third trimester pregnancy doctor visits

Your Guide to Prenatal Appointments

Medical review policy, latest update:.

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Typical prenatal appointment schedule

Read this next, what happens during a prenatal care appointment, what tests will i receive at my prenatal appointments, what will i talk about with my practitioner at prenatal care appointments , first trimester prenatal appointments: what to expect, second trimester prenatal appointments: what to expect, third trimester prenatal appointments: what to expect, questions to ask during prenatal appointments  .

Prenatal care visits are chock-full of tests, measurements, questions and concerns, but know that throughout the process your and your baby’s wellbeing are the main focus. Keep your schedule organized so you don’t miss any appointments and jot down anything you want to discuss with your doctor and your prenatal experience should end up being both positive and rewarding.

What to Expect When You’re Expecting , 5th edition, Heidi Murkoff. American College of Obstetricians and Gynecologists,  Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy , 2020. American College of Obstetricians and Gynecologists,  Routine Tests During Pregnancy , 2020. US Department of Health & Human Services, Office on Women’s Health,  Prenatal Care and Tests , January 2019. Journal of Perinatology ,  Number of Prenatal Visits and Pregnancy Outcomes in Low-risk wWomen , June 2016. Mayo Clinic,  Edema , October 2017. Mayo Clinic,  Prenatal Care: 2nd Trimester Visits , August 2020. Mayo Clinic,  Prenatal Care: 3rd Trimester Visits , August 2020. Jennifer Leighdon Wu, M.D., Women’s Health of Manhattan, New York, NY. WhatToExpect.com, Preeclampsia: Symptoms, Risk Factors and Treatment , April 2019. WhatToExpect.com, Prenatal Testing During Pregnancy , March 2019. WhatToExpect.com,  Urine Tests During Pregnancy , May 2019. WhatToExpect.com,  Fetal Heartbeat: The Development of Baby’s Circulatory System , April 2019. WhatToExpect.com,  Amniocentesis , Mary 2019. WhatToExpect.com,  Ultrasound During Pregnancy , April 2019. WhatToExpect.com,  Rh Factor Testing , June 2019. WhatToExpect.com,  Glucose Screening and Glucose Tolerance Test , April 2019. WhatToExpect.com, Nuchal Translucency Screening , April 2019. WhatToExpect.com, Group B Strep Testing During Pregnancy , August 2019. WhatToExpect.com,  The Nonstress Test During Pregnancy , April 2019. WhatToExpect.com,  Biophysical Profile (BPP) , May 2019. WhatToExpect.com,  Noninvasive Prenatal Testing , (NIPT), April 2019. WhatToExpect.com,  The Quad Screen , February 2019. WhatToExpect.com,  Chorionic Villus Sampling (CVS) , February 2019. WhatToExpect.com,  The First Prenatal Appointment , June 2019. WhatToExpect.com,  Breech Birth: What it Means for You , September 2018.

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Prenatal visits: What to expect and how to prepare

Regular prenatal visits are an important part of your pregnancy care. Find out how often you'll see a healthcare provider, what to expect at each appointment, and smart ways to prepare.

When to schedule a prenatal visit

Prenatal visitation schedule, how should i prepare for a prenatal visit, what happens during prenatal visits, how can i make the most of my pregnancy appointments.

Make an appointment for your first prenatal visit once you're aware you are pregnant – when you receive a positive home pregnancy test, for example. Booking it around week 8 of pregnancy is typical.

You'll come back regularly in the weeks and months following that initial appointment. Most people have between 8 and 14 prenatal visits throughout the course of their pregnancy.

During this time, you'll see a lot of your healthcare practitioner. That's why it's so important to choose someone you like and trust. If you're not comfortable or satisfied with your provider after your first visit or visits, don't be afraid to find someone with whom you have a better connection.

Typically, a pregnant woman will visit their doctor, midwife , or nurse practitioner every four weeks during the first and second trimesters. In the third trimester, you'll be seen more often – usually every other week until 36 weeks, and then every week until the baby is born.

For more information on what happens at these visits, see:

Your first prenatal visit

Second trimester prenatal visits (14 weeks to 27 weeks)

Third trimester prenatal visits (28 weeks through the end of pregnancy)

The specific number of scheduled appointments you'll have depends on if your pregnancy is considered to be high-risk. This is determined by your medical history and whether you have any complications or conditions that warrant more frequent checkups, such as gestational diabetes , high blood pressure , or a history of preterm labor . If you've had any medical problems in the past or develop any new problems during this pregnancy, you may need more prenatal visits than the average pregnant woman.

In the weeks before each visit, jot down any questions or concerns in a notebook or a notes app on your smartphone. This way, you'll remember to ask your practitioner about them at your next appointment. You may be surprised by how many questions you have, so don't miss the opportunity to get some answers in person.

For example, before you drink an herbal tea or take a supplement or an over-the-counter medication , ask your provider about it. You can even bring the item itself – or a picture of the label – with you to your next appointment. Then, your doctor, midwife, or nurse practitioner can read the label and let you know whether it's okay to ingest.

Of course, if you have any pressing questions or worries, or develop any new, unusual, or severe symptoms , don't wait for your appointment – call your practitioner right away.

In addition to your list, you may want to bring a partner, friend, family member, or labor coach with you to some or all of your prenatal visits. They can comfort you, take notes, ask questions, and help you remember important information.

The goal of prenatal visits is to see how your pregnancy is proceeding and to provide you with information to help keep you and your baby healthy. It's important that you go to all of your prenatal appointments, even if you're feeling just fine and believe that everything is progressing perfectly.

Your practitioner will start by asking how you're feeling physically and emotionally, whether you have any complaints or worries, and what questions you may have. They'll also ask you about your baby's movements once you begin to feel them, typically during the second trimester. Your practitioner will have other questions as well, which will vary depending on how far along you are and whether there are specific concerns.

