Check ups during pregnancy

Prenatal care checkups | March of Dimes

Prenatal care is medical care you get during pregnancy. At each prenatal care visit, your health care provider checks on you and your growing baby.

Call your provider to schedule your first prenatal care checkup as soon as you know you’re pregnant.

Getting early and regular prenatal care can help you have a healthy pregnancy and a full-term baby.

Go to all your prenatal care checkups, even if you’re feeling fine.

What is prenatal care and why is it important?

Prenatal care is medical care you get during pregnancy. At each visit, your health care provider checks on you and your growing baby. Call your provider and go for your first prenatal care checkup as soon as you know you’re pregnant. And go to all your prenatal care checkups, even if you’re feeling fine.

Getting early and regular prenatal care can help you have a healthy pregnancy and a full-term baby. Full term means your baby is born between 39 weeks (1 week before your due date) and 40 weeks, 6 days (1 week after your due date). Being born full term gives your baby the right amount of time he needs in the womb to grow and develop.

Don’t be afraid to talk to your provider about personal things. Your provider needs to know all about you so she can give you and your baby the best care. She asks lots of questions about you, your partner and your families. Your medical information and anything you tell her are confidential. This means she can’t share them with anyone without your permission. So don’t be afraid to tell her about things that may be uncomfortable or embarrassing, like if your partner hurts or scares you or if you smoke, drink alcohol, use street drugs or abuse prescription drugs.

Who can you go to for prenatal care?

You can get prenatal care from different kinds of providers:

An obstetrician/gynecologist (also called OB/GYN) is a doctor who has education and training to take care of pregnant women and deliver babies. The American College of Obstetricians and Gynecologists can help you find an OB in your area.
A family practice doctor (also called a family physician) is a doctor who can take care of every member of your family. This doctor can take care of you before, during and after pregnancy. The American Board of Family Medicine can help you find a family practice doctor in your area.
A maternal-fetal medicine (also called MFM) specialist is an OB with education and training to take care of women who have high-risk pregnancies. If you have health conditions that may cause problems during pregnancy, your provider may want you to see a MFM specialist. The Society for Maternal-Fetal Medicine can help you find a specialist in your area.
A certified nurse-midwife (also called CNM) is a nurse with education and training to take care of women of all ages, including pregnant women. The American College of Nurse-Midwives can help you find a CNM in your area.
A family nurse practitioner (also called FNP) or a women’s health nurse practitioner (also called WHNP). A FNP is a nurse with education and training to take care of every member of your family. A WHNP is a nurse with education and training to take care of women of all ages, including pregnant women. The American Association of Nurse Practitioners can help you find these kinds of nurse practitioners in your area.

Think about these things to help you choose a provider:

Is the provider licensed and board certified to take care of you during pregnancy, labor and birth? Licensed means the provider can legally practice medicine in a state. To have a license, a provider has to have a certain amount of education and training and pass certain tests to make sure he can safely take care of patients. Board certified means that a provider has had extra training in a certain area (called a specialty).

Is the provider covered by your health insurance?
Have you heard good things about the provider? Is she recommended by your friends or family? How does your partner feel about her as your prenatal care provider?
Would you rather see a man or a woman provider? How old to you want the provider to be? Does he explain things clearly?
Is the office easy to get to? Do the office hours fit into your schedule? Is the office staff friendly and helpful?
Who takes care of phone calls during office hours? Who handles them after hours or in an emergency? Do you have to pay if your provider spends time with you on the phone?
Is the provider in group practice? If yes, will you always see your provider at prenatal care checkups? Or will you see other providers in the practice? Who will deliver your baby if your provider’s not available when you go into labor?
What hospital or birthing center does the provider use? What do you know about it? Is it easy for you to get to?

How often do you go for prenatal care checkups?

Most pregnant women can follow a schedule like this:

Weeks 4 to 28 of pregnancy. Go for one checkup every 4 weeks (once a month).
Weeks 28 to 36 of pregnancy. Go for one checkup every 2 weeks (twice a month).
Weeks 36 to 41 of pregnancy. Go for one checkup every week (once a week).

