we preform involves drinking a very sugary drink, usually given at the previous visit, followed by having blood drawn one hour later. If this blood sugar value is above 140, you need to take an additional test that will clearly tell us if you have gestational diabetes. After this visit, the time between appointments decreases from one month to two weeks.

Normal symptoms:

Uterine cramping, or "Braxton-Hicks" contractions, are very common at this stage in your pregnancy. The more times you have become pregnant, the earlier they begin and the stronger they can feel. Most women have only a few of these contractions in a single day. If you have more than six in an hour, this could be signs of pre-term labor, and you should call us.
 

What to expect at your visit:

During this stage, your visits will occur every two weeks unless there is a complication with your pregnancy and we need to see you more often. At every visit, we will check the growth of your uterus  and listen to the baby's heartbeat. There are no routine labs or tests done during this period. This is also the time when you should be signing up for birthing classes and scheduling a tour of the hospital.

Normal symptoms:

Back pain is very common at this point in your pregnancy. As the baby grows, the extra weight puts a lot of strain on your lower back. Massages and heat on your back, NOT on your abdomen, work the best to relieve pain. Heartburn is also common as the baby starts to push up on your stomach. We have a list of safe medicines for this and other common problems available if you have not already received one.

What to expect at your visit:

You're getting very close now! During the final stages of your pregnancy, your visits will be every week. Around 36 weeks we perform a test for the Group B Strep (GBS) bacteria on all women. This bacteria usually doesn't cause infections in adults, but can cause serious infections in newborns. The test involves a quick vaginal swab and results take about a week. If you have this bacteria, as about 1 in 4 women do, you'll receive antibiotics during labor to protect the baby. The antibiotics are administered through your IV. They cross the placenta and enter the baby's circulation, protecting him during birth. During the final weeks of your pregnancy we start performing checks to see if your cervix, the opening of the uterus/womb where the baby comes out, is dilating.

Normal symptoms:

Labor is the obvious sign to look for at this point in your pregnancy. If you have contractions every five minutes for an hour, any vaginal bleeding, a sudden gush of fluid, or your baby is not moving, call us immediately.