New OB Appointment: Exam, Labs, and Ultrasound
At your first new OB visit, you can expect to spend a longer amount of time in the office than will typically be required on subsequent visits. During this visit, you will meet your obstetrician and discuss your past medical history, receive a full physical examination, and your provider will address any questions or concerns you have about the pregnancy. Your provider will ask questions about your family and genetic history at this appointment. You can print the genetic screening form prior to coming to the office, fill it out, and bring it with you to your new appointment. Any genetic concerns will be addressed at this visit. Please read the section: Birth Defects and First Trimester Screening. If you have any questions or are interested in this, please address these with your provider at your appointment. Most women will also receive an ultrasound in our office at this visit to assist in pregnancy dating. All new obstetric patients require labwork, but we have the capability of drawing that in our office.
There are a number of tests that are recommended for screening in all obstetric patients. We follow the recommendations of ACOG (American College of Obstetricians and Gynecologists) and the CDC regarding recommended testing.
1. Blood type and antibody screen—your blood type can be A, B, AB, or O. It can be Rh positive or Rh negative. The baby’s blood type is determined by the genes of both the mother and father. If the mother is Rh negative, she can form Rh antibodies if she is exposed to Rh positive blood. In other words, if a mother is Rh negative and has a baby that is Rh +, during delivery she can be exposed to some of this blood. The mother’s body recognizes this as foreign blood and treats it the same way it would if she encountered a virus or other infection—it forms antibodies to it. When the mother’s body forms antibodies, these can be present from that point on in her body. The problem with this is that these antibodies can cross the placenta in future pregnancies. If this happens, the baby can become very anemic.
2. CBC—this is a complete blood count. It checks the levels of a number of different blood cells including white blood cells, red blood cells, and platelets. This test can screen for high and low levels of these cells. If low levels of red blood cells are found, this is consistent with anemia. Prenatal vitamins have iron in them to help treat and prevent anemia.
3. Rubella (German measles)—most people have been vaccinated against rubella. If you have had rubella or received a vaccination against it, your body will have antibodies present to it. This infection can be dangerous to the baby if contracted during pregnancy. If you are not immune to rubella, you can receive a vaccination after you’ve delivered.
4. Syphilis—syphilis is another infection that can be passed to the baby. Syphilis is a sexually transmitted disease. If it is not treated, it can cause serious problems to the baby. Syphilis can be treated and cured during pregnancy with penicillin.
5. Hepatitis B virus—hepatitis is an infection of the liver that is transmitted through the blood or infected bodily fluids exchanged through sexual contact. There are several different forms of hepatitis and many people have been vaccinated against hepatitis B. If you have not, and you contract the virus while pregnant, you can pass it to the baby. All babies are given a vaccine against the virus after birth.
6. Human immunodeficiency virus (HIV)—HIV is another virus that is contracted through blood or infected bodily fluids. While there is no cure for HIV, advances in medications have drastically improved survival and decreased the risk that the infection will be passed to the baby.
We are checking the urine for the presence of glucose (sugar) and protein. Large amounts of sugar can be a sign of diabetes. Protein in the urine can be a sign of infection, kidney disease, or preeclampsia (high blood pressure associated with pregnancy).
A Pap smear is a test that is obtained to screen for cervical cancer and abnormalities of the cervical cells that could eventually lead to cancer. Even if you have had a Pap in the last year, we will often repeat the Pap smear.
It is not uncommon to have an abnormal Pap during pregnancy. Depending on the Pap findings, your doctor may recommend colposcopy (Please see our section: Colposcopy to learn more about this). Abnormal cells seen during pregnancy very often resolve, but it is important that you keep scheduled follow-up after you deliver to ensure that these abnormal cells do resolve.