Maternity - Pregnancy, part 2: Prenatal Care: 1st, 2nd, and 3rd Trimester Visits

by Meris Shuwarger August 30, 2021 Updated: September 05, 2021

Full Transcript

Hi, I'm Meris, and in this video, I'm going to be talking about what happens at OB/GYN visits in the first, second, and third trimesters. I'm going to be following along using our maternity flashcards. These are available on our website leveluprn.com. And if you already have a set of your own, I would absolutely invite you to follow along with me. So let's go ahead and jump right in with what happens at the first-trimester visit. So I say visit because typically there's only one. However, it just depends on when a patient realizes that they may be pregnant. So the first visit, the initial visit, should be done before 12 weeks of gestation. However, if that patient does come in and they're very early, let's say six weeks, they'll probably come back again four weeks later. But for most people, they have just the one. Now, this is a really big visit for a lot of reasons. First is baby is too small for us to use a Doppler to assess the heart rate. So instead, we have to do an ultrasound. That's the only way to confirm cardiac activity at this point. So there will be an ultrasound to assess that the fetus has a heartbeat and what that rate is. And then going forward, the heart rate will be assessed with a Doppler from the outside. The other thing is that this is where a lot of labs and diagnostic testing is performed. So on this card, you can see that there is a heading called labs. And on here, we have a lot of big ones. I want to call your attention to CBC. Do we already have a problem with anemia? Do we already have an infection? We want to know that. STI testing. In a lot of states, this is mandatory. So be familiar with your state's laws. A PAP test. If my patient has not had a PAP test recently or is due for one, then we're going to do it at this visit. Blood typing. Blood typing, including Rh factor. This is very important. And we will talk about that in a little bit. And then we're going to be testing for hepatitis B, or hepatitis B immunity, for HIV. And then if your patient is high risk, as in they may have had multiple miscarriages or something along those lines, they may also have serial, meaning in a row, a few HCG, which is the pregnancy hormone levels drawn to be sure that the pregnancy seems to be developing appropriately. Also, maternal teaching will be done, and we'll talk about that in a later video. And then, until 28 weeks - we have a line on here - but until 28 weeks, these visits will be monthly, so every four weeks. There's not a lot to see or do at these visits in the early days because baby is very little.

So let's move on to the second trimester. Now, when you look at the second-trimester card, [whoo-hoo-hoo?]. There is a lot of bold red text on here. And to me, that means I should really know this card, and probably want to star and highlight this card because it might be really important for me to know. So, from 14 to 18 weeks, anywhere in that time, MSASP, maternal serum alpha-fetoprotein testing will be done. We'll talk about that in a later video. But that is when that will occur. If there is an abnormal MSASP, then we can progress to an amniocentesis. Again, we'll talk about that later. And then gestational diabetes screening happens at this early time for patients who are high risk, as in they had gestational diabetes in a prior pregnancy. Maybe they were prediabetic before getting pregnant. Maybe they have a strong family history. We're going to test them much earlier than everybody else. Now, from 18 to 22 weeks, we have a lot. We will have an ultrasound. This is commonly called an anatomy scan because it is looking for abnormalities in the fetal anatomy. So we're going to check everything out with baby, see if we have any sort of congenital heart defects, neurological defects, anything that can be seen on the ultrasound. Fundal height assessment will begin at this point. This is very important. Fundus height means I'm measuring from the pubic symphysis all the way up to the fundus. The fundus is the topmost part of the uterus. And we're going to measure this in centimeters. The gestational age of the pregnancy should correlate to the fundal height in centimeters plus or minus two weeks, beginning around 18 weeks, so from 18 to 32 weeks. Let's say I'm 24 weeks pregnant. My fundal measurement should be about 24 centimeters. Anything drastically less or more is cause for further investigation. And then, from 22 to 24 weeks, this is where a routine gestational diabetes screening will happen. This is going to be a one-hour oral glucose tolerance test. And then follow up with a three-hour if needed. We'll talk about that in a later video. And for first-time pregnancy, it's very commonly there will be an ultrasound done, a transvaginal ultrasound, to assess the length of the cervix. This can help us to identify risk factors for preterm labor. But as long as that is normal and the patient does not have preterm labor this pregnancy, that won't be repeated in the future.

Now, let's talk about the third trimester. Again, we can see a lot of bold red text on here. So let's go through it. 28 weeks. If the patient is Rh-negative, which we know because we did the blood type at the first visit, if our patient is Rh-negative, they will receive RhoGAM, or the RhoGAM is the anti-D antibody. So this is going to help to suppress that. That will be administered to Rh-negative patients at 28 weeks. From this point on, all visits are going to be every two weeks. So now, 28 weeks. We're going to be seen at 30 weeks, and then 32 and 35. So then, 30 to 32 weeks, this is going to be huge education for your patients. At 30 weeks, your patient should be performing kick counts. They are what they sound like. It's counting how many times the baby kicks. This is important. It helps us to assess the fetal well-being. So that's going to be something that we want to start at 30 weeks. Also, at thirty weeks, we can give TDaP vaccine to the pregnant patient. So that's the tetanus, diphtheria, and acellular pertussis vaccine. If given in the third trimester, it does impart some protection to the baby. And then, NSTs. Nonstress test may be performed at this time if they are indicated from 35 to 37 weeks. Really, really important. Listen to me. 35 to 37 weeks, we are going to do a vaginal and rectal swab for group B, beta hemolytic strep. So you will hear this just called group B strep. And it's a swab of the vagina and rectum. This is a bacteria that some people just carry. But if the patient has it, we need to treat them at the time of delivery. And then starting at 36 weeks, visits with the provider will be weekly. So 36, 37, 38, 39, 40, and beyond until the patient delivers, just depending on when that baby comes.

So I hope that review kind of comprehensively of what happens throughout the three trimesters of prenatal care was helpful. We're going to talk a lot more about what all of those things are and what they mean in future videos. So be sure that you subscribe so that you're the first to know when they are alive on our channel. If this review was helpful for you, I would love it if you could like this video so that I know. And if you have a great way to remember something or a really good story, I would love to hear it below. Please leave us a comment so we know. All right. Thanks so much, and happy studying.


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