WOMEN’S BODIES: YOUR FIRST ANTENATAL CHECKUP
Even if you’ve confirmed your pregnancy with a home test and have developed pregnancy symptoms, it’s best to plan your first antenatal checkup no sooner than four weeks and no later than eight weeks after the first missed period. However, if you’ve had any bleeding, pain or other worrying symptoms earlier, see a doctor as soon as possible.
You’ll be asked many questions at your first visit. First, you will be asked about the present pregnancy: LMP date and details; probable date of conception, if known; recent contraceptive use; when pregnancy symptoms started. Then there’ll be questions about your general health history; operations; any significant family history; your gynaecological history; details of any previous pregnancies.
You will be given a full general physical examination to exclude the possibility of health disorders that could affect the pregnancy. Weight, height and blood pressure are measured. Neck, lungs, heart and breasts are examined next; then the abdomen, spine, legs and feet. Armpits and groin are checked for swollen glands.
Finally, a careful pelvic examination is performed with the following aims:
• to assess the size of the uterus; is it consistent with the enlargement that could be expected since the time of LMP?
• to check the condition of the external genitals, vagina, pelvic floor, cervix, uterine wall, tubes, ovaries and other organs and tissues in the pelvis.
A Pap smear will be done, if due.
Routine tests
A blood sample is taken for the following tests (some won’t be repeated if they’ve been done before):
• blood group and screening for blood group antibodies that may have developed in previous pregnancies or other circumstances. If you’re Rh (Rhesus) negative you may need more tests later in pregnancy to see if Rh antibodies have developed
• blood count to make sure that you’re
not anaemic and that all blood cells normal
• rubella (German measles) antibody level. Occasionally rubella immunization doesn’t result in sufficient immunity, immunity decreases with time. If your
immunity is low you’ll be advised how best to avoid infection during pregnancy. If you develop a fever and changes in rubella antibody levels confirm the diagnosis. Rubella dif the first three months of pregnancy ties a high risk of serious foetal malformation. If you’re infected with rubella
at the critical time, you may request termination of your pregnancy. Ideally you should be checked for rubella antibodies before your first pregnancy that your immunity can be boosted necessary.
The following tests aren’t always recommended. Some doctors doubt usefulness as a routine but may suggest them in some circumstances, or you request them.
Alpha-fetoprotein This protein passes from foetal to maternal blood. Raised levels in the mother’s blood may be found when there is multiple pregnancy, in some instances where there are uncommon foetal abnormalities such as spina bifida (though the test doesn’t always detect these conditions), and sometimes when everything is quite normal. If a repeat test is also high, other tests such as ultrasound and amniocentesis may be need to search for the cause.
VDRL (Venereal Diseases Reference Laboratory) This is a screening test for syphilis. Maternal infection with syphilis can be passed on to the foetus, causing malformations and serious illness, though fortunately not until the second trimester so action can be taken immediately to cure the mother and protect the foetus from harm. Though syphilis is uncommon in Australia now, the odd unexpected positive result turns up. Because some other conditions can cause a positive VDRL, further tests are always done to see whether the cause is really syphilis. No matter how unlikely your risk of syphilis, VDRL screening is a wise precaution, and it’s reassuring to know that you’re negative.
Pelvic ultrasound This test is very useful if the length of pregnancy is in doubt; to detect multiple pregnancy; if ectopic pregnancy is suspected; to detect some (not all) foetal abnormalities; and to detect abnormal positions of the placenta. Ultrasound isn’t done routinely because it hasn’t been shown to improve the pregnancy outcome for mothers and babies unless it is used for a specific purpose.
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