Sunday, June 7, 2009

What to Expext at the Doctor's Office

Your first appointment will include a history and physical exam. Make sure that you bring information about the date of your last period and whether it was a normal period in terms of your usual cycle length, amount aad duration. Did you conceive on the pill? Information such as this and family medical history are important. You may have an early ultrasound and it will most probably be a transvaginal ultrasound, if it is early in the pregnancy. This type of ultrasound is not uncomfortable and affords a much better visualization when the fetus is very small. Don't expect to see a heartbeat until six weeks, from the first day of your last menstrual period. And don't expect to see a real baby. Just a very small prenancy.

There will be blood tests early in the pregnancy. A panel which includes: a complete blood count, blood typing, detection of antibodies for hepatitiis B and an antibody screen that should be negative for antibodies associated with your blood type. Expect to be tested for immunities to rubella ( German Measles ) and exposure to HIV. A test to determine your carrier status for sickle cell anemia will be done if your ethnicity dictates it. Based on your unique medical history, other tests may be preformed. Perhaps you have a thyroid disorder. Maybe you have concerns about your cats and exposure to toxoplasmosis. Inform the healthcare provider about your particular circumstances. There is alot of information about you and your pregnancy that can be obtained form the blood tests. A lot of woman are more nervous about having blood drawn than they should be. Ask for a small, pediatric needle, called a butterfly and don't panic about the amount of blood drawn. It looks like alot of tubes but they don't hold very much blood. You won't run out and the good news is when you are pregnant, you actually increase your blood volumn and vessels get larger. Have hamburger for dinner.

You will have a pap smear and tests for urinary tract infection. You will have vaginal cultures to rule out any infections. You will have a breast exam and it is a very good time to be taught self breast exam, if you don't already know. You should do a breast self exam every month, even when you are pregnant. Remember: every month for the rest of your life.

You will be offered special tests to come at specific times in your pregancy to screen for Down's Syndrome and Neural Tube Defects ( open spine, spina bifida ). These are not genetic tests but rather tests for probibility which may necessitate further evaluation. Many women wory needlessly over amniocentesis. This test is definately NOT done routinely.

At around twenty weeks, you will have an ultrasound that is considered the anatomy scan. At that time in the pregnancy all the organ systems should be visualised, in the right place, doing what they are supposed to do. That is the time when the baby's sex can be revealed, if your baby is in the correct position. If the baby isn't cooperating, you may be asked to walk around or change position in order to determine gender. Sometimes it's just not visable. If it is difficult to see some important structure, you will be asked back for another look, sometimes even by another facility.

There will be a test for gestational diabetes in your second trimester and a vaginal culture at around thirty- six weeks ( a pregnancy is forty weeks ). These tests are important. Remember, it is better to find out if there is a problem that can be remedied than not identify a problem that could be very serious. If we can "fix" it, well it's not such a big problem.

There are tests to help your providers determine whether you have pre-eclampsia ( pregnancy induced hypertension ) and tests to rule out problems that may be of concern, such as exposures. These are individually based and not necessary for everyone.

Every labor and delivery, like every pregnancy, is different. You will be asked to collaborate with your healthcare professionals to get you all the testing that you need and also to help you get the information that is necessary for making good informed decisions about those tests that are optional. Generally, you are seen every four weeks until twenty- eight weeks and then every other week until thirty- six weeks and then weekly until you deliver ( a pregnancy is forty weeks ). At every visit you will be weighed and your blood pressure will be taken. You will be asked to leave a urine specimen for checking on protein and glucose in your urine. Fetal heart tones will be auscultated at about ten and one-half weeks with a dopplar and from then on. Uterine fundal measurements are made with a tape measure on your abdomen from twenty weeks on. Everyone wants the same good outcome. This is very definately a team effort and YOU are part of the team.