Antenatal visit in the weeks 9 to 13 of gestation roughly makes third month and is almost the end towards the first trimester of pregnancy. It carries pivotal role in the diagnosis and management of certain mother and fetal conditions.
Patient visits her doctor now the second time if the pregnancy is uneventful up till now. The number of visits is definitely decided on how this certain pregnancy is going on. But in case of normal healthy pregnancy, certain guidelines have been provided by higher research authorities.
Antenatal visit form
Key components of the visit form are;
- It starts with the usual introduction of the patient and the doctor’s name on the top just like her first visit.
- Other details of the patient are not needed here because the previous record from her first visit is sufficient if kept and well maintained.
- Date of examination being held
Current weight of the patient is measured and compared to the previous weight to keep a track of how much she is gaining. In 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
At this time carries importance because the physiological changes in 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 till 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
- Raised blood pressure
- Headache along with nausea and vomiting
- Swelling of feet or eyes
- Epigastric pain
- If these signs appear along with a raised blood pressure, we need to investigate and be more vigilant about this pregnancy.
- It does include the blood pressure and other vital signs including general look, and her weight.
- Breast examination is done as a part of
- Pap smear is taken if necessary
- Abdominal examination can also be done where we measure the size of uterus to correlate with her gestational age and ultrasound. This gives us a good idea if 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
- Abdominal ultrasound now starts giving us a good idea about the fetus and surroundings inside the uterus. Placenta starts to develop and fetal parts are more visible. Fetal Nuchal thickness is measured for diagnoses of downs syndrome. Fetal gestational age is now measured according to crown-rump length.
- 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.
- Carrier screening of mother is screened for certain diseases. For example thalassemia, cystic fibrosis, 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 timely management plan is devised with full consent of the patient.
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 future and when to come back for her next visit.