Your midwife, doctor, or nurse practitioner will also:

• Check your weight , blood pressure , and urine
• Check for swelling
• Measure your abdomen
• Check the position of your baby
• Listen to your baby's heartbeat
• Perform other exams and order tests, as appropriate
• Give you the appropriate vaccinations
• Closely monitor any complications you have or that you develop, and intervene if necessary

Near the end of your pregnancy, your provider may also do a pelvic exam to check for cervical changes. You will also discuss your delivery plan in more depth.

At the end of each visit, your practitioner will review their findings with you. They'll also explain the normal changes to expect before your next visit, warning signs to watch for, and the pros and cons of optional tests you may want to consider. Lifestyle issues will likely be a topic of discussion, as well. Expect to talk about the importance of good nutrition , sleep, oral health, stress management, wearing seatbelts, and avoiding tobacco , alcohol , and illicit drugs.

Many people look forward to their prenatal appointments but are disappointed to find that, with the exception of the first visit, they're in and out of the office in 10 minutes. A quick visit is typical and is usually a sign that everything is progressing normally. Still, you want to make sure your concerns are addressed – and that you and your baby are being well cared for.

Here are some things you can do to ensure that your prenatal visits are satisfying:

• Speak up. Your practitioner isn't a mind reader and won't be able to tell what you're thinking just by performing a physical exam. So, if anything is bothering you, say your piece. Are you having trouble controlling your heartburn ? Managing your constipation ? Suffering from headaches ? This is the time to ask for advice. Consult the notebook of questions you've been compiling. In addition to physical complaints, let your practitioner know if you have emotional concerns or fitness or nutrition questions.
• Ask the staff about the administrative stuff. Save your questions about things like insurance and directions to the hospital for the office staff so your practitioner has more time to answer your health-related questions. Go to the admin staff with any inquiries about payments, scheduling, office policies, and your contact information.
• Be open-minded. When talking with your doctor, midwife, or nurse practitioner, you should feel comfortable speaking freely. But remember to listen, too. Take notes if you find it helpful.

Keep in mind, too, that some days are busier than others. This is especially true during the COVID-19 pandemic. That doesn't mean your practitioner doesn't have to answer your questions, but sometimes a discussion can be continued at the next visit if it's a really busy day or if your practitioner needs to head to the hospital to deliver a baby.

At the same time, don't tolerate a healthcare practitioner who won't give you thorough answers, doesn't show reasonable compassion, or barely looks up from your chart. You and your baby deserve more than that.

Now that you know what to expect during all those prenatal visits, you might like a sneak peek at what else is in store. Here's an overview of the next nine months .

Learn more:

• The ultimate pregnancy to-do list: First trimester
• 12 steps to a healthy pregnancy
• When will my pregnancy start to show?
• Fetal development timeline

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What happens at second trimester prenatal appointments

What to expect at your first prenatal appointment

What to expect from third trimester prenatal appointments

Prenatal testing

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

MedlinePlus. (2021). Prenatal care in your first trimester. https://medlineplus.gov/ency/patientinstructions/000544.htm Opens a new window [Accessed September 21, 2021.]

March of Dimes. (2017). Prenatal Care Checkups. https://www.marchofdimes.org/pregnancy/prenatal-care-checkups.aspx Opens a new window [Accessed September 21, 2021.]

Office on Women’s Health. (2019). Prenatal Care and Tests. https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2017). What happens during prenatal visits? https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/prenatal-visits Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2017). What is a high-risk pregnancy? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk Opens a new window [Accessed September 21, 2021.]

NIH: Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2018). What are some factors that make a pregnancy high-risk? https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo/factors Opens a new window [Accessed September 21, 2021.]

March of Dimes. (2020). Over-the-Counter Medicine, Supplements, and Herbal Products During Pregnancy. https://www.marchofdimes.org/pregnancy/over-the-counter-medicine-supplements-and-herbal-products.aspx Opens a new window [Accessed September 21, 2021.]

Associates in Women’s Healthcare (2021). Preparing for Your First Prenatal Visit. https://www.associatesinwomenshealthcare.net/blog/preparing-for-your-first-prenatal-visit/ Opens a new window [Accessed September 21, 2021.]

National Health Service (UK). (2018). Your baby’s movements. https://www.nhs.uk/pregnancy/keeping-well/your-babys-movements/ Opens a new window [Accessed September 21, 2021.]

MedlinePlus. (2021). Prenatal care in your third trimester. https://medlineplus.gov/ency/patientinstructions/000558.htm Opens a new window [Accessed September 21, 2021.]

UCLA Health. (2021). Schedule of prenatal care. https://www.uclahealth.org/obgyn/workfiles/Pregnancy/Schedule_of_Prenatal_Care.pdf Opens a new window [Accessed September 21, 2021.]

UCR Health. (2021). Healthy Pregnancy: The Importance of Prenatal Care.   https://www.ucrhealth.org/2018/07/healthy-pregnancy-the-importance-of-prenatal-care/ Opens a new window [Accessed September 21, 2021.]

Mayo Clinic. (2020). Prenatal care: 1 st trimesters visits. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044882 Opens a new window [Accessed September 21, 2021.]

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3rd trimester pregnancy: What to expect

The third trimester of pregnancy can be tiring and uncomfortable. Here's help relieving symptoms — and anxiety — as your due date approaches.

The third trimester of pregnancy can be physically and emotionally challenging. Your baby's size and position might make it hard for you to get comfortable. You might be tired of pregnancy and eager to move on to the next stage. If you've been gearing up for your due date, you might be disappointed if it comes and goes uneventfully.

Try to remain positive as you look forward to the end of your pregnancy. Soon you'll hold your baby in your arms! Here's what to expect in the meantime.

