By Dr. Charles H. Bowers, Jr., M.D., FACOG, FACS
During the 40 weeks that a woman is pregnant, she will have numerous visits with her OB/GYN or other health care provider. This is where various tests are performed, progress of the fetus is checked and questions are answered. Doctors throughout the country follow the same pregnancy timeline to ensure that the health of both the fetus and the mother are maintained and any issues are discovered as early as possible.
At each doctor’s visit, a pregnant woman should expect to have her weight recorded, her blood pressure checked and a urine sample taken. While weight gain is a given during pregnancy, gaining too much weight can result in issues for both the mother and baby. The possible consequences include high blood pressure, gestational diabetes and preeclampsia. Her urine sample can also indicate several problems, so it will be tested each week to look for protein, sugar and evidence of an infection. It is also important to note that if a pregnant woman has high blood pressure and protein in her urine after week 20 of the pregnancy, it could be a sign of preeclampsia.
The doctor will also check for the fetal heart rate to make sure it is in the proper range at each appointment. This can be started early on in the pregnancy, since a Doppler can pick up a fetal heart rate from around 8 weeks on.
Most OB/GYN practices will perform an ultrasound as early as possible, within the first 12 weeks. This ultrasound is performed to verify that it is a viable pregnancy and establish the due date. According to the ACOG (The American Congress of Obstetricians and Gynecologists), the only ultrasound that is actually required is referred to as the “anatomy scan.” This ultrasound should be completed early in the second trimester, around 20 to 24 weeks along in the pregnancy. During this ultrasound, the baby’s position and size, location of the placenta and amount of amniotic fluid are all checked. Additionally, the ultrasound tech also looks for any structural abnormalities of the fetus. The brain, face, skeletal structures, internal organs and extremities are all evaluated at this point.
Beginning at 20 weeks, her fundal height will be measured. Fundal height refers to the distance from the pubic bone to the top of the uterus. This is measured in centimeters and will typically match the number of weeks that a woman is pregnant. For instance, if a patient is 32 weeks pregnant, her fundal height will likely measure right around 32 centimeters. The fundal height measurement can also be an indicator of certain conditions. If it measures much larger or smaller than expected, it could be a sign of too much amniotic fluid, not enough amniotic fluid, rapid fetal growth, slow fetal growth or uterine fibroids. It can also be a sign that the baby is moving into a breech or other presentation that is not ideal for a routine, vaginal delivery.
At each appointment with her OB/GYN, a pregnant woman should always have an opportunity to present any questions she may have. In the beginning, some common questions include: How much weight should I expect to gain? Can I continue exercising? What types of medications can I take? Is it safe to have sex while I am pregnant? Later on in the pregnancy, questions may evolve to things like: How far along can I fly? Will I be able to deliver my baby vaginally? Especially when a woman is pregnant, there is no such thing as a stupid question. Even what seems like a basic question could potentially make a huge difference in how the pregnancy and delivery turn out. Most importantly, if a healthcare provider ever dismisses a patent’s questions or fails to give a proper answer, it is time to find a new provider/OB/GYN.
Prenatal visits with an OB/GYN are a significant part of every woman’s pregnancy. To help support a healthy pregnancy and a safe delivery, it is important to make sure the proper care is received and questions are answered.
Dr. Charles H. Bowers, Jr. was the Chief of the Obstetrics and Gynecology Department at Kings County Hospital Center in Brooklyn, NY where he delivered hundreds of babies. He now works with Ross Feller Casey consulting on birth injuries and other medical issues.