Doctor Visit Form Week 09-14

Antenatal visit in the weeks 9 to 13 of gestation roughly makes the third month and is almost the end of the first trimester of pregnancy. It carries a pivotal role in the diagnosis and management of certain mother and fetal conditions.

The patient visits her doctor now for the second time if the pregnancy is uneventful up till now. The number of visits is definitely decided by how this certain pregnancy is going on. But in the case of a normal healthy pregnancy, certain guidelines have been provided by higher research authorities.

Antenatal visit form

Key components of the visit form are;

Introduction

1. It starts with the usual introduction of the patient and the doctor’s name on the top just like her first visit.
2. Other details of the patient are not needed here because the previous record from her first visit is sufficient if kept and well maintained.
3. Date of examination being held

Weight tracking

The current weight of the patient is measured and compared to the previous weight to keep track of how much she is gaining. In the first-trimester female usually loses some pounds because of morning sickness and being unable to eat properly. But after that, she should ideally gain some amount of weight.

Blood pressure and signs of pre-eclampsia

This time carries importance because the physiological changes in the mother start appearing. Usually, the blood pressure is measured at every visit even in a normal healthy pregnancy. Blood pressure is the first sign of pregnancy-induced hypertension leading to pre-eclampsia or eclampsia in severe cases. Usually, they don’t appear up to 14 weeks but there is no hard and fast rule about it. We should always listen to the patient if she mentions any signs of it. For example

1. Raised blood pressure
2. Headache along with nausea and vomiting
3. Swelling of feet or eyes
4. Epigastric pain
5. If these signs appear along with raised blood pressure, we need to investigate and be more vigilant about this pregnancy.

Physical examination

1. It does include the blood pressure and other vital signs including general look, and her weight.
2. Breast examination is done as a part of a routine examination
3. A pap smear is taken if necessary
4. An abdominal examination can also be done where we measure the size of the uterus to correlate with her gestational age and ultrasound. This gives us a good idea that the fetus is developing well. However, we cannot measure the uterus size at very early gestation just by an abdominal examination. 12 weeks uterus size and onwards can be measured.

Ultrasound and investigations

1. Abdominal ultrasound now starts giving us a good idea about the fetus and its surroundings inside the uterus. Placenta starts to develop and fetal parts are more visible. Fetal Nuchal thickness is measured for diagnoses of Down syndrome. Fetal gestational age is now measured according to crown-rump length.
2. Amniocentesis and chorionic villus sampling are done for diagnoses of some fetal abnormalities but it is not usually recommended in all pregnancies. It is done only if highly indicated and chromosomal defects are to be ruled out. Plus, they are performed at the beginning of the second trimester ideally.
3. Carrier screening of mothers is screened for certain diseases. For example thalassemia, cystic fibrosis, and sickle cell anemia. Usually, diagnosis is already made before pregnancy but if missed, can be done now to avoid any abnormal pregnancies and fetal disabilities later on.

Management plan and counseling

If the mother is diagnosed with any disease and likely to affect or transfer it to her fetus, she is counseled and informed about all the possible consequences of her pregnancies, and a time management plan is devised with the full consent of the patient.

Follow up

In the follow-up instructions, she is advised to take proper supplements and proportioned food. She is advised about her activity and any investigation for the future and when to come back for her next visit.