As your pregnancy progresses, your baby's movements will become more obvious. These exciting sensations are often accompanied by increasing discomfort and other signs and symptoms, including:

• Braxton Hicks contractions. You might feel these mild, irregular contractions as a slight tightness in your abdomen. They're more likely to occur in the afternoon or evening, after physical activity or after sex. These contractions also tend to occur more often and become stronger as you approach your due date. Contact your health care provider if the contractions become regular and steadily increase in strength.
• Backaches. Pregnancy hormones relax the connective tissue that holds your bones in place, especially in the pelvic area. These changes can be tough on your back, and often result in discomfort during the third trimester of pregnancy. When you sit, choose chairs with good back support. Get regular exercise. Wear low-heeled — but not flat — shoes with good arch support. If you have severe or persistent pain, contact your health care provider.
• Shortness of breath. You might get winded easily. Practice good posture to give your lungs more room to expand.
• Heartburn. Pregnancy hormones relax the valve between your stomach and esophagus. This can allow stomach acid to reflux into your esophagus and cause heartburn. To prevent heartburn, eat small, frequent meals. Also, avoid fried foods, citrus fruits, chocolate, and spicy or fried foods.
• Spider veins, varicose veins and hemorrhoids. Increased blood circulation might cause tiny red-purplish veins (spider veins) to appear on your face, neck and arms. Redness typically fades after delivery. You might also notice swollen veins (varicose veins) on your legs. Painful, itchy varicose veins in your rectal area (hemorrhoids) may also occur. To ease swelling, exercise and elevate your legs frequently, include plenty of fiber in your diet and drink lots of fluids. For hemorrhoid relief, soak in a warm tub or apply witch hazel pads to the area.
• Frequent urination. As your baby moves deeper into your pelvis, you'll feel more pressure on your bladder. You might find yourself urinating more often. This extra pressure might also cause you to leak urine — especially when you laugh, cough, sneeze, bend or lift. If this is a problem, consider using panty liners. If you think you might be leaking amniotic fluid, contact your health care provider.

Your emotions

As anticipation grows, fears about childbirth might become more persistent. How much will it hurt? How long will it last? How will I cope? If you haven't done so already, consider taking childbirth classes. You'll learn what to expect — and meet others who share your excitement and concerns. Talk with others who've had positive birth experiences, and ask your health care provider about options for pain relief.

The reality of parenthood might begin to sink in as well. You might feel anxious, especially if this is your first baby. To stay calm, write your thoughts in a journal. It's also helpful to plan ahead. If you'll be breastfeeding, you might get a nursing bra or a breast pump. If you're expecting a boy — or you don't know your baby's sex — think about what's right for your family regarding circumcision.

Prenatal care

During the third trimester, your health care provider might ask you to come in for more frequent checkups — perhaps every two weeks beginning at week 32 and every week beginning at week 36.

Like previous visits, your health care provider will check your weight and blood pressure and ask about any signs or symptoms you're experiencing. In some cases, virtual prenatal care may be an option if you don't have certain high-risk conditions. If you and your health care provider opt for virtual prenatal visits, ask if there are any tools that might be helpful to have at home, such as a blood pressure monitor. To make the most of any virtual visits, prepare a list of questions ahead of time and take detailed notes.

If you haven't yet received a COVID-19 vaccine, get vaccinated. COVID-19 vaccines don't cause infection with the COVID-19 virus. Studies have shown COVID-19 vaccines don't pose any serious risks for pregnant women or their babies. Vaccination can help pregnant women build antibodies that protect their babies. If possible, people who live with you should also be vaccinated against COVID-19.

Also, one dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine is recommended during each pregnancy — ideally during the third trimester, between weeks 27 and 36 of pregnancy. This can help protect your baby from whooping cough before he or she can be vaccinated.

You will also need screening tests for various conditions, including:

• Gestational diabetes. This is a type of diabetes that sometimes develops during pregnancy. Prompt treatment and healthy lifestyle choices can help you manage your blood sugar level and deliver a healthy baby.
• Iron deficiency anemia. Iron deficiency anemia occurs when you don't have enough healthy red blood cells to carry adequate oxygen to your body's tissues. Anemia might cause you to feel very tired. To treat anemia, you might need to take iron supplements.
• Group B strep. Group B strep is a type of bacteria that can live in your vagina or rectum. It can cause a serious infection for your baby if there is exposure during birth. If you test positive for group B strep, your health care provider will recommend antibiotics while you're in labor.

Your health care provider will also check your baby's size and heart rate. Near the end of your pregnancy, your health care provider will also check your baby's position and ask about your baby's movements. He or she might also ask about your preferences regarding labor and pain management as you get ready for delivery. If you have specific preferences for labor and birth — such as laboring in water or avoiding medication — define your wishes in a birth plan. Review the plan with your health care provider but keep in mind that pregnancy problems might cause plans to change.

As your due date approaches, keep asking questions. Knowing what to expect can help you have the most positive birth experience.

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• American College of Obstetricians and Gynecologists. Your Pregnancy and Childbirth Month to Month. 6th ed. American College of Obstetricians and Gynecologists; 2015.
• Auerbach M. Treatment of iron deficiency anemia in adults. http://www.uptodate.com/contents/search. Accessed Oct. 22, 2019.
• Lockwood CJ, et al. Prenatal care: Second and third trimesters. http://www.uptodate.com/contents/search. Accessed Feb. 8, 2022.
• Frequently asked questions: Pregnancy FAQ115. Back pain during pregnancy. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Back-Pain-During-Pregnancy. Accessed Oct. 22, 2019.
• Frequently asked questions: Pregnancy FAQ169. Skin conditions during pregnancy. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Skin-Conditions-During-Pregnancy. Accessed Oct. 22, 2019.
• Frequently asked questions: Labor, delivery and postpartum care FAQ004. How to tell when labor begins. American College of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/How-to-Tell-When-Labor-Begins. Accessed Oct. 22, 2019.
• COVID-19 vaccines while pregnant or breastfeeding. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html. Accessed Feb. 8, 2022.
• Lipkind HS, et al. Receipt of COVID-19 vaccine during pregnancy and preterm or small-for-gestational-age at birth — eight integrated health care organizations, United States, December 15, 2020 – July 22, 2021. Morbidity and Mortality Weekly Report. 2022; doi: 10.15585/mmwr.mm7101e1.
• Berghella V, et al. COVID-19: Overview of pregnancy issues. https://www.uptodate.com/contents/search. Accessed Feb. 8, 2022.
• Novel coronavirus 2019 (COVID-19): Practice advisory. The American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019. Accessed Feb. 8, 2022.

