Initial Prenatal Visit
Your first visit will be between 8 and 10 weeks with one of our physician assistants, and it will take approximately 90 minutes. A CMA will review your past history and provide comprehensive educational counseling. Please bring a list of questions you may be concerned about and both the nurse and provider will discuss them with you.
To determine your approximate due date, please use our Due Date Calculator.
A complete history and physical examination includes:
- Blood pressure
- Urine Screening
- Prenatal education and counseling
- Initial prenatal blood work
- Vaginal Cultures
Blood work will include: Complete blood count (CBC) to measure for infection and anemia. Maternal blood type and Rh factor, antibody screen, to evaluate your resistance to German measles, syphilis, glucose level, and screen for hepatitis B. We request that you have a HIV screening blood test if you have not had one recently. Research has shown that pregnant women who are HIV positive will be less likely to transmit the HIV virus to their baby if they are treated with ATZ. Cystic fibrosis carrier testing is also offered at this visit.
Insurance and financial counseling will also be done when you arrive at the office for your first visit.
Your future visits will be scheduled as follows
- Beginning at 8 weeks, we will see you for monthly visits.
- At 28 weeks, we will see you for biweekly visits.
- From 36 weeks to delivery, we will see you for weekly visits.
- This may vary depending on the health needs of each individual.
- Cervical checks will be done toward the very end of pregnancy, (37 weeks) unless you may be having a potential problem. (i.e. premature onset of labor or amniotic fluid leak).
At each follow up visit we will check:
- Blood pressure
- Urine screening (check for glucose and protein)
- Listen to fetal heart tones and evaluate growth
- Answer any questions regarding your pregnancy
There are special tests that are offered during pregnancy depending on your health needs and personal requests. A summary of these is as follows:
Cystic Fibrosis screening- Cystic fibrosis is a genetic life long illness causing problems with digestion and breathing. It is usually diagnosed in the first few months of life. Cystic fibrosis carrier testing is to see if a couple is at increased risk for having a child with cystic fibrosis. The test is done on a sample of blood. It does not detect all CF carriers. If the test is positive on the mother, additional testing is done on the father to determine if the child will be at risk for having cystic fibrosis. If one parent is a carrier and the other parent is not a carrier there is still a small chance the child could have cystic fibrosis.
Nucal translucency is a test done by ultrasound at 10-11 weeks. It is a measurement of the space behind the fetal neck. Fetuses with a thickened nucal translucency may be at risk for chromosomal abnormalities such as Down’s syndrome. In conjunction with the nucal translucency a maternal blood test can be done at this time to screen for chromosomal abnormalities. This blood test does not screen for neural tube defects, so an AFP should be considered at 16-18 weeks of pregnancy. Women that are at an increased risk for chromosomal abnormalities may consider this test. This test is optional. You will be given an appointment with a perinatalogist (high risk pregnancy physician) for this testing.
16 to 19 weeks:
Alpha Fetoprotein Test is offered between 16 and 19 weeks of pregnancy. A sample of blood is taken from the mother’s arm so no harm can be done to the fetus with this type of test. This test detects 95% risk for neural tube defects, such as spina bifida or anencephaly (absence of skull). The test also detects 60% risk for Down’s syndrome. There is a possibility that this test will give a false positive result. If your result comes back as a false positive, we will schedule an appointment for you with a perinatalogist for further work up. The work up would consist of a comprehensive anatomy ultrasound, and genetic counseling. At this same appointment you will be offered a choice to do another procedure called amniocentesis. The Alpha Fetoprotein Test is strictly optional and you and your family should make this decision.
Alpha Fetoprotein screening looks for alpha fetoprotein (AFP) that is naturally produced by the fetus. A small amount of AFP normally crosses the placenta and enters the mother’s bloodstream. Abnormal levels may indicate a problem with the fetus. High levels of AFP may indicate that the fetus has a neural tube defect, commonly anencephaly or spina bifida. Low levels of AFP may indicate Down’s syndrome.
Other factors can cause a false positive result such as miscalculation of fetal age or a twin pregnancy.
This screening looks at three substances normally found in the bloodstream of pregnant women:
Maternal serum alpha protein (MSAFP)
Human chorionic gonadotropin (HCG)- a hormone produced in the placenta
Estriol- an estrogen produced by both the fetus and placenta
15 to 19 weeks:
New genetic testing is available through Harmony and you can be counseled on this if you wish.
In addition, amniocentesis is offered to women that are at increased risk for birth defects. This test is performed by inserting a needle through the abdomen and into the uterus to withdraw a sample of amniotic fluid.
You will be referred to a perinatalogist if you would like this test.
20 to 24 weeks:
Ultrasound is the use of sound waves to create a picture of the baby while still in the uterus. It evaluates the age of the fetus, size, rate of growth, position of fetus and placenta, fetal movements, heart rate, twins, and some birth defects. An ultrasound is usually done at the 20th or 24th week of pregnancy. Additional ultrasounds may be ordered if deemed medically necessary.
24 to 28 weeks:
Gestational diabetes screen – this is a blood test that is taken one hour after you finish a glucola drink that is provided at the time you first arrive for your regular visit. It is recommended that you do not eat any concentrated sugars for eight hours before this test. This is not a fasting test. You may eat, just not anything with a lot of sugar in it.
28 to 42 weeks:
Non-stress test- this test is used to check the well being of the baby. This is not a routine test. It is done when there is a suspected fetal or maternal problem. For instance, a women complaining that she hasn’t felt her baby move enough, she develops gestational diabetes or high blood pressure during her pregnancy. At the 28th week visit the nurse will go over an information sheet that allows the mother to keep a record of how often her baby moves in a twenty-four hour period. As soon as the mother detects that the baby is not moving adequately she should immediately notify the office or if after office hours the physician on call.
Group B strep screening- this is a vaginal culture performed on the mother to detect if the mother has group B strep present. If group B strep is detected, the mother will be given IV antibiotics when she is in labor. These antibiotics are given to the mother to decrease the chance that the baby will develop a Group B infection. This treatment does not guarantee that the baby will not develop this infection. If your baby develops a fever during the first few weeks of life you must notify your pediatrician so they may culture your baby for group B strep.
Click here for pregnancy/parenting classes at Mary Washington Healthcare.
For further questions and to register please call Mary Washington Hospital Health Link at 540.741.1404 ext 1.