This blog is written by our clinicians and aims to keep patients informed with up to date information on medical conditions.
The first thing you need to know about pregnancy is that everything is documented and discussed over several pregnancy appointments. Oddly, the first day of your last period before you get pregnant is termed Week 1 and your due date is at Week 40 – so yes, that’s actually 10 months of pregnancy!
When you are pregnant for the first time you will have approximately 10 pregnancy appointments until you give birth. The pregnancy appointments are initially spaced out, until every 2 weeks up to your due date.
You need to notify your GP as soon as you find out you are pregnant. More, you may wish to have an appointment with your GP before you get pregnant, when you are planning to get pregnant, so that you are well informed and have a general health check.
First Appointment When You Are Pregnant
At the first pregnancy appointment, the GP will:
- Take a history,
- Conduct a general examination and
- Assess any potential risk factors during the pregnancy.
Your GP may also carry out tests at the first appointment. You will then be referred to a midwife or an obstetrician. In the NHS a midwife appointment is the usual and this is called ‘booking appointment’, although privately an obstetrician will undertake this. At the booking appointment, that usually takes place at 12 weeks, you will also have your first scan.Quite often women may decide to have an earlier scan, privately.
At the first appointment with a doctor or midwife you will have the chance to ask any questions. I recommend you take your partner with you as you’d be surprised how many questions Fathers-to-be have!
You will be asked about previous smears tests and any previous pregnancies. An illness history will be taken to anticipate whether you will need additional care or support.
Bloods tests undertaken in the early stages include the following:
- Blood count and Haemoglobin screen
- Antibody Screen
- HIV testing
- Blood group and Rhesus type
- Thyroid function
- Chicken Pox, Rubella and Toxoplasma immunity
- Hepatitis B and C
- Sugar level
Your height, weight and blood pressure will be measured and Down’s Syndrome screening will be discussed with you. Pregnancy advice and leaflets will also be provided to you.
First Scan When You Are Pregnant
Your first scan, known as the dating scan, should be around the time of your booking appointment. This scan measures the baby’s length and can accurately predict your due date (particularly helpful if you have irregular periods). You will also be offered a combined test for Down’s Syndrome where your age, the thickness of the fluid area at the back of the baby’s neck on the dating scan (nuchal translucency/NT) and blood test results are all combined to give your baby the risk of having Down’s syndrome.
16 Weeks Pregnancy Appointment
The next appointment is at 16 weeks when your blood results and Down’s screening result are discussed again and documented in your self-held maternity records. Your blood pressure and urine will be checked again. Antenatal classes will be discussed.
The following pregnancy appointments are conducted by the midwife, GP or hospital Consultant / Obstetrician depending on your circumstances.
20 Weeks Pregnancy Scan
Around 20 weeks you will have an anomaly scan that looks for any structural abnormalities and measures various growth parameters. Your scan report (to be attached to your maternity records) will comment on the baby’s head, brain, face, spine, neck, skin, chest, heart, abdomen, intestines, kidneys, bladder, limbs and skeleton. It will also tell you where in the womb the placenta is attached.
24 Weeks Of Pregnancy Appointment
Around 24 weeks the midwife will measure your SFH (or symphysis-fundal height) which goes from your pubic bone to the top of your womb.
This length in centimetres should equal your gestation in weeks, give or take 1cm e.g. you should measure 23-25cms when you are 24 weeks pregnant.
The midwife will also check your blood pressure and your urine for any protein.
These 3 checks (SFH, Blood Pressure and urine) will be done at each appointment from now on so best get used providing a urine sample!
28 Weeks Of Pregnancy Appointment
At 28 weeks you should have a blood test to check for anaemia (low red blood cells) and some clinics check for gestational diabetes.
If you are Rhesus negative then you will be offered an anti-D injection. If you are working, you should have been given your MatB1 form by now to pass to your employer for maternity benefits.
31 Weeks Of Pregnancy Appointment
At 31 weeks you have the standard 3 checks and the blood results from the 28 week appointment will be discussed.
34 Weeks Of Pregnancy Appointment
At 34 weeks, the standard 3 checks are done and if you are Rhesus negative you will be offered the second dose of Anti-D.
36 Weeks Of Pregnancy Appointment
The 36 week appointment signifies the final position of the baby for birth as it can no longer move around.
If at this stage your baby is breech (upside-down) you will be offered the chance to try and turn the baby from the outside (ECV), or you can opt for a caesarian section operation. If the placenta was low, near the cervix at the 20 week scan, you will be offered another scan now to reassess it’s position.
38 Weeks Of Pregnancy Appointment
At 38 weeks the standard 3 checks are done and you should take the time to ask any last minute questions or concerns.
40 Weeks Of Pregnancy Appointment
The 40 week appointment is made just in case you haven’t had the baby yet and in my experience a lot of women don’t make it to these appointments!
If there are no signs of baby’s arrival, you will be booked in for an extra appointment at 41 weeks during this appointment so that should you not have given birth by then, they can discuss how to induce labour medically should you want this.
For subsequent babies, there are 2 less appointments later on in pregnancy as you and your body should know what you are doing by then!