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Prenatal care in your third trimester

The word prenatal means before birth. Trimester means 3 months. A normal pregnancy is around 10 months and has 3 trimesters.

Your health care provider may talk about your pregnancy in weeks, rather than months or trimesters. The third trimester goes from week 28 through week 40.

What to Expect

Expect increasing fatigue during this time. A lot of your body's energy is directed toward supporting a rapidly growing fetus. It's common to feel the need to reduce your activities and your work load, and to get some rest during the day.

Heartburn and low back pain are also common complaints at this time in pregnancy. When you're pregnant, your digestive system slows down. This can cause heartburn as well as constipation. Also, the extra weight you are carrying puts stress on your muscles and joints.

It is important that you continue to:

• Eat well -- including protein rich foods and vegetables frequently and in small amounts
• Rest as needed
• Get exercise or get a walk in on most days

Routine Prenatal Visits

In your third trimester, you will have a prenatal visit every 2 weeks until week 36. After that, you will see your provider every week.

The visits may be quick, but they are still important. It is OK to bring your partner or labor coach with you.

During your visits, the provider will:

• Measure your abdomen to see if your baby is growing as expected
• Check your blood pressure
• Take a urine sample to test for protein in your urine, if you have high blood pressure

Your provider may also perform a pelvic exam to see if your cervix is dilating.

At the end of each visit, your doctor or midwife will tell you what changes to expect before your next visit. Tell your provider if you have any problems or concerns. It is OK to talk about them even if you do not feel they are important or related to your pregnancy.

Lab Tests and Ultrasounds

A few weeks before your due date, your provider will perform the test that checks for group B strep infection on your perineum (groin area). There are no other routine lab tests or ultrasounds for every pregnant woman in the third trimester. Certain lab tests and tests to monitor the baby may be done for women who:

• Have a high-risk pregnancy, such as when the baby is not growing
• Have a health problem, such as diabetes or high blood pressure
• Have had problems in a prior pregnancy
• Are overdue (pregnant for more than 40 weeks)

Checking Your Baby's Movement

In between your appointments, you will need to pay attention to how much your baby is moving. As you get closer to your due date, and your baby grows bigger, you should notice a different pattern of movement than earlier in your pregnancy.

• You will notice periods of activity and periods of inactivity.
• The active periods will be mostly rolling and squirming movements, and a few very hard and strong kicks.
• You should still feel the baby move frequently during the day.

Watch for patterns in your baby's movement. If the baby suddenly seems to be moving less, eat a snack, then lie down for a few minutes. If you still don't feel much movement, call your doctor or midwife.

Call your provider any time you have any concerns or questions. Even if you think you are worrying over nothing, it is better to be on the safe side and call.

When to Call the Doctor

Call your provider if:

• You have any signs or symptoms that are not normal.
• You are thinking of taking any new medicines, vitamins, or herbs.
• You have any bleeding.
• You have increased vaginal discharge with odor.
• You have a fever, chills, or pain when passing urine.
• You have headaches.
• You have changes or blind spots in your eyesight.
• Your water breaks.
• You start having regular, painful contractions.
• You notice a decrease in fetal movement.
• You have significant swelling and weight gain.
• You have chest pain or difficulty breathing.

Alternative Names

Pregnancy third trimester

Gregory KD, Ramos DE, Jauniaux ERM. Preconception and prenatal care. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 7th ed. Philadelphia, PA: Elsevier; 2021:chap 5.

Hobel CJ, Williams J. Antepartum care. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 7.

Ormandy J. Antenatal and postnatal care. In: Magowan BA, ed. Clinical Obstetrics and Gynaecology . 5th ed. Philadelphia, PA: Elsevier; 2023:chap 23.

Smith RP. Routine prenatal care: third trimester. In: Smith RP, ed. Netter's Obstetrics and Gynecology . 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 200.

Williams DE, Pridjian G. Obstetrics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine . 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 20.

Review Date 4/19/2022

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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• Prenatal Care

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The Ultimate Pregnancy Appointment Guide: What to Expect Week by Week at Your Prenatal Visits

Central to ensuring the health and well-being of you and your growing baby is seeing your care team regularly for touchpoints and milestones that are part of your pregnancy appointment schedule. Diana Kaufman, MD , UnityPoint Health, shares the recommended timeline for prenatal visits, and the importance of each test and discussion that’ll prepare you for a safe pregnancy and delivery.

Confirming Your Pregnancy

Every woman’s body is unique, but it’s a good idea to visit a doctor to confirm a pregnancy when you’re experiencing early symptoms, such as a missed period or you’ve received a positive home pregnancy test. Typically, this visit happens at 6-8 weeks of pregnancy.

Your doctor may confirm your pregnancy through urine tests, blood tests or ultrasounds.

Initial Prenatal Appointment: 5-12 Weeks

Your first prenatal visit consists of important screenings and discussions, so your healthcare team can create a care plan that ensures you and baby stay healthy throughout your pregnancy. Prepare a few things for this visit, including:

• Complete medical history: It’s important for your doctor to know your past and present health conditions or concerns, medications and any history of disease, substance abuse or known genetic conditions in your family.
• Insurance information: This includes consents for care, your insurance carrier and other paperwork

Here’s what to expect at your first pregnancy appointment

• A physical, which will likely include a breast and pelvic exam.
• A urine sample is collected to check for certain infections and conditions that can occur during pregnancy. Urine tests may be taken at your following prenatal visits as well. Urine drug screening tests are also recommended for women, or their partners, with a history of substance use — including smoking.
• Routine testing that includes blood draws to check your blood type and complete blood count (CBC) and look for specific diseases including hepatitis, HIV, syphilis and checking for immunity against rubella. Other testing that may occur includes genetic screening and testing for diabetes.

