Once pregnant, a woman should be seen by a doctor between the sixth and eighth weeks of pregnancy (or when her menstrual period is two to four weeks late). This allows the doctor to estimate when the baby is due.
The first visit should include a complete physical examination, a complete pelvic examination and laboratory tests, including:
- A complete blood test
- A test for hepatitis B virus
- Tests for syphilis, gonorrhea and chlamydia
- Blood typing for the major blood groups and for the Rh factor and antibodies to it
- A test for rubella
- Urinalysis
- Pap smear
Screening tests for various conditions should be considered for women who are:
- Older than 35. These women should have chorionic villus sampling or amniocentesis for chromosome analysis
- Black women who may be at risk of having sickle cell trait or disease
- At high risk of having conditions such as Tay-Sachs or others that can be inherited
- From Asia or Latin America, homeless or susceptible to having tuberculosis
In providing care for a woman who is pregnant, a doctor may recommend:
- An ultrasound at least once during the pregnancy to ensure that progress is satisfactory. This can also help date a pregnancy if the delivery date is uncertain. It can help detect multiple pregnancy or potential risks such as placenta previa and ectopic pregnancy, the positioning and size of the fetus
- Taking steps to monitor the fetus if it appears to be in distress
- Procedures to diagnose before birth any abnormalities the fetus may have such as hydrocephaly, congenital heart defects, bowel or urinary tract obstructions or polycystic kidney disease.
- A fetoprotein (AFP) test should be given at 15 to 16 weeks. If AFP levels are high, it may mean that the fetus has spina bifida or other neural tube defect, multiple pregnancies or an inaccurate due date. If AFP levels are too low, there may be genetic abnormalities.
- A screening for abnormal carbohydrate metabolism around the first 12 weeks or so of pregnancy if a woman has a history of large newborns, unexplained fetal losses, repeatedly has sugar in her urine or a strong family history of diabetes
After the first visit, a pregnant woman should see her doctor again on the following schedule:
- Once a month until she reaches the 32nd week of pregnancy
- Once every two weeks until she has reached her 36th week of pregnancy
- Once a week until the baby is delivered
This allows the doctor or the doctor's assistant to check her vital signs, including blood pressure, weight and the size and shape of her uterus as the baby grows. The doctor will listen for the heart beat of the fetus. The patient will be checked for swollen ankles. Her blood sugar levels and urine will also be checked.
An average sized woman should expect to gain 25 to 30 pounds during her pregnancy -- about two to three pounds a month. It is important that mother and fetus get good nutrition as the fetus grows. Too much weight gain too early can deposit fat on both the fetus and the mother making pregnancy, labor and delivery potentially more difficult.
During this time a woman should ask questions and prepare for labor and delivery. She, her spouse or other support person should attend childbirth education classes.
Because anything that a pregnant woman eats or drinks circulates to her fetus, she should avoid any drugs (including vitamins and aspirin) unless her doctor prescribes them.
A doctor may prescribe iron supplements or folic acid supplements. Folic acid can help prevent neural tube defects.
If a woman is having nausea and vomiting during her pregnancy, she should try managing it with diet. Eating or drinking small amounts frequently to avoid hunger helps. Taking in bland foods like bouillon, rice and pasta may also help. Soda crackers and a soft drink often relieve nausea, as does eating before rising.
A woman can continue her normal activities and exercise during pregnancy. Sexual desire may change during pregnancy. Sexual intercourse is acceptable during this time. It should be stopped if the woman has any vaginal bleeding, pain, leakage of amniotic fluid or contractions of the uterus.
A woman should report it promptly to her doctor if she has any of the following:
- Headaches that don't go away
- Nausea and vomiting that persists
- Dizziness
- Disturbances in her vision
- Pain or cramps in the lower abdomen
- Contractions
- Vaginal bleeding or rupture of membranes
- Swelling of hands or face
- Lowered urinary output
- Any illness or infection
- Any problems that puzzle her
The next phase of pregnancy is labor.
