It is the second trimester and now the time for fourth visit to the doctor. Week 21 to 27 is roughly the fifth and sixth month of pregnancy and begins to make the patient and doctor more worried about the outcome.
If the patient is not diagnosed with any medical condition in pregnancy, she has to undergo routine checkup anyways. If a woman is diagnosed with hypertension or Pregnancy induced diabetes, she may suffer from very evident signs. By this time, her doctor may have already prescribed the medicine and necessary care in diet and activity.
Antenatal visit form
- Some little changes in the antenatal form can be noticed now but the beginning of the form is usual.
- Introduction of the doctor or midwife, date of examination, weight, height, blood pressure is measured in routine.
- Presenting complaints of the patients are now given even more space because there are high chances for that.
- Swelling of hands and feet, urinary frequency, burning micturition, backache and any other symptoms if any are mentioned.
- Examination of the patient is done as in the previous visit. Uterus size, fetal heart sound, fetal kicks if felt by the patient all are mentioned.
- Examination for the vaginal bleeding, leaking or discharge is made only if there is any complaint. In case of placenta previa, or low-lying placenta, excessive vaginal examination is avoided.
- Patient may feel some contraction which are of light intensity and called as Braxton hick’s contraction.
- If she feels strong contractions, she needs to be admitted and evaluated properly.
- Ultrasound examination may be done for getting idea of fetal growth, the placental site and maturity. If she has undergone any prior surgery or caesarian section, the abdominal wall thickness and condition is also assessed by ultrasound.
- Blood tests including complete blood picture for Hemoglobin, hematocrit and plate count is now required because we don’t want the woman to suffer from anemia later in pregnancy to reduce the chances of peri partum or post-partum bleeding.
- Blood peripheral film is also done to know the type of anemia in the woman.
- Blood glucose test is very crucial at this time. We have to carry out oral Glucose tolerance test to check the status of blood glucose and know if the woman has developed insulin intolerance.
- We label such woman as having GDM and depending upon the readings we start her on oral or injectable hypoglycemic drugs.
Things to do after evaluation
- Patient is prescribed necessary drugs with proper dose and proper instructions
- She is advised to take iron and calcium supplements regularly
- Proper food and light exercises are also advised in normal pregnancies
- She is educated about important and warning signs in which case she has to rush to the hospital even if the due date for next visit is far away.
- She may be advised to attend pregnancy classes if she wishes to.
- In the end, she is given the next date for her visit and advised to note down her queries and concern for the next visit.