Your care team will review prenatal educational materials with you and remedies for any unpleasant pregnancy symptoms, such as nausea or vomiting . Your team also will provide an estimated due date for baby.

It’s also important to take good care of your teeth and gums during pregnancy. Changing hormone levels make your gums more sensitive to disease, which increases your risk for a low-birth weight or premature baby. Consider making an appointment to see your dentist during your first trimester.

Prenatal Appointment: Second Trimester (13 – 26 Weeks)

During weeks 13-26, you’ll see your doctor every four weeks. It’s a good idea to write down questions or concerns before your appointments to ensure they’re addressed.

At each appointment throughout the rest of your pregnancy, your care team will check the following:

• Blood pressure
• Position of baby
• Baby’s heartbeat

Here are some additional things to expect.

• Prenatal genetic testing: There are many different options for prenatal genetic testing. Your care team will review these with you.
• Pregnancy blood tests: These are tailored to your specific needs. Most patients are tested for anemia and diabetes of pregnancy between weeks 24-28. Other recommended tests will be reviewed with you.
• Ultrasound: It’s common to have an ultrasound in the first trimester to confirm the estimated due date. Ultrasound is also common at 20 weeks to check on baby's growth and development. Further ultrasounds could be needed if changes in your pregnancy make it necessary, such as concerns about baby’s growth or to see if baby is head down.
• Discuss preterm labor signs: Preterm labor refers to labor that begins before the 37th week of pregnancy and requires medical attention. Knowing what to look for — such as contractions, changes in vaginal discharge  — is important for preventing potential complications.
• Childbirth classes: It’s a good idea to register for a class  to help you prepare for baby’s arrival.

When to Call Your Doctor

Pregnancy creates new and unfamiliar symptoms in many women. However, some symptoms need attention. Here’s when to call your doctor in the second trimester:

• Vaginal bleeding, even a small amount
• Leg pain with numbness or leg weakness
• Pain or tenderness in one of both calves that doesn’t go away
• Thoughts of hurting yourself or others
• Severe headaches that don’t go away with Tylenol
• Persistent changes in vision such as blurriness or floaters
• More than five contractions in an hour

Now, your visits to your care team become more frequent — happening every two weeks until you’re 36 weeks pregnant. Your care team continues to monitor you and baby. Here’s what else to expect:

Prenatal Appointments: Third Trimester (27 Weeks – Baby’s Arrival)

• Check fetal movement: It’s important to be aware of your baby's movements. If you notice a sudden change or absence of fetal movement, let you care team know.
• Rhogam injections: If an Rh-negative blood type was found during your initial prenatal visit, you’ll receive an injection to prevent immune system complications for future pregnancies. This usually happens at 28 weeks.
• Additional prenatal testing: Around 35-37 weeks, you’re checked to see if you carry group B streptococcus bacteria . This is one of many bacteria that can live on our skin and typically does not cause problems. However, it can infect a newborn when you deliver. Antibiotics are given during delivery to prevent infection in a newborn if you test positive.

Prenatal Appointments: 36 Weeks – End of Pregnancy

Once you’ve reached 36 weeks, you’ll see your doctor every week until you deliver. These visits are essential for ensuring the well-being of both you and your little one, as well as preparing for a safe and smooth delivery. In addition to routine physical examinations and checking baby’s heartbeat and movement, here’s what else you can expect:

• Cervical exams: If you’re having frequent contractions or preparing to be induced, your doctor will likely need to perform this exam.
• Discuss labor signs: You’ll likely discuss signs of labor with your doctor and when to go to the hospital.
• Discuss birth preferences: It’s not necessary to have a birth plan. Your care team has that covered. Our goal is to keep you and your baby healthy throughout the entire pregnancy and delivery process. However, if you have strong desires or needs for delivery, please discuss those during a prenatal appointment. It’s also helpful to write these things down and bring them to the hospital, since you may not be able to fully express your wishes during labor.

Postpartum Visits

After delivering baby, but before you leave the hospital, call your doctor to make your postpartum appointment, if it hasn’t been scheduled yet. This visit typically occurs around 6 weeks after you deliver. Other visits are scheduled based on your individual needs.

These visits are a time for your doctor to check on your healing , discuss normal or abnormal postpartum bleeding, talk about your well-being and any signs of postpartum depression or anxiety , discuss when it’s safe to start exercising again and address other questions or concerns you may have .

Our UnityPoint Health care team is here to care for you and baby throughout the entirety of your pregnancy and beyond. Call us  to schedule your first appointment or if you have questions about any future appointments.

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Third Trimester of Pregnancy: Doctor's Appointments and Tests

If you’re in your third trimester ( weeks 28  through 40 weeks ) you’re in the home stretch. Doctor visits are coming up more frequently, and depending on how your pregnancy is progressing so far, you will either have them monthly or weekly. Near the last few weeks of the third trimester, weekly visits are not uncommon.

The new approach to prenatal care since the advent of the COVID-19 epidemic (not only to prenatal care but all medical visits) means that in-person contacts are limited by reducing in-person visits at your doctor’s office and the hospital and replacing some in-person care with virtual prenatal care. 

Doctor’s appointments

Like with the second trimester , third-trimester doctor’s appointments begin with a physical examination, pelvic exam, and sometimes an  ultrasound . Your blood pressure and weight will be checked and the doctor would take note of fetal movements and check the heartbeat. Your doctor will also check your level of swelling . During this time, you may also be asked to track the movement of your baby.

During these appointments, your doctor will ask you questions about your health and your pregnancy. Questions you may be asked include: “Have you been having headaches” and “Have you been feeling contractions.”

Near the end of the third trimester , many of your appointments are based around checking the baby’s position. If your baby is feet first ( breech ) or rump first, they will attempt to turn your baby by pressing gently on your abdomen.

