Your first trimester prenatal visit

Your medical history will be taken. Be prepared to answer many questions about yourself and your family. Be sure to answer all questions honestly. It is important to the health of your baby.

A physical exam will be done that includes height, weight, blood pressure, lung sounds and reflexes.

A pelvic exam is done to measure the size of your uterus and pelvis so any future changes can be observed (e.g. pap smear, cervical cultures for sexually transmitted diseases such as gonorrhea or chlamydia.)

You will be asked to give a urine sample to detect kidney or bladder problems.

A blood test screening for anemia, syphilis, immunity to rubella (german measles), HIV, hepatitis and toxoplasmosis will be conducted. In addition, blood testing also determines your blood type and whether you are Rh positive or Rh negative.

Questions you should ask the doctor

• What things should be reported to the doctor immediately?
• What are the doctor's dietary and vitamin recommendations?
• What should you avoid in addition to alcohol, smoking and some medications?
• Will there be any restrictions on your activities?
• What physical and emotional changes should you expect in the first trimester?
• Daily fluid requirements and impacts of dehydration on uterine irritability and preterm labor.

Your second trimester prenatal visit

The nurse will check your weight and blood pressure.

You will be asked to give a urine sample for analysis.

Your abdomen will be externally measured to check the growth of your uterus.

The doctor will begin listening for the baby's heartbeat.

Tests such as ultrasound, amniocentesis and alpha fetoprotein (referred to as the Triple Screen Test) may be ordered for you by your physician. Learn more about:

• Ultrasound
• Amniocentesis
• Alpha fetoprotein

Questions you should ask the doctor:

• What warning signs or changes does the doctor want to know about immediately?
• Are there any changes in your diet or activity needed at this time?
• What should you expect in the second trimester?
• What should you do if you have backaches or leg cramps?

Your third trimester prenatal visit

The nurse will check your weight and blood pressure.

You will be asked to give a urine sample for analysis.

A pelvic exam may be performed as you approach your due date.

Additional maternal/fetal tests that your doctor may perform or order:

Glucose Tolerance Test (also known as a Glucose Challenge Test)
The glucose tolerance test measures carbohydrate metabolism after ingestion of a challenge dose of glucose.

A one-hour glucose tolerance test screens for gestational diabetes. It is done on the first visit if the woman has risk factors. Otherwise, it is done between 24 and 28 weeks for all patients. A three-hour glucose tolerance test is done if the woman has an elevated glucose level after the one-hour test.

Non-stress test (NST)
A non-stress test (NST), also called fetal activity determination (FAD), is a non-invasive test of fetal activity. It involves the use of a Doppler transducer to determine the fetal heart rate in response to movement.

Results are captured by a monitor and recorded on a rhythm strip as reactive or non-reactive. A reactive result is a good outcome, meaning that the fetal heart rate increases when the fetus moves. A non-reactive result occurs if fetal movement does not produce a corresponding fetal heart rate acceleration or if there is no fetal movement. This may occur because the fetus is sleeping. Efforts to wake the fetus may involve acoustically stimulating the fetus via a sound source applied to the patient's abdomen. If the test persists as non-reactive, a contraction stress test is done.

Contraction Stress Test (CST)
A Contraction Stress Test (CST) assesses fetal response to stress. Its purpose is to identify a fetus that was stable at rest but showed evidence of compromise with the introduction of stress. The CST is helpful in assessing how well the fetus will tolerate the stress of labor. Contractions decrease uterine blood flow and placental perfusion. If the contractions cause fetal hypoxia, a deceleration in fetal heart rate will result. This late deceleration will begin at the peak of the contraction and persist after the contraction ends. Late decelerations usually do not occur if the fetal/placental unit is healthy.

Since the object of the test is to assess fetal health during contractions, they are induced by nipple stimulation and/or Oxytocin IV. When three uterine contractions occur within a ten minute period, the simultaneous fetal heart rate pattern is interpreted. If no late decelerations are seen, the test is considered to be negative. Repetitive late decelerations make the stress test positive. A negative result is considered a good outcome.


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Questions for your prenatal doctor visit

Going to the doctor can be a nervous time. It may be hard to remember everything you want to ask and everything you hear from the doctor and staff.

It helps to prepare a list of important questions. Print a form that will allow you to list the questions that you want answered. Take your questions to your appointment so you can take notes about what the doctor tells you. Before you leave the doctor's office, be sure that you understand your condition, treatment and care, including any medications or tests.