For a first pregnancy, routine checks happen every four weeks following the booking-in appointment. Around week 28 the check increase to every two weeks, and from week 36 they are weekly. At every appointment your midwife/ doctor will check:
- Weight – you may not be weighed at each appointment but you should let your midwife know of any rapid increase in weight, which can be a sign of diabetes or water retention (the latter can be a symptom of pre-eclampsia, a potentially serious condition of pregnancy).
- Abdomen – feeling (palpating) your abdomen can determine the size and position of the baby. The distance between pubic bone and the top of the uterus (height of fundus) is also measured.
- Blood Pressure – a significant leap may indicate pre-eclampsia.
- Urine – this is tested for protein, a sign of pre-eclampsia and glucose, an indicator of diabetes.
- Baby’s Heart Rate – this is usually monitored using a hand-held device placed on the abdomen. You will also be asked about any other health concerns, from swelling in the legs and hands to your emotional wellbeing. Be sure to report any concerns, from headaches to nausea or disturbed vision. If you have severe itching, especially on the hands and feet, this could indicate a pregnancy condition called obstetric cholestasis, which is caused by liver malfunction.
If the blood test at your booking-in appointment showed very low levels of haemoglobin, you will be given further tests to monitor your levels.
Fetal Anomaly Scan
This is routinely offered at 18 – 20 weeks to confirm EDD and pick up on abnormalities, for example congenital heart defects, kidney and gastrointestinal problems, and spina bifida. Depending on the position of your baby, the scan may also be able to confirm gender. Potential problems that may be identified by this scan could include:-
- Placenta Praevia (low lying placenta) – this is when the placenta is located low down in the uterus, partially or fully blocking the cervix, the baby’s birth route. It can also cause bleeding during pregnancy. In the majority of cases the placenta moves up and away from the cervix as the uterus grows. You will require further scans to monitor its position.
- Breech Presentation – the optimum position for birth is when the baby’s head is down and his spine is facing away from our spine. Other positions, such as breech, where the presenting part closest to the cervix is the bottom or feet, can make a normal vaginal delivery more difficult. At this stage there is plenty of time for your baby to switch position, and the majority do so. However, you should remain flexible in your birth plan to allow for the possibility of a breech birth.
Johan Theron Nel
M.B.Ch.B (Stellenbosch) M.Med. (O.& G.) (Stellenbosch) F.C.O.G. (S.A.), M.R.C.O.G. (London), F.R.C.S. (Edinbourgh)
Core Obstetrics and Gynaecology with Examination Guidelines for M.B.Ch.B. Published 1995