In addition, your doctor will also measure your cervix to look for how much you are dilated and how thin it is. This is to look for signs that you will be delivering your baby soon, with your cervix opening and thinning out more as you near the end of your third trimester.

Tests and screenings

Aside from checking your cervix and measuring your baby, additional tests are performed during your last trimester. These are routine tests that offer your OB-GYN additional information about your health and the health of your baby.

• Group B Strep : One of the screenings performed in the third trimester is group B streptococcus, or group B strep (GBS) . The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening during a 2-week window between 36 0/7 and 37 6/7 weeks of gestation. This test looks for a type of bacteria that is harmless to you but can make your baby ill.
• Blood and lab tests : If you were previously diagnosed with anemia, your doctor will run another blood test to check your iron levels. The same goes if you are at risk for a sexually transmitted infection , such as gonorrhea, HIV, or Chlamydia. Your blood glucose level is checked again if it was high during a previous test. Your protein in the urine levels will be checked for any indications of preeclampsia.
• Ultrasound : If you had a low lying placenta or were found to have placenta previa during a second-trimester ultrasound, another ultrasound is performed to look for your placenta’s current location.
• Non-stress test : The non-stress test is done in the last weeks of your pregnancy to take a closer look at your baby’s heartbeat, especially if you are still pregnant past 40 weeks.

Third-trimester doctor visits and tests are primarily focused around you being ready for labor and delivery. Your third-trimester doctor visits are also a good time to ask any lingering questions you may have about the impending labor and delivery and postpartum considerations.

Read More:  Third Trimester Checklist Pregnancy Week by Week The Six Trimesters of Pregnancy

• > Prenatal Visit Schedule: What To Expect During Each Appointment

Prenatal Visit Schedule: What To Expect During Each Appointment

Prenatal care is an important part of a healthy pregnancy and allows your doctor to regularly monitor you and your baby . But what should you expect when it comes to your prenatal visit schedule?

Basically, you’ll visit your doctor once a month at the beginning of your pregnancy and then once a week at the end of your pregnancy. That said, it’s important to schedule your first prenatal visit as soon as you see a positive pregnancy test!

In this article, the experts at Mustela discuss how your prenatal visit schedule will most likely look and what to expect during each appointment.

Prenatal Visit Schedule: First Trimester

This is such an exciting time in your life! When you saw the positive pregnancy test , you were probably four to six weeks pregnant, so go ahead and call your doctor to schedule your first appointment.

During the first trimester , you will have your initial prenatal visit, and then your doctor will schedule your visits every four weeks or once a month.

Check with the doctor or staff for a printout of your prenatal visit schedule.

What To Expect At Your First Appointment

Your first prenatal visit will be around six to nine weeks and will most likely be the lengthiest of all your appointments, so block out a good bit of time on your calendar.

Your doctor will ask a good bit of detailed questions and perform a pretty thorough check. Let’s take a look at what they’ll do during this appointment.

Medical History

Your doctor will ask questions about your:

• Last menstrual cycle so they can give you a due date
• Gynecological history
• Obstetrical history (any past pregnancies)
• Personal and family medical history
• Supplements or medicines you’re taking (if any)
• Lifestyle (use of tobacco products, alcohol, and caffeine; eating and exercising habits)
• Recent travel adventures
• Feelings of depression or anxiety (if any)

Your doctor will order various lab work to check your blood for:

• Blood type and Rh status
• Hemoglobin levels
• Infections such as hepatitis B, syphilis, gonorrhea, chlamydia, and HIV
• Thyroid levels
• Any other important screenings

Physical Exam

To give you and your baby the best care, your doctor will need to do a thorough physical exam, which most likely will also include a Pap smear to detect any abnormal cervical cells.

Your doctor’s observation also includes:

• Checking your blood pressure
• Measuring your height and weight to determine your recommended weight gain for a healthy pregnancy
• A breast exam
• A pelvic exam
• Screening your heart, lungs, and thyroid

Discuss any pregnancy discomforts , such as nausea and fatigue, with your doctor. Be honest with your doctor so they can take care of you and your baby to the best of their knowledge.

Some doctors also do an ultrasound during the first trimester to confirm or date your pregnancy. (Your first prenatal visit will vary based on the specific policies of your doctor’s office.)

What To Expect At Your 12-Week Appointment

You're nearing the end of your first trimester! During this appointment, you can expect your doctor to check the following:

• Weight and blood pressure
• Urine for sugar and protein levels
• Your baby’s heartbeat (This will be the first time you’ll hear it!)
• Size of your uterus
• Hands and feet for any swelling

Prenatal Visit Schedule: Second Trimester

Assuming you have a healthy pregnancy and no further examinations are necessary, this is what your prenatal visit schedule will look like during your second trimester :

• Four-month appointment (around 16 weeks)
• Five-month appointment (around 20 weeks)
• Six-month appointment (around 24 weeks)

What To Expect During Routine Appointments

Many of your appointments from here on out will look similar regarding what your doctor will check for. During these visits, you can expect your doctor to look at:

• Your baby’s heartbeat
• Your fundal height (The size of your uterus is used to assess fetal growth and development. Your doctor will get this measurement by measuring the length from the top of your uterus to the top of your pubic bone. This measurement should match how many weeks you are. Example: If you’re 20 weeks pregnant, your fundal height should equal 20 centimeters.)
• Hands and feet for swelling
• Any symptoms you’ve been experiencing

At this point in your pregnancy, you may notice your skin becoming dry and starting to stretch a bit. Don’t worry; it’s completely normal!

To tackle dry skin, try Mustela’s Stretch Marks Cream . This velvety, hard-working cream delivers immediate moisture and comfort to your skin!

And our Stretch Marks Oil treats recently formed stretch marks. It’s a fast-absorbing oil that hydrates your skin throughout your pregnancy!

