OB Visit Intervals

In women who are low risk, visits usually occur:

• Every 4 weeks until 28 weeks
• Every 2 weeks until 36 weeks
• Every week until delivery

Frequency of visits may increase if a pregnancy is determined to be high risk.

What to Expect at Each Visit:

First Trimester: (0-13 weeks)

Every visit will include:

• Weight, blood pressure and urine, uterine size, fetal heart rate
• Each assessment is to ensure the pregnancy is progressing well
• Time to answer questions
• Nuchal Translucency Ultrasound to assess the risk for down syndrome
• Chorionic Villus sampling Trisomy 18 screening (If desired)

Second Trimester (14-28 weeks):

The second trimester is very similar to the first in terms of routine evaluation of weight, blood pressure, urine, and uterine size.

The other important tests that are performed during this trimester are:

• Fetal Anatomy ultrasound –Looks at the development of vital organs, placental location and Amniotic fluid level. (@16-20 weeks)
• Amniocentesis (if desired)
• Sequential and/or Neural Tube Defect testing (MSAFP)
• Gestational Diabetes testing (@24-28 weeks)

Third Trimester (28-40 weeks):

Prenatal visits still include evaluation of weight, blood pressure, urine, uterine size and fetal heart rate.

The important tests that are performed during this trimester are:

• Gestational Diabetes testing (if not done in the second trimester)
• Antibody Screening in women with Rh negative blood type.This done to ensure that she can receive the Rhogam injection.
• CBC/blood count to check for anemia. Increase iron requirements in pregnancy often result in anemia. Checking for anemia in the early third trimester allows for proper supplementation and counseling.
• Group B Streptococcus Screening (GBS) (35-37 weeks): This is a swab of the lower vaginal and rectal area to screen for colonization of the GBS bacteria organism. GBS colonization is not harmful to the pregnant woman, but may harmful to the baby if it passes through the birth canal. A baby’s immune system is immature at birth and may be unable to fight off the GBS bacteria. This in turn can cause life threatening infections such as sepsis, pneumonia and meningitis.
• Ultrasound: May be done to follow up on placenta location, fetal growth in at risk women with Intrauterine Growth Restriction, Chronic Hypertention, Diabetes, and women with larger fibroids.

Another goal of Third Trimester Screening is to diagnosis fetal malposition and Preeclampsia.

• Detection of a baby presenting in the wrong direction after 36 weeks allows for the possibility to turn the baby to the “head down” position. This is known as an External Cephalic Version.
• Detection and treatment of preeclampsia is known to improve pregnancy outcomes.

Postdates/Post term Pregnancy: (40+ weeks)

Approximately 6-8% pregnancies will go past the assigned due date. The risks of going past the due date include:

• Large or macrosomic baby and potential birth traum
• Increases risk of still birth, meconium aspiration and low amniotic fluid
• Maternal risks include: Increase in labor abnormalities, 3rd and 4th degree lacerations and increase risk of having a cesarean section
• Biophysical profile and non stress tests will be performed to assess fetal well being

Because of the risks or postdate pregnancies most practices will favor induction at 40+ weeks.