What To Expect In Obstetrics Care
Congratulations on detection of pregnancy :)
Each of your visit is with the intention of finding out if the pregnancy is progressing well and both mother and the growing baby are fine. We are outlining some of the things that you may expect during your office visits to us. Please note that the outlined plan and text serves as a general guidance, and individual plans will vary based on your specific situations.
Pregnancy Visit Planner
We generally suggest for the following frequency of Visit:
- First 28 weeks: Every 4 weeks
- 29th to 36 weeks: Every 2 weeks
- After 36th week: Every week till delivery
On your first visit:
A thorough medical history and examination will be done to have a risk assesment for mother and the growing baby inside you. It helps anticipate whether your pregnancy journey will be normal without any risks or whether it is a high risk pregnancy.
You may be asked questions such as :
- Detail history of any previous pregnancy
- History of blood pressure or diabetes in you or in your family
- History of any liver disease , or kidney disease in family or any such past history in you
- History of any allergies to any medications
You must disclose and tell us, any medications that you are taking on a long term basis. It includes ayurvedic or natural medicine as well.
Physical examination will be done, that may include pelvic examining outside of your vagina, vulva, vaginal opening for detecting any abnormalities, and a check on the uterus size etc.
First trimester visit (First 13 weeks)
Pregnancy duration is divided into three trimesters. Until the completion of 12 weeks is called the first trimester.
- Weight charting, BP measurement, uterine size, fetal heart rate assesment may be done
- Initial laboratory tests may include: tests for blood group, anemia (low hemoglobin), ruling out infectious disease such as hepatitis, HIV, immunity to Rubella etc.
- Ultrasound will be conducted to document a normal appearing fetus Chorionic Villus Sampling Trisomy 18 screening (in special cases)
In the first trimester, there is an increased chances of miscarriage, that can go upto 20 percent, due to some faulty genetic make up of the baby. Any bleeding during your first trimester, is a ‘high-risk- pregnancy’, and may signify threatened miscarriage. Such high risk pregnancy may need more deailed ultrasound and may need serial monitoring of hCG levels (hCG is a pregnancy hormone).
Second trimester visit (14-28 weeks)
Apart from ongoing clinical evaluation on weight, BP, uterine size, fetal heart assesment, there are some special tests that may be done during second trimester.
- Gestational diabetes testing (between 24-28 weeks)
- Fetal Anatomy Ultrasound
- Amniocentesis for genetic studies (in special cases)
- Alpha-fetoprotein (AFP) test to screen for neural tube defects and Down Syndrome
Third trimester visit (28-40 weeks)
You may expect the following evaluation during your third trimester:
- Evaluation of weight, Blood Pressure, uterus size and fetal well being assesment
- Biophysical profile of fetus and non stress test will be done here
- Detecting early preeclampsia
- Routine blood tests
- Gestational diabetes testing (if not done during second trimester)
- Group B Streptococcus screening (GBS) from vaginal swab may be conducted. This is done to prevent passage of harmful bacteria to the baby during child birth.
- Ultrasound to indentify location of placenta, growth of fetus to determine if there is macrosomia (big size baby) or intrauterine growth restriction (IUGR)
Post term pregnancy (after 40 weeks)
Some pregnancy may continue beyond 40th week (the due date). They are called ‘Postdate pregnancy’ or ‘Post-term’ pregnancy. They may lead to risks of oversize baby (other wise called as large or macrosomic baby); increase risk of labor abnormalities, increased risk of cesarean section. We favour induction of labour at 40+ weeks, to avoid various risks to mother and fetus. For post-term pregnancy, you will have a robust discussion on whether to go for elective induction , based on non stress tests (NST) and ultrasound findings to ensure well being of your baby.
High Risk Pregnancy
More detail evaluation with specific plans may be conducted in case you classify to a high risk pregnancy. There are multiple risks as per different trimesters that may put you into a high risk category.
High Risks during first trimester:
- Bleeding (threatened miscarriage): Remember it is the first trimester that has the highest risk of miscarriage. Any bleeding should be taken very seriously.
- History of any previous miscarriage
- Multiple gestation
High Risks during second trimester:
- Bleeding, during second trimester may be due to placenta abruption or placenta previa.
- Incompetent cervix (also called as cervical incompetence)
- Premature rupture of membranes
- Infection , kidney infection, urine infection during pregnancy
High Risks during third trimester:
- Decreased fetal movement
- Amniotic fluid abnormal: Low amniotic fluid (oligohydroamnios), high volume amniotic fluid (polyhydroamnios)
- Decrease reactivity on non-stress-test
- Liver problems during pregnancy: Hepatitis during pregnancy
High Risks during all trimesters:
- Bleeding or abnormal pain
- Diabetes during pregnancy or Gestational diabetes mellitus
- Hypertension during pregnancy or Pregnancy Induced Hypertension
- Thyroid disease during pregnancy, Hypothyroidism and pregnancy, Hyperthyroidism and pregnancy
- Alcohol intake
- Infection such as HIV, Hepatitis, Tuberculosis
- Any chronic illness for which you need any long term medication etc.