What To Expect During Your 20-Week Sonogram:

Sometime around your 20-week appointment, your doctor will schedule an ultrasound to determine the gender of your baby! During this sonogram, your sonographer will take a look at:

• Baby’s size and all their major organs
• Amniotic fluid
• Location of placenta

Your sonographer passes this information to your doctor to give them a clear picture (literally!) of the overall health of your baby and your pregnancy.

Prenatal Visit Schedule: Third Trimester

During your third trimester , your prenatal visits will be every two weeks until the last month of your pregnancy, when you’ll have them every week. So that means your prenatal visit schedule will look like this:

What To Expect At Your Seventh- and Eighth-Month Visits

During your seventh and eighth months of pregnancy, expect your doctor to check the following:

• Urine for sugar and protein
• Your fundal height (top of your uterus)
• Size and position of your baby
• Feet and hands for swelling
• Varicose veins in your legs
• Glucose screen test (read below for more information)
• Group B strep test (read below for more information)
• Blood test for anemia
• Any symptoms you’ve been having

Glucose Screen Test

This test is used to determine if you have gestational diabetes. Once you arrive at your doctor’s office, be prepared to have your blood drawn first.

Next, you’ll drink a very sugary drink that tastes like flat orange soda. Some women enjoy the taste, while others feel a little queasy afterward!

After you consume the entire drink, you’ll wait one hour before having your blood drawn again. If your blood work comes back with elevated numbers, your doctor will order the next level of tests, which is used to officially diagnose gestational diabetes.

Should you need to take the second test (no studying required!), you’ll have to fast before the appointment. Just like with the initial round of tests, your doctor will draw your blood first and then have you consume the drink.

The only difference is this time, your blood will be drawn every hour for three hours. Be prepared to stay in your doctor’s office for three to four hours.

If the results from this test also come back elevated, your doctor will discuss management techniques for gestational diabetes.

But don’t let this information worry you. Most women who monitor their blood sugar levels and work closely with their doctor have perfectly normal pregnancies and healthy babies!

Group B Strep Test

Group B Strep (GBS) is bacteria that can be found in the vaginas of healthy women. (It’s not related to strep, the throat infection.)

If you are a carrier of GBS, your baby can catch the infection during delivery when they pass through the birth canal. While this bacteria isn’t harmful to you, it can be dangerous for your baby.

To check for GBS, your doctor will perform a test just like they would a Pap smear. If the test shows that you’re a carrier, you’ll receive antibiotics through an IV once you’re in labor. This way, you won’t pass the infection to your baby!

You’re routinely tested for GBS around the seventh or eighth month of pregnancy so your doctors can be prepared to give you the antibiotics at the onset of labor.

What To Expect During Your Ninth Month

Similar to months seven and eight, your doctor will closely monitor you and your baby during this time. Since you’re getting closer to your due date, expect a few additional observations from your doctor.

During your last month of pregnancy, they will take a look at:

• Your cervix by an internal examination to check for effacement (thinning) and dilation (opening)
• Baby’s heartbeat
• Baby’s size (At this point in your pregnancy, your doctor may give you an estimation of your baby’s weight. They can tell your baby’s presentation: head or bottom first, and their position: front- or rear-facing.)
• Any questions or concerns you may have about delivery

A Beautiful Pregnancy And Beautiful Skin

Throughout these nine months , your prenatal visits are special moments of checking on your sweet little baby. It’s exciting to see your belly grow with each visit! But that also means possible stretch marks.

The good news is that Mustela offers a line of prenatal products, including our Stretch Marks Cream and Bust Firming Serum , to soothe and hydrate your skin while you manage the busyness of your prenatal visit schedule.

Let Mustela help you start your beautiful pregnancy with beautiful skin!

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INTRODUCTION

This topic will discuss prenatal care in the second and third trimesters. Other important issues related to prenatal care are reviewed separately:

● Prenatal care issues at the first visit and in the first trimester: (See "Prenatal care: Initial assessment" .)

● Specific issues related to prenatal care for patients with multiple gestations: (See "Twin pregnancy: Overview" and "Triplet pregnancy" .)

● Prenatal care during the COVID-19 pandemic: (See "COVID-19: Overview of pregnancy issues", section on 'Prenatal care' .)

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• Continuing Education Activity

Globally, there are more than 200 million pregnancies each year. Of these pregnancies, more than 40% are unintended. Unintended does not imply unwanted. Every couple must have the opportunity to plan for pregnancy and choose when they are ready for pregnancy. Of the 40 percent of unintended pregnancies, early prenatal care is important to prevent poor perinatal outcomes and complications. Opportunities for diagnosing pregnancy and preventing unwanted and unplanned pregnancies exist during routine visits, sports exams, well-woman exams, emergencies, and during acute visits. Taking these opportunities for a pregnancy test can play a major role in getting women to early prenatal care. The key determinants to a healthy pregnancy and reproductive life are the interprofessional team preventing, identifying, and addressing preconception health issues, pregnancy readiness, early prenatal care, and minimizing risks during the perinatal and interconception period.

• Review the importance of the clinical significance of pregnancy readiness including options, disclosure of risks and benefits, and implications of short-interval pregnancy.
• Summarize evaluation during pregnancy in each trimester and after 40 weeks gestation.
• Review the evidence-based recommendations of the US Preventive Task Force for care during pregnancy.
• Outline the importance of coordinated care and collaboration in caring for pregnant patients regardless of the primary provider to enhance patient outcomes.
• Introduction

Globally, there are more than 200 million pregnancies each year. Of these pregnancies, more than 40% are unintended. Unintended does not imply unwanted. Every couple must have the opportunity to plan for pregnancy and choose when they are ready for pregnancy. Of the 40% of unintended pregnancies, early prenatal care is important to prevent poor perinatal outcomes and complications. Opportunities for diagnosing pregnancy and preventing unwanted and unplanned pregnancies exist during routine visits, sports exams, well-woman exams, emergencies, and during acute visits. Taking these opportunities for a pregnancy test can play a major role in getting women to early prenatal care. All women of reproductive age should receive folate at 400 mcg to 800 mcg to prevent neural tube defects. This is a grade A recommendation by the United States Preventive Task Force (USPTF) and The American College of Obstetrics and Gynecology (ACOG) since most women present after the critical part of organogenesis. [1] The key determinants to a healthy pregnancy and reproductive life are preventing, identifying, and addressing preconception health issues, pregnancy readiness, early prenatal care, and minimizing risks during the perinatal and interconception period. [2] [3]

