What To Expect At First Prenatal Appointment?

Pregnancy brings about a lot of hormonal and physiological changes within a woman’s body. Having a normal pregnancy with normal and uncomplicated delivery of the child is desired by all women. However, this requires proper knowledge about pregnancy and a regular follow up with a doctor throughout pregnancy.

What Is Prenatal Care?

Routine prenatal care is an example of preventive health care during pregnancy. The purpose of prenatal care is:

• To educate pregnant women and help them to achieve optimum health so that the course of pregnancy is favorable for both mother and child.
• Identification of pregnant women and fetuses at high risk and applying timely diagnostic and therapeutic interventions to reduce the risk.
• Application of other health measures not specific to pregnancy such as Pap smears, rubella antibody test, HIV screening.
• Providing adequate psychological counseling
• Advise on contraceptive planning for the future.

Whenever a pregnant woman visits the doctor for her first prenatal checkup, various questions can cross their minds related to investigations and examinations and whether the entire process will be comfortable or not.

Investigation and examinations which are done as a part of the prenatal checkup help the doctor to know the health status of the female and the fetus and also evaluate risks which a pregnant woman is likely to face during pregnancy. This prenatal checkup also provides with information about the gestational age.

What To Expect At The First Prenatal Appointment?

The first prenatal visit involves the following steps:

1. Complete case history
2. Complete physical examination including systemic and obstetric examination
3. Routine laboratory investigations
4. Mother is advised regarding diet, immunizations, medications and family planning.
5. Mother is informed about the progress of pregnancy, investigations necessary during the course of pregnancy and plans suggested for delivery.
6. The patient is also encouraged to discuss her fears, apprehensions, expectations, and needs.

A complete history recorded at the first prenatal visit includes the following points:

1. Demographic Data – To rule out risks involved during pregnancy. This includes:

• Maternal age
• Pre-pregnancy maternal weight
• Social background and educational status
• Habits such as tobacco chewing, alcohol, drugs or cigarette smoking
• Previous history of low birth weight, stillbirth or neonatal death
• Family attitude towards pregnancy

2. Previous Obstetric History – A detailed record will be maintained which includes the following points:

• Number of pregnancies
• Year of pregnancy
• Events during pregnancy
• Delivery outcome – Details of how and at which week delivery was conducted
• Events at puerperium (after delivery)
• Family planning methods are chosen
• The outcome of the baby – The gender of baby, weight, Apgar score at birth and immunization status

3. Past Medical And Surgical History – This history helps to assess the risks involved during pregnancy and delivery.

4. Personal And Family History – This includes the following points:

• Menstrual history and last menstrual period (LMP)
• Calculation of expected date of delivery
• History of allergies
• The family history of major illnesses

5. General Examination – The following parameters are recorded:

• Height
• Weight
• Build – obese/average/thin
• Examination of the oral cavity – Teeth, tongue, gums
• Examination of the neck – For the thyroid gland, neck veins and lymph nodes
• Edema of legs – To rule out other pathological causes
• Presence of varicosities
• Vital signs – Pulse, blood pressure, temperature, and respiratory rate

6. Systemic Examination – An examination of the following major systems:

• Cardiovascular system
• Nervous system
• Abdominal examination
• Respiratory system
• Examination of breasts

7. Vaginal Examination – A gentle, careful vaginal examination is done to assess the following:

• Assessment of pelvis
• Feto-pelvic relationship

8. Speculum Examination – Routinely performed during pregnancy for the following:

• Assessment of cervix
• Presence of normal discharge
• Pap smear
• Culture samples may be taken for the culture of infective organisms in high-risk pregnancies

On taking a detailed history, the obstetrician advises and educates the pregnant woman regarding the following points in order for the woman to have a normal pregnancy:

• Occupational Risks – Especially women who are involved in strenuous activities, physical labor, exposure to chemicals, environmental toxins, fumes, teratogens, and so on.
• Travel – It is advised to avoid long traveling during the first and last trimester.
• Clothing And Footwear – Clothing should be loose and preferably not synthetic. Footwear should not have a height of more than 1 inch.
• Sexual Activity – Abstinence from sexual activity is advised in high-risk pregnancies
• Rest And Physical Activities – Mothers are asked to avoid over-lifting and asked to rest for at least 2 hours in the afternoon and 8 hours at night.
• Prenatal Exercises – Exercises which improve muscle tone and breathing may be advised
• Education regarding delivery and breastfeeding

Women are also explained certain minor signs and symptoms which occur during pregnancy such as:

• Nausea and vomiting
• Heartburn
• Constipation
• Increased frequency of urine
• Leg cramps
• Backache
• Ankle edema
• Creamy or thin vaginal discharge

Laboratory Evaluation At First Antenatal Visit

1. Complete blood count – Hemoglobin and hematocrit values
2. Blood group test – ABO and Rh grouping
3. Routine urine analysis – To assess the presence of glucose, albumin
4. Rubella antibody titer
5. Blood test for Hepatitis B antigen (HBsAg)
6. Pap smear
7. Blood sugar levels – Fasting and post-prandial
8. HIV testing

Special Laboratory Investigations For High-Risk Patients

1. Urine culture for the presence of infective organisms
2. Cervical culture for chlamydia, gonorrhea
3. Mantoux test – For patients with a family history of tuberculosis or exposure to tuberculosis
4. G6-PD deficiency screening
5. HIV screening
6. Thalassemia screening in cane of family history
7. Genetic evaluation for maternal age over 40 years, family history of genetic defects or if the mother has a history of diabetes or exposure to teratogens.
8. Maternal alpha-fetoprotein to detect abnormalities like Down’s syndrome or neural tube defects.

A prenatal check-up is an important tool for a mother to know if her pregnancy is progressing normally. Prenatal care is essential to establish confidence and educate the patient in accepting health measures right from the beginning of pregnancy. This forms a basis for evaluating and judging various changes associated with normal and complicated pregnancies.

Prenatal care has also proved to reduce maternal mortality and morbidity significantly as well as improve pregnancy outcome. Yet, unfortunately still a large number of women exist in society who are either not aware of prenatal care or are unable to afford it.

Dr. Archana Tegwal

Dr. Archana Tegwal is currently working as a lecturer in under-graduate faculty of Homoeopathy in Jawaharlal Nehru Homoeopathic Medical College, Parul University, Vadodara (Gujarat). She has done BHMS & MD in Homeopathic Materia Medica in March 2016 from Dr. V.H.Dave Homeopathic Medical College and Hospital, Anand (Gujarat). She also serves as a regional manager in NGO “World Healing Society Foundation”.