Prenatal Care

Prenatal Care can Lead to a Healthy Pregnancy

There have been tremendous strides in medicine to improve the health and well being of every newborn. Modern medicine has reduced the dangers and discomforts of pregnancy through years of research and technological advances. Although most pregnancies proceed normally, every pregnancy poses some degree of risk. Assessing the risk on an ongoing basis is a central part of prenatal care. While no two pregnancies are alike, prenatal care will help you prepare for the changes to come.

Regular visits to your doctor are central to your care. Your first visit will be longer and more involved than other visits. It will include a medical history, laboratory tests, and physical examination. Many physicians prefer to see you for your first obstetrical visit between 8 and 12 weeks from the first day of your last menstrual period. The average length of pregnancy is 280 days, or 40 weeks from the first day of the last menstrual period. A normal full term pregnancy can last anywhere between 37 and 42 weeks gestation. The estimated date of delivery (EDD), or estimated date of confinement (ECC) as it is sometimes called can be estimated by taking the date your last menstrual period began, adding 7 days, and then counting back 3 months. Your doctor will use an obstetrical wheel to calculate your exact date during your first visit. Often an early ultrasound will be scheduled to confirm your pregnancy and the estimated date of delivery. Ultrasound scans done in the first 13 weeks of pregnancy are excellent at diagnosing the baby’s age, possible twins, and ruling out potential miscarriages. In addition a special ultrasound can be preformed, Nuchal Translucency scan, combined with blood hormone levels to help evaluate the fetus for possible chromosomal abnormalities.

After your first prenatal visit, the following visits are usually monthly till 28 to 30 weeks. These visits are shorter and generally used to see how you are doing and how the baby is growing. During these visits, your weight and blood pressure are checked, and a urine sample is taken for analysis. Testing offered during this time will vary but in general consist of two blood tests and possibly an ultrasound.

The first test is an alpha- fetoprotein (AFP) test. This test is used to help identify fetuses that may have abnormalities of the brain and spinal cord. The two most common abnormalities are anencephaly and spinal bifida commonly referred to as neural tube defects. Anencephaly occurs when the brain and the head do not develop normally. Spinal bifida occurs when the lower part of the spinal cord is open and the spinal cord and nerves are exposed.

This test, the AFP, is often combined with two other blood tests and called a triple test.

The AFP combined with three blood hormones can estimate the risk of the baby having Down syndrome. In the United States, the majority of babies are born healthy. Birth defects occur in 2 to 3 percent of babies born each year. Neural tube defects occurs in 1 to 2 babies per 1000 births and Down syndrome is seen in 1 in 800 babies born. The second blood test is a glucose tolerance test to help rule out diabetes that may develop in pregnancy. This test is usually done between 24 and 28 weeks gestation. In some pregnancies, a second trimester (14 to 26 weeks) ultrasound may be done to assess the babies anatomy and growth. Women over the age of 35, and those with medical conditions such as diabetes, high blood pressure, or thyroid disease will usually have this high level scan done.

Visits from 28-30 weeks to 36 weeks are generally every two weeks. A vaginal culture is often done between 34 and 36 weeks gestation for group B Streptococcus. Group B Streptococcus (GBS) is a type of bacteria that can be found in up to 40% of pregnant women. A woman can pass GBS to her baby during delivery. Most babies who get GBS from their mothers do not have any problems. Some babies can get sick and have major health problems or even die. If group B Streptococcus is recovered by culture, it is often treated at the time of labor to try and prevent infection of the baby.

Visits from 36 weeks to delivery are usually weekly. During this time a cervical exam is often preformed. The events to occur in labor and delivery should be discussed and labor warnings are given.