Obstetrics: Expectations from the first antenatal visit

Background: Most people will see me for their first antenatal appointment soon after they have a positive home pregnancy test. Generally this may occur between week 6 - week 10 of a pregnancy. The first antenatal visit is a busy appointment as we confirm the pregnancy and its location, review common symptoms of early pregnancy, establish risks of the pregnancy and take a detailed medical history from biological parents. We will also make a plan for expectations during each of the trimesters in pregnancy and important investigations (eg: ultrasounds and chromosomal abnormality testing) to be undertaken. Below is some of the information I would generally cover and some links to useful resources.

Supplementation:
Folic acid 400 microg (oral, daily) ideally from 4 weeks prior to conception to 14 weeks after conception
Calcium 1000 mg (oral, daily) through out the pregnancy
B12 - 2.6 microg (oral, daily) throughout the pregnancy if vegan or vegetarian
Vitamin D 400 i.u (oral, daily) through out the pregnancy if in a high risk category/ minimal sun exposure
Omega 3 fatty acids (oral, daily) through out the pregnancy if you have a low seafood diet

Lifestyle advice:
1. Stop smoking, alcohol or other non-prescribed substances
2. Exercise regularly - generally anything you were doing before is safe to continue; contact sports should stop between week 14 - 16 and maternal heart rate should never be sustained above 120 bpm for a prolonged period.
3. Be aware of common substances that may increase the risk of problems with your baby (eg: medications, alcohol, high dose X-rays, chemicals), speak to me if you’re concerned about your exposure to any of these substances immediately prior to conception or during the pregnancy.

Infectious diseases - specifically related to pregnancy and the necessary precautions
Information on CMV https://www.health.nsw.gov.au/Infectious/factsheets/Pages/cmv-and-pregnancy.aspx
Information on Toxoplasmosis https://www.nhmrc.gov.au/about-us/publications/staying-healthy-guidelines/factsheets/Toxoplasmosis  

Vaccinations recommended in pregnancy
1.Influenza vaccine - the new strain comes out in April annually, recommended for everyone but especially in pregnancy as it can cause a more severe illness. Administered at any gestation.
2.Respiratory synctial virus (RSV) - recently approved for use in pregnancy and part of most protocols internationally. Not available in Kenya but may be obtained when travelling overseas (eg: Europe or USA). Administered in the 3rd trimester.
3. Pertussis vaccine (dTpa) - this vaccine boosts maternal immunity to tetanus and whooping cough, this boost is transferred to the baby during the pregnancy. Often not available in Kenya but may be obtained when travelling overseas. Administered in the 3rd trimester. If unavailable in Kenya I will prescribe tetanus toxin on its own.

First trimester screening for genetic and structural abnormalities
It is common to screen for genetic and structural abnormalities in your first trimester. It is an opportunity to understand the inherent risks in a pregnancy and plan for how those risks will unfold and influence a pregnancy. I recommend a high quality ultrasound for all women between 12 - 14 weeks of pregnancy. This ultrasound will examine specific fetal structures such as the nuchal fold and nasal bone as well as uterine structures such as uterine arteries, length of the cervix and location of the placenta.
This ultrasound can be combined with maternal blood markers to give us a risk of genetic abnormality in the baby. This test is known as the first trimester combined screening test. Seperately, some people may choose to have the non-invasive prenatal testing (NIPT), this is more sensitive than the FTCS but also more expensive. The test examines fetal chromosomes circulating in maternal blood and analyses them for genetic abnormalities. The sex of the baby can also be determined with this test.

Information on antenatal screening for genetic abnormalities between week 9 - 14:  https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/first-trimester-screening-nuchal-translucency-and-nipt

- please feel free to make a seperate appointment or via telehealth, if you need more information or would like to organise the above tests. 

Progress
We will see each other every 4 weeks in the first and second trimesters, in the third trimester we will see each other every fortnight and after 36 weeks we will see each other weekly till delivery.  In the final weeks of the pregnancy we will go over expectations during birth, individual preferences and education on what happens when you are in hospital.

It is difficult to cover all the necessary information in one appointment - which is why I have collated this information here in order to provide written information and relevant resources to guide you in the first trimester of your pregnancy