If you have complications during pregnancy, your provider may want to see you more often.

Your partner or support person (a friend or someone from your family) is welcome at your prenatal checkups.

How can you get ready for your first prenatal care checkup?

Be ready to talk with your provider about:

The first day of your last menstrual period (also called LMP). Your provider can use this to help find out your baby’s due date.
Health conditions you have, like depression, diabetes, high blood pressure, and not being at a healthy weight. Conditions like these can cause problems during pregnancy. Tell your provider about your family health history. This is a record of any health conditions and treatments that you, your partner and everyone in your families have had. Use the March of Dimes Family Health History Form and share it with your provider. If you have a record of your vaccinations, take it to your checkup. A vaccination is a shot that contains a vaccine that helps protect you from certain harmful infections.
Medicines you take, including prescription medicine, over-the-counter medicine, supplements and herbal products. Some medicines can hurt your baby if you take them during pregnancy, so you may need to stop taking it or switch to another medicine. Don’t stop or start taking any medicine without talking to your provider first. And tell your provider if you’re allergic to any medicine. You may be allergic to a medicine if it makes you sneeze, itch, get a rash or have trouble breathing when you take it.
Your pregnancy history. Tell your provider if you’ve been pregnant before or if you’ve had trouble getting pregnant. Tell her if you’ve had any pregnancy complications or if you’ve had a premature baby (a baby born before 37 weeks of pregnancy), a miscarriage or stillbirth. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy.
Smoking, drinking alcohol, using street drugs and abusing prescription drugs. All of these can hurt your baby. Alcohol includes beer, wine and liquor. Street drugs are illegal to use, like heroin and cocaine. Abusing prescription drugs means you use them differently than your provider tells you to. This means you take more than your provider says you can take, you take it with alcohol or other drugs or you use someone else’s prescription drugs.
Stress you feel. Stress is worry, strain or pressure that you feel in response to things that happen in your life. Talk to your provide about ways to deal with and reduce your stress. High levels of stress can cause complications during pregnancy.
Your safety at home and work. Tell your provider about chemicals you use at home or work and about what kind of job you have. If you’re worried about abuse during pregnancy and ask about ways you can stay healthy and safe at home and work.

What happens at your first prenatal care checkup?

Your first checkup is usually the longest because your provider asks you lots of questions about your health. At your first prenatal care checkup, your provider:

Gives you a physical exam and checks your overall health. Your provider checks your weight and height to figure out how much weight you should gain during pregnancy.
Checks your blood, blood pressure and urine. Blood tests can tell your provider if you have certain infections, like syphilis, hepatitis B and HIV. Your provider also uses a blood test to find out your blood type and Rh factor and to check for anemia. Anemia is when you don't have enough healthy red blood cells to carry oxygen to the rest of your body. Rh factor is a protein that most people have on their red blood cells. If you don’t have it and your baby does, it can cause Rh disease in your baby. Treatment during pregnancy can prevent Rh disease. Blood pressure and urine tests can help your provider diagnose a serious condition called preeclampsia. This is a kind of high blood pressure that can happen during pregnancy. Having too much protein in your urine may be a sign of preeclampsia. Urine tests also can tell your provider if you have a kidney or bladder infection or other conditions, like diabetes.
Gives you a pelvic exam and a Pap smear. Your provider checks the pelvic organs (pelvis and womb) to make sure they’re healthy. For the Pap smear, your provider collects cells from your cervix to check for cancer and for infections, like chlamydia and gonorrhea. The cervix is the opening to the uterus (womb) that sits at the top of the vagina.
May give you vaccinations, like a flu shot. It’s safe to get a flu shot any time during pregnancy. But some vaccinations are best at certain times and some aren’t recommended during pregnancy. Talk to your provider about what’s best and safe for you and your baby.
Tells you your due date. Your provider usually uses your LMP to figure out your due date. But you may get an early ultrasound to confirm that you’re pregnant and help your provider figure out your baby’s age. An ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.
Prescribes a prenatal vitamin. This is a multivitamin made for pregnant women. Your prenatal vitamin should have 600 micrograms of folic acid in it. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take it before pregnancy and during early pregnancy, it can help protect your baby from birth defects of the brain and spine called neural tube defects (also called NTDs), and birth defects of the mouth called cleft lip and palate.
Talks to you about prenatal tests. These are medical tests you get during pregnancy. They help your provider find out how you and your baby are doing. You may want to have certain tests only if you have certain problems or if you’re at high risk of having a baby with a genetic or chromosomal condition, like Down syndrome. If your provider thinks you’re at risk for having a baby with one of these conditions, he may recommend that you see a genetic counselor. This person has training to help you understand about genes, birth defects and other medical conditions that run in families, and how they can affect your health and your baby’s health.