• Issues of Concern

Prenatal Diagnosis

Many women will come in for interim visits with complaints of abdominal pain, abnormal uterine bleeding, and irregular menses. Women with a functioning reproductive system must have a pregnancy test to rule out pregnancy. The gold standard for pregnancy testing is the quantitative beta HCG radioimmunoassay. Most providers in the emergency, ambulatory, or episodic care environments use the urine HCG tests for the initial screen. The quantitative HCG is usually done in conjunction with examination and ultrasound to confirm a normal versus abnormal pregnancy, to correlate gestational age with the last normal menstrual period, or to guide in the management of a potential miscarriage. Once a woman has a confirmed pregnancy, she should be scheduled for the first prenatal visit that includes a full review of the pertinent history.

The prenatal intake should include a thorough history and physical to identify potential risks and to assist in referral to appropriate services. Components include:

• Medical history
• Surgical history (especially history of any uterine or abdominal incisions, salpingectomies, and cesareans)
• Family history (especially history of diabetes, genetic disorders, and hemoglobinopathies)
• Obstetric history including last normal menstrual period, previous pregnancy complications, preterm births, and previous pregnancy losses
• Gynecologic history 
• Mental health history

Risk Assessment

• Diabetes (assessment for undiagnosed type 2 diabetes using risk factor criteria as set by the American Diabetic Association)
• Genetic [4]
• Occupational and environmental
• Psychosocial
• Substance and drug use
• Tobacco use
• Other risks that might impact pregnancy such as medications, exposures, and known teratogens.
• Clinical Significance

Every couple should have the opportunity to review and decide on readiness for parenting. Family planning options must be discussed, including abstinence, natural family planning, oral contraceptives, condoms, implants, injections, intrauterine devices, and sterilization options. Family planning education and counseling should be noncoercive, including full disclosure of risks and benefits. For couples who have recently completed a pregnancy, education must include risks associated with short-interval pregnancy. Couples should receive information about contraceptive options before, during, and after pregnancy.

First Trimester Testing and Education

First-trimester testing includes the following:

• Complete blood count
• Screening for hemoglobinopathy in at-risk populations. 

African Americans and women of African descent are at risk for sickle cell trait or disease, i.e., AS or SS and Hemoglobin C. Women of Southeast Asian descent are at risk for Hemoglobin E disease, usually associated with mild hemolytic anemia. Hemoglobin E-beta thalassemia is associated with more severe disease. Women of Mediterranean descent are at risk for sickle-beta thalassemia disease. The severity of the disease varies depending on the amount of hemoglobin A present.

• Screening for tuberculosis in women who are at risk
• Blood type and Rh with antibody screen ( Grade A Recommendation , USPTF)
• Hepatitis B surface antigen ( Grade A Recommendation , USPTF)

Women at high risk for hepatitis B should receive hepatitis B vaccination. Risk factors for hepatitis include unprotected sex with multiple sexual partners with a known risk for hepatitis B, living with someone with hepatitis B, men having sex with men, intravenous (IV) drug use, an infant born to a mother with hepatitis B, working in the healthcare setting with exposure to body fluids, and travel to a country that is high-risk for hepatitis B. [5] [6]

• HIV screening using an opt-out approach ( Grade A Recommendation , USPTF).

Women who are HIV-positive should present for early prenatal care. Treatment and management of HIV during pregnancy and childbirth reduce transmission of disease from mother to newborn. 

• Screening for other infectious diseases like chlamydia, gonorrhea, and syphilis ( Grade A Recommendation , USPTF). 

The USPTF does not recommend screening low-risk asymptomatic pregnant women for bacterial vaginosis. The USPTF reports insufficient evidence for screening asymptomatic women at high risk for preterm labor for bacterial vaginosis.

• TSH for women with known thyroid disease 
• Urine culture ( Grade A Recommendation , USPTF)

Screening for asymptomatic bacteriuria is recommended between 12 to 16 weeks gestation or first prenatal visit if it occurs later. Women with sickle cell trait are at increased risk for asymptomatic bacteriuria. They should have a urine culture at intake and each trimester until delivery.

• Varicella titer
• First-trimester genetic screening for chromosomal abnormalities done between 10 and 13 weeks (cell-free DNA testing that determines risk for aneuploidy) and ultrasound evaluation of the nuchal fold of the fetus. For women at high risk, chorionic villus sampling is a diagnostic test that can confirm genetic disorders before birth. Women of advanced maternal age, greater than 35 years old, and having a history of having a previous child with a genetic disorder can consider this screening and diagnostic tests to evaluate genetic risks. Providers must discuss testing and risks with women during the appropriate period. [7]
• Other health maintenance items are updated at the initial visit, such as the Hepatitis B vaccine for women at risk and the tetanus vaccine. Women older than 21 years of age who are due for pap smears should have those at the first visit along with other sexually transmitted infections screening as listed above for high-risk groups.

First-trimester education includes general information about hyperemesis, constipation, early discomforts such as fatigue and dizziness, and emotional stressors. First trimester visits are usually every four weeks for low-risk women. However, women who are high risk may require additional visits with the primary obstetric provider, high-risk specialists, social services, and case managers. The first visit must include visit plans, an overview of routine testing, medication safety in pregnancy, and expectations for weight gain.

Second Trimester: Evaluation, Testing, and Education

Second-trimester prenatal visits include a targeted examination and limited testing. During each visit, the prenatal provider evaluates the history and updