So you’ve just confirmed your pregnancy, but now what? When should you start seeing a gynaecologist and how often should you go for check-ups? Dr Ben Choey answers some frequently asked questions.
Q: When should I go for my first checkup?
It is advisable to see your gynaecologist when you are about 7 – 8 weeks unless you have any issues like vaginal bleeding or abdominal pain, for which earlier consult is important. At 7 weeks you should be able to see your baby’s heart beat on trans abdominal ultrasound. Scanning in the first trimester is important as screening for multiple pregnancies is most accurate at this time.
In the first trimester, your gynaecologist may also screen you for risk factors such as diabetes, thalassemia syndromes, hypertension, previous premature labor and genetic syndromes. Early identification of risk factors can improve pregnancy outcome if preventive measures are undertaken at an earlier gestational age.
Q: How often do I need to go for an ultra sound scan?
There are a few essential scans for a normal pregnancy.
At the first booking visit, a dating ultrasound scan most accurately determines the estimated date of delivery in the first trimester.
- Down Syndrome screening (First Trimester Screening) – this is an optional screening scan for risk of trisomy 21(Down Syndrome), trisomy 18 and trisomy 13. It can only be performed between 11 – 13weeks+6 days gestation;
- Fetal anomaly scan – this is a detailed structural scan performed between 18 – 22 weeks to screen for structural fetal anomalies and soft markers of chromosomal abnormalities. It is an important scan as early detection of abnormalities allows ample time for fetal karyotype and subsequent termination of abnormal pregnancies. Early detection of cardiac abnormalities also allows early consultation with pediatric cardiologist and neonatal surgical planning.
- Growth ultrasound – usually performed between 28 – 32 weeks, growth ultrasound allows your doctor to monitor fetal growth and fetal well-being. The amniotic fluid levels, fetal presentation, and estimated fetal weight are checked. Abnormal growth rates will necessitate close fetal monitoring and frequent scans. More frequent scans may also be performed if your pregnancy is complicated and requires close fetal surveillance.
Q: How often should I meet my gynaecologist?
Visits are usually once every month until 28 weeks gestation. Thereafter follow up interval shortens to 3 weekly till 34 weeks, 2 weeks from 34-46 weeks, and weekly thereafter from 36 weeks gestation. More frequent visits may be necessary if you develop any pregnancy-related complications or close fetal surveillance is required.
Q: Are there any medical tests mothers need to take when they are pregnant?
There are a few tests at each visit with your gynecologist:
- Blood pressure measurement – any fluctuations in blood pressure will be detected. If blood pressure is too high it may be a sign of developing pre-eclampsia, a severe form of hypertension during pregnancy.
- Urine dipstix – a test strip impregnated with chemical which will detect protein or glucose, Presence of protein may signify urinary infection or if you are developing pre-eclampsia. Sugar may be a sign of diabetes and should be investigated further with a formal glucose tolerance test at 28 weeks gestation. Blood in late pregnancy may be a sign that labor may be about to start. Urinary tract infection may also be a possible cause.
- Antenatal blood tests – This usually includes Blood group and Rhesus status, syphilis screen, hepatitis B screen, HIV screen, complete blood count and rubella immunity.
- Down syndrome screening blood tests (first or second trimester) – if you are opting for Down syndrome screening, blood samples will be taken for measurement of PAPP-A (Pregnancy-associated plasma protein A),free beta-hcg, alpha fetoprotein and estriol levels.
- Oral glucose tolerance test – this involves a fasting glucose level and a post 75gram glucose 2-hour blood sample to exclude gestational diabetes mellitus. It is not a routine test and usually performed for patients with risk factors for diabetes.
- Vaginal swab test for Group B Streptococcus – a vaginal swab is performed at 36 weeks to screen for GBS, a bacteria which can cause potential infections to your baby during passage through the birth canal. If you are found to be a carrier of GBS, intravenous antibiotics will be commenced when you are in active phase of labor.
This article was first published in The New Age Parents e-magazine
By Dr Ben Choey
Specialist in Obstetrics and Gynaecology
A gynaecologic surgeon who has been committed to women’s health for more than 10 years, Dr Choey obtained his Master of Medicine (O&G) and became a member of the Royal College of Obstetricians and Gynaecologists (United Kingdom) in 2007. He was also appointed Clinical Tutor in Yong Loo Lin School of Medicine and Duke-NUS Graduate Medical School
Article contributed by SBCC.
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