What happens at later prenatal care checkups?

Later prenatal care checkups usually are shorter than the first one. At your checkups, tell your provider how you’re feeling. There’s a lot going on inside your body during pregnancy. Your provider can help you understand what’s happening and help you feel better if you’re not feeling well. Between visits, write down questions you have and ask them at your next checkup.

At later prenatal care checkups, your health care provider:

Checks your weight and blood pressure. You also may get urine and blood tests.
Checks your baby’s heartbeat. This happens after about 10 to 12 weeks of pregnancy. You can listen, too!
Measures your belly to check your baby’s growth. Your provider starts doing this at about 20 weeks of pregnancy. Later in pregnancy, she also feels your belly to check your baby’s position in the womb.
Gives you certain prenatal tests to check you and your baby. For example, most women get an ultrasound at 18 to 20 weeks of pregnancy. You may be able to tell if your baby’s a boy or a girl from this ultrasound, so be sure to tell your provider if you don’t want to know! Later in pregnancy, your provider may use ultrasound to check the amount of amniotic fluid around your baby in the womb. Between 24 and 28 weeks, you get a glucose screening test to see if you may have gestational diabetes. This is a kind of diabetes that some women get during pregnancy. And at 35 to 37 weeks, you get a test to check for group B strep. This is an infection you can pass to your baby.
Asks you about your baby’s movement in the womb. If it’s your first pregnancy, you may feel your baby move by about 20 weeks. If you’ve been pregnant before, you may feel your baby move sooner. Your provider may ask you to do kick counts to keep track of how often your baby moves.
Gives you a Tdap vaccination at 27 to 36 weeks of pregnancy. This vaccination protects both you and your baby against pertussis (also called whooping cough). Pertussis spreads easily and is dangerous for a baby.
Does a pelvic exam. Your provider may check for changes in your cervix as you get close to your due date.

How can you get free or low-cost prenatal care?

If you don't have health insurance or can't afford prenatal care, find out about free or low-cost prenatal care services in your community:

Call (800) 311-BABY [(800) 311-2229]. For information in Spanish, call (800) 504-7081.
Visit healthcare.gov to find a community health center near you. Community health centers can provide low-cost prenatal care.

Last reviewed: June, 2017

What Happens at a Prenatal Care Check-Up Appointment?

In This Section

Prenatal Care
What happens at an appointment?
What is prenatal testing?
What’s an ultrasound?

What’s chorionic villus sampling?
What’s amniocentesis?
Where can I get prenatal care?
What pregnancy complications can happen?

Prenatal services include tests and physical exams to make sure you and your pregnancy are healthy. It’s a good time to ask questions about your pregnancy and the birth of your future baby.

What happens during my first prenatal care appointment?

Your first prenatal care visit is usually the longest one. You’ll talk with your doctor about your medical history, the other parent’s medical history, and your family's’ medical history.

