Pregnancy Archive

Pregnancy: 1st Trimester

Questions to Discuss with Your Doctor:

• Your age and how it will affect your pregnancy.
• Have you been pregnant before? If so, what was the outcome of each pregnancy. Did you have a full-term pregnancy (your baby was born close to your due date)? Did you give birth via a vaginal delivery or a cesarean section ("C-section") surgery? If you had a C-section, what type of C-section was it? Did any of your pregnancies end in miscarriage, voluntary abortion, or an ectopic (tubal) pregnancy?
• Does this pregnancy come at a good time for you?
• When was the first day of your last menstrual period?
• What is the usual length of your menstrual cycle?
• Do you have any medical problems such as diabetes, high blood pressure, thyroid problems, asthma, tuberculosis, epilepsy, or heart disease?
• Have you ever had any sexually transmitted infections such as gonorrhea, herpes, syphilis, or human papilloma virus (HPV)?
• Do any medical problems tend to run in your family such as sickle cell anemia, cystic fibrosis, Down syndrome, or hemophilia?
• Are you taking any medications (including over-the-counter medications)? If so, what are they?
• Do you smoke? If so, how many packs per day?
• In an average week, how many alcoholic beverages do you consume?
• Do you use any recreational drugs?
• Did you have any problems getting pregnant?
• Do you eat a well-balanced diet? Are you taking any vitamins, including folic acid (folate)?
• Do you exercise regularly?
• What is your home situation like? Who do you live with? Is your partner supportive of this pregnancy? If not, has your partner hit or threatened you?
• Are you having any problems with morning sickness (that is, nausea and vomiting)?
• Are you having any bleeding from your vagina?

Your Doctor Might Examine the Following Body Structures or Functions:

• Temperature, blood pressure, pulse, weight
• Chest exam
• Heart exam
• Abdominal exam
• Pelvic exam with Pap smear and cervical cultures
• Leg exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Confirm pregnancy with blood or urine test
• Complete blood count and blood type
• Blood tests for syphilis, rubella antibodies, hepatitis B, HIV
• Urinalysis
• Portable Doppler instrument or stethoscope to measure fetal heart sounds
• Urine culture
• "Triple screen" (also known as "AFP-3" or "Enhanced AFP"
• Genetic testing

Pregnancy: 3rd Trimester

Questions to Discuss With Your Doctor:

• Do you have adequate support at home from family or friends?
• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had any pain or uterine cramping?
• Have you had any discharge or leakage of fluid from your vagina?
• Have you noticed swelling of your face or ankles?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you noticed a change in the frequency or intensity of fetal movement?
• Are you planning to breast-feed or bottle-feed?
• Have you selected a pediatrician for your baby?
• Are you taking classes on labor and delivery?
• Have you added health insurance coverage for your new baby?
• Have you purchased a special car seat to hold your baby when riding in your car?
• Have you decided on whether the baby will have a circumcision, if a boy?
• Have you talked with your doctor about the length of your stay in the hospital?
• Do you know the signs of going into labor so that you can call your doctor when labor begins? (These include uterine contractions and rupture of the membranes).

Your Doctor Might Examine the Following Body Structures or Functions:

• Breasts (to see if your nipples are inverted)
• Abdominal exam, including measurement of the height of your fundus (top of the uterus)

Your Doctor Might Order the Following Lab Tests or Studies:

• Culture of the vagina and rectum for Group B streptococcus bacteria
• Fetal ultrasound

Pregnancy: 2nd Trimester

Questions to Discuss with Your Doctor:

• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had persistent vomiting?
• Have you had any pain or uterine cramping?
• Have you noticed swelling of your face or fingers?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you had any vaginal discharge?
• Have you noticed fetal movement?
• Are you planning to breast-feed or bottle-feed?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, weight
• Abdominal exam including measurement of the height of your fundus (top of the uterus) and using a portable Doppler instrument or stethoscope to measure fetal heart sounds

Your Doctor Might Order the Following Lab Tests or Studies:

• Consider repeat complete blood count
• Fetal ultrasound
• Glucose tolerance test

Your Doctor Might Order the Following Treatment:

• Rhogam (Rh-Immunoglobulin), if your blood type is Rh negative (see p. 920)

Research from Denmark found an association between the use of hormonal birth control and an increased likelihood of depression. While the risk of depression among women using hormonal forms of birth control was clearly increased, the overall number of women affected was small and was found to be highest in women under 20.

Many women may plan to start using birth control at their six-week postpartum checkup, but as many as 40% of women do not go to a follow-up appointment. The American Congress of Obstetricians and Gynecologists advocates for offering women the option of long-acting, implantable contraceptives in the period immediately following giving birth, before leaving the hospital. It’s safe, effective, and eliminates the need for an outpatient visit during a hectic time. Making postpartum contraception easily available and a covered benefit is essential to reduce unintended pregnancy and rapid, repeat pregnancy rates.

A major controlled clinical trial indicates that taking progesterone doesn’t prevent miscarriage in women at elevated risk.

Miscarriages can be devastating — especially for women who experience recurrent miscarriage, defined as three or more in a row. Doctors used to give these women supplements of progesterone, a hormone that helps maintain a healthy pregnancy. However, a recent study has confirmed that these supplements don’t improve pregnancy outcomes. For those who experience recurrent miscarriage, the best solution may be to simply keep trying.