YOUR CARE DURING ROUTINE PRENATAL VISITS
Having a baby is a glorious moment. Here is a quick rundown of the most common things done during routine visits and your time at the hospital. If you have questions, be sure to ask your provider.
Prenatal Visits
Prenatal care is recommended to start during the 1st trimester, that is from the time of conceptions to less than 12 weeks gestational age.
Prenatal appointments usually occur in the following order:
o Monthly visits until 28 weeks of pregnancy
o Visits every 2 weeks from 28-36 weeks of pregnancy
o Visits every week after 36 weeks until you deliver your baby
During each prenatal appointment you will probably be given a specimen cup and wipe. This is so you can provide a urine
sample which is tested for glucose and protein levels, which helps determine if there are any issues to evaluate further. If you have any chronic conditions, a complete urinalysis might be done.
TIP: Plan on arriving with a full bladder to provide a urine sample right after checking in or before you are called back to see your provider.
What happens in each visit?
Initial OB Visit (8 to 12 weeks)
During this initial visit all of your past medical history will be obtained and discussed with you an the following laboratory studies and images are usually ordered:
o A sonogram/ultrasound will be order or even done in office to determine viability, dating, and number of pregnancies.
o Blood is also drawn and will be tested for several labs. Most common labs are a blood count, blood type, as well as HIV, Syphilis, Hepatitis, and Herpes. You might be screened for sexually transmitted diseases; this might be done with a urine sample, a swab collection, or during a PAP smear if needed. A urine sample is needed to test of any urinary infections.
NOTE: Providers only order diagnostic sonograms/ultrasounds. During a routine pregnancy, two sonograms are performed (dating & anatomy). If any other ultrasounds are needed because there is a concern with your
pregnancy, your provider will order it and let you know.
• 12 - 21 weeks
Several things happened during this time, they include
o A Non-Invasive Prenatal Screening (NIPT) also known as antenatal screening (Free Cell DNA/Tetra/Quad/Panorama/Maternity21) is offered. This NIPT is an optional screen, and it offered to determine Down’s Syndrome, Spina Bifida, Trisomy 18, among others. If the screen is positive for either of these conditions, you may be referred to Maternal/Fetal Medicine (MFM) for further screening.
o An anatomy sonogram/ultrasound will be ordered. This is usually done between 18 and 22 weeks of pregnancy to look at the baby’s anatomy (head, heart, lungs, kidneys, bladder, arms, legs, etc.)
NOTE: The purpose of the ultrasound is NOT to determine the gender of the baby. If you are interested in a sonogram that is to find out the gender of your baby, you can search online for a business that performs
entertainment sonograms.
• 24 to 28 weeks
During this time, screening for diabetes in pregnancy is done. This is done fasting (nothing by mouth after midnight except water):
o A 1-hr glucose screening (Glucose Challenge Test) is done. You will be given a sugary drink and asked to drink it within 5 minutes. You are only allowed to drink water during the 1-hour testing period. No food, candy, gum, or other beverages are allowed. This screen checks how well your body can handle sugar while being pregnant. Your blood will be drawn after 1 hour to check your blood sugar level. If the 1-hr glucose test is elevated, you will be asked to return to the clinic for a 3-hr glucose test. For the 3-hr test, you can drink water prior to your test but please do not have food, candy, gum, or other beverages.
o Along with the 1-hr glucose, a repeat blood drawn (CBC) will probably be done. This is to check for anemia.
• After 28 weeks
After 28 weeks, discussions about your delivery plans should be well underway. The following might also be done
o Repeat screening for HIV and Syphilis, which can be done at any time during your 3rd trimester.
o The tetanus, diphtheria, and pertussis (TDaP) vaccine is also offered. This vaccine is a recommended vaccine and its optional, so discuss your thoughts, options, and choice with your provider.
o Other vaccines recommendations throughout pregnancy include RSV, Influenza, and COVID. Talk to your provider about these.
Pregnancy and Vaccines info link - English
Vacunas y el Embarazo enlace de Información - Español
• 35 - 36 weeks
Getting ready!!! The following is done after 35 weeks:
o Group Beta Strep (GBS) screening is done during this visit. This is a vaginal/rectal swab that is done to determine if you are a carrier of GBS. GBS is not an infection, some people naturally carry the bacteria on their skin. If the test is positive for GBS you will be given antibiotics before and after you deliver your baby. This is done to protect your baby. PLEASE LET YOUR PROVIDER KNOW YOU ARE ALLERGIC TO PENICILLIN.
Enlace de Bacterias de Estreotococos Grupo B y el Embarazo
o You will potentially be rescreened for sexually transmitted diseases at this time as well.
o Cervical exams usually begin at 38 weeks or sooner if needed. The provider who will be attending your deliver will be determining the exact time when this will begin. The cervical exam is done to determine how your body is getting ready for labor and to see if the baby’s position (vertex vs breech) and if the head is dropping into the pelvis. It is common to have a bloody or mucous discharge after the cervical exam.
o Intercourse can happen at any time as long as you are comfortable. After 36 weeks, you may experience a bloody or mucous after intercourse. This is because the cervix is very sensitive at this stage of pregnancy.
PREGNANCY DO'S & DON'TS
It’s okay to…
• Take WARM baths in your bathtub
• Maintain your current level of exercise, this is acceptable and healthy
• Working in your garden, wear gloves
• Eat canned tuna once a week or less
• Eat a balanced diet
• Take a prenatal vitamin daily, any over the counter prenatal vitamin is fine.
• Try to drink at least 64 ounces (6 to 8 glasses) of water per day.
Avoid While Pregnant
• Alcohol
• Street drugs such as:
▪ Marijuana
▪ Cocaine
▪ Ecstasy
▪ Meth
• Medication or Prescription Drugs
- Do not take any medications, over the counter, or prescribed medications that has not been prescribed by your Provider
- Do not take any supplements that are not approved by your Provider
• Tobacco, all types
• Excessive caffeine (50 mg per day or less)
• Raw meat
• Swordfish, shark, marlin, and fresh tuna
• Refrain from non-pasteurized milks and cheeses
• Deli meats that are not heated to steaming
• Overheating your body, such as very hot showers, baths, hot tubs, saunas, too much time spent outside during the summer months.
• Lifting anything weighing more than 15 pounds
• High impact exercise or excessive or Valsalva maneuvers
• Changing cat litter boxes and scooping feces
• Gardening without wearing gloves
The Top 6 Pregnancy Questions I Hear From First-Time Moms (ACOG)
AM I IN LABOR?
If you think you are in labor, please go to your planned delivery hospital emergency or labor & delivery department to be evaluated. Labor can present as follows:
- When your contractions are 5 minutes apart (10 minutes apart if a previous delivery went very quickly) and you have been having contractions for the last hour.
- Your water breaks. Your water leakage can be a big gush of fluid, little gushes that are worse with coughing, or a trickle.
Papanicolaou (PAP)
Indications & Guidelines for a Pap Smear
- Used for screening of precancerous or cancerous changes on the cervix or vagina if you had a hysterectomy.
- Current evidence suggests that infection with HPV is the leading cause of cervical cancer.
- Infection with HPV can occur in the absence of sexual intercourse through hand and/or mouth-to-genital contact. Therefore, it is important to consider Pap smear for people who have not had intercourse and lesbian patients.
Screening Guidelines
- United States Preventative Services Task Force
- American Cancer Society
- American College of Obstetricians and Gynecologists
- American Society for Colposcopy and Cervical Pathology (ASCCP)
Pap Smear Results
ASC-US: Atypical Squamous Cells of Undetermined Significance
ASC-H: Atypical Squamous Cells, cannot rule out High Grade
AGC: Atypical Glandular Cells
LSIL: Low-Grade Squamous Intraepithelial Neoplasia (also called mild dysplasia)
HSIL: High-Grade Squamous Intraepithelial Neoplasia (also called moderate or severe dysplasia