Your doctor will give you a complete check-up, usually with a physical exam and blood and urine tests to make sure you’re healthy. This can include:

measuring your height, weight, blood pressure, breathing, and pulse
a breast exam
a pelvic exam
a Pap test
testing for sexually transmitted infections (like chlamydia, gonorrhea, syphilis, and HIV)
screening for diabetes, anemia, hepatitis B, and rubella

Your doctor might also talk with you about your diet and lifestyle, and prenatal vitamins. The most important vitamin you can take is folic acid, which ideally you would start taking before you’re even pregnant. Your doctor can give you advice about any changes you can make to have the healthiest pregnancy possible.

Some types of medicine are dangerous to use during your pregnancy. Tell your doctor about every medicine, supplement, or drug you’re using, and always check with your doctor before starting any new ones.

What will happen during my follow-up prenatal care appointments?

During your follow-up prenatal care visits, your doctor, nurse, or midwife will examine you to make sure your pregnancy is developing well, and that you and the fetus are healthy.

During prenatal care visits, your doctor, nurse, or midwife may:

update your medical history
check your urine
check your weight and blood pressure
check for swelling
feel your belly to check the position of your fetus
measure the growth of your belly
listen to the fetal heartbeat
give you any genetic testing you decide to do

These prenatal checkups are a great time to talk about any questions or concerns that have come up since your last visit.

What changes to my body can I expect during my pregnancy?

There’s no getting around it — your body will change a lot during your pregnancy. You’ll go through lots of hormonal changes, and you’ll get bigger as the fetus develops. Your uterus will grows up to 18 times its normal size, and your breasts and nipples will probably get larger, too.

It’s normal to gain up to 35 pounds during your pregnancy, and some people may gain more. Your sex drive can increase or decrease throughout your pregnancy. And some people notice changes in the texture and amount of their body hair.

Unfortunately, almost everyone feels uncomfortable at some point in their pregnancy. Some common issues include:

nausea or vomiting, especially in the morning
swollen and tender breasts
heartburn
constipation
aches and pains in your lower back and hips
tiredness and fatigue
trouble sleeping

There are things you can do to feel more comfortable, like changing your diet, and doing certain exercises. Your doctor, nurse, or midwife will have tips for feeling better during your pregnancy.

How do I relieve common pregnancy discomforts?

For nausea and vomiting:

Eat a few bites of food before getting out of bed.
Drink ginger or peppermint tea.
Eat small meals throughout the day, instead of a few big ones.
Drink fluids between meals instead of with your meals.
Avoid strong spices, strong odors, and greasy foods.

For heartburn:

Eat small meals throughout the day, instead of a few big ones.
Chew your food slowly.
Don't lie down for at least 1 hour after you eat.
Wear clothes that are loose around your waist.
Raise your head with pillows when you sleep.

For constipation

Talk with your doctor, nurse, or midwife about getting help for pain or discomfort that doesn’t go away.

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Gestational age	Analyzes	Events (registration, medical examinations, doctor visit schedule)
Up to 12 weeks		Early registration in the antenatal clinic nine0020 Taking medications: folic acid throughout the first trimester, no more than 400 mcg / day; potassium iodide 200-250 mcg/day (in the absence of thyroid disease)
At first appearance		An obstetrician-gynecologist collects anamnesis, conducts a general physical examination of the respiratory, circulatory, digestive, urinary system, mammary glands, anthropometry (measurement of height, body weight, determination of body mass index), measurement of the size of the pelvis, examination of the cervix in the mirrors, bimanual vaginal study nine0007
Not later than 7-10 days after the initial visit to the antenatal clinic		Inspections and consultations: - general practitioner; - a dentist; - an otolaryngologist; - an ophthalmologist; - other medical specialists - according to indications, taking into account concomitant pathology nine0007
First trimester (up to 13 weeks) (and at first visit)	1. General (clinical) blood test. 2. Biochemical blood test (total protein, urea, creatinine, total bilirubin, direct bilirubin, alanine transaminase (hereinafter - ALT), aspartate transaminase (hereinafter - AST), glucose, total cholesterol. 3. Coagulogram - platelet count, clotting time, bleeding time, platelet aggregation, activated partial thromboplastin time (hereinafter referred to as APTT), fibrinogen, determination of prothrombin (thromboplastin) time. nine0007 4. Determination of antibodies of classes M, G (IgM, IgG) to the rubella virus in the blood, to the herpes simplex virus (HSV), to cytomegalovirus (CMV), determination of antibodies to toxoplasma in the blood. 5. General analysis of urine. 6. Determination of the main blood groups (A, B, 0) and Rh-affiliation. In Rh-negative women: a) examination of the father of the child for group and Rh-affiliation. 7. Determination of antibodies to pale treponema (Treponema pallidum) in the blood, determination of antibodies of classes M, G to the human immunodeficiency virus HIV-1 and HIV-2 in the blood, determination of antibodies of classes M, G to the antigen of viral hepatitis B and viral hepatitis C in blood. nine0007 8. Microscopic examination of the discharge of female genital organs for gonococcus, microscopic examination of the vaginal discharge for fungi of the genus Candida. 9. PCR chlamydial infection, PCR gonococcal infection, PCR mycoplasma infection, PCR trichomoniasis.	Visiting an obstetrician-gynecologist every 3-4 weeks (with the physiological course of pregnancy). nine0007 Electrocardiography (hereinafter - ECG) as prescribed by a general practitioner (cardiologist). Up to 13 weeks of pregnancy are accepted: - folic acid no more than 400 mcg / day; - potassium iodide 200-250 mcg / day (in the absence of thyroid disease)
1 time per month (up to 28 weeks)	Blood test for Rh antibodies (in Rh-negative women with Rh-positive affiliation of the father of the child) nine0007
11-14 weeks	Biochemical screening for serum marker levels: - pregnancy-associated plasma protein A (PAPP-A), - free beta subunit of human chorionic gonadotropin (hereinafter - beta-CG)	In the office of prenatal diagnostics, an ultrasound examination (hereinafter referred to as ultrasound) of the pelvic organs is performed. nine0007 According to the results of complex prenatal diagnostics, a conclusion of a geneticist is issued.
After 14 weeks - once	Culture of midstream urine	To exclude asymptomatic bacteriuria (the presence of bacterial colonies more than 105 in 1 ml of an average portion of urine, determined by a culture method without clinical symptoms) to all pregnant women. nine0008
In the second trimester (14-26 weeks)	General (clinical) analysis of blood and urine.	Visiting an obstetrician-gynecologist every 2-3 weeks (with the physiological course of pregnancy). At each visit to the doctor of the antenatal clinic - determination of the circumference of the abdomen, the height of the fundus of the uterus (hereinafter referred to as VDM), uterine tone, palpation of the fetus, auscultation of the fetus with a stethoscope. nine0007 Potassium iodide 200-250 mcg/day
1 time per month (up to 28 weeks)	Blood for Rh antibodies (in Rh-negative women with Rh-positive affiliation of the father of the child)
16-18 weeks	Blood test for estriol, alpha-fetoprotein, beta-hCG	Only at late turnout unless biochemical screening for serum marker levels at 11-14 weeks nine0007
18-21 weeks		The second screening ultrasound of the fetus is performed in the antenatal clinic
In the third trimester (27-40 weeks)	1. General (clinical) blood test. 2. Biochemical blood test (total protein, urea, creatinine, total bilirubin, direct bilirubin, alanine transaminase (hereinafter - ALT), aspartate transaminase (hereinafter - AST), glucose, total cholesterol). nine0007 3. Coagulogram - platelet count, clotting time, bleeding time, platelet aggregation, activated partial thromboplastin time (hereinafter referred to as APTT), fibrinogen, determination of prothrombin (thromboplastin) time. 4. Determination of antibodies of classes M, G (IgM, IgG) to the rubella virus in the blood, determination of antibodies to toxoplasma in the blood. 5. General analysis of urine. 6. Determination of antibodies to pale treponema (Treponema pallidum) in the blood, determination of antibodies of classes M, G to the human immunodeficiency virus HIV-1 and HIV-2 in the blood, determination of antibodies of classes M, G to the antigen of viral hepatitis B and viral hepatitis C in blood. nine0007 7. Microscopic examination of the discharge of female genital organs for gonococcus, microscopic examination of the vaginal discharge for fungi of the genus Candida.	A visit to an obstetrician-gynecologist every 2 weeks, after 36 weeks - weekly (with the physiological course of pregnancy). At each visit to the doctor of the antenatal clinic - determination of the circumference of the abdomen, VDM, uterine tone, fetal palpation, auscultation of the fetus with a stethoscope. nine0007 Potassium iodide 200-250 mcg/day
24-28 weeks	Oral glucose tolerance test (OGTT)
28-30weeks	In Rh-negative women with Rh-positive blood of the child's father and the absence of Rh antibodies in the mother's blood	Administration of human immunoglobulin antirhesus RHO[D] nine0007
30 weeks		A certificate of incapacity for work is issued for maternity leave
30-34 weeks		The third screening ultrasound of the fetus with dopplerometry in the antenatal clinic. Inspections and consultations: - general practitioner; - a dentist. nine0007
After 32 weeks		At each visit to the doctor of the antenatal clinic, in addition to determining the circumference of the abdomen, the height of the uterine fundus (hereinafter referred to as VDM), uterine tone, determine the position of the fetus, the presenting part, the doctor auscultates the fetus with a stethoscope.
After 33 weeks		Cardiotocography (hereinafter referred to as CTG) of the fetus is performed nine0007
Throughout pregnancy		In antenatal clinics there are schools for pregnant women, which are attended by expectant mothers along with fathers. In the process of learning, there is an acquaintance with the changes in the body of a woman during physiological pregnancy, acquaintance with the process of childbirth, the correct behavior in childbirth, the basics of breastfeeding.
Over 37 weeks nine0007		Hospitalization with the onset of labor. According to indications - planned antenatal hospitalization.
41 weeks		Planned hospitalization for delivery
No later than 72 hours after delivery	All women with an Rh-negative blood group who gave birth to a child with a positive Rh-belonging, or a child whose Rh-belonging is not possible to determine, regardless of their compatibility according to the AB0 system nine0007	Re-introduction of human immunoglobulin anti-rhesus RHO[D]
postpartum period		1. Early breastfeeding 2. Recommendations for breastfeeding. 3. Consultation of medical specialists on concomitant extragenital disease (if indicated). 4. Toilet of the external genital organs. nine0007 5. Dry processing of seams (if any). 6. Removal of external non-absorbable sutures (if any) on the 5th day. 7. Early discharge.
Daily postpartum		1. Examination by an obstetrician-gynecologist; 2. Inspection and palpation of the mammary glands.
3 days after birth nine0007		Ultrasound of the pelvic organs
After delivery by caesarean section	1. Complete blood count, general urinalysis. 2. Biochemistry of blood (according to indications).	Ultrasound of the pelvic organs

Why is a chair examination needed during pregnancy? nine0001

Inspection on a chair during pregnancy: what is it for?

Obstetrician-gynecologist Olga Petrova has prepared an article in which she will tell you why you need an examination on a chair and what can be found during the examination.

Examination on the chair is one of the most important stages of the examination at the appointments with an obstetrician-gynecologist.

If the pregnancy is proceeding normally, then the examination is carried out only in the 1st and 3rd trimesters, but special attention should be paid to the examination during the first visit of the woman. nine0007

As a result of the examination, the doctor may:

1. Diagnose and prevent concomitant gynecological pathologies

2. Take the necessary tests

3. Give recommendations appropriate to the results of the inspection.

The 1st point is important, since there are quite a few diseases that are not clinically manifested in any way, and on examination they can be suspected/diagnosed. nine0007

What are these diseases?

STIs (sexually transmitted infections).

STIs can be suspected during examination on the chair at the gynecologist, as well as during pH-metry. As a result, it will be possible to prescribe treatment in a timely manner and take the necessary tests.

There are situations when, after an examination, it is possible to reassure a patient who is worried about a change in the nature of the discharge, explaining that this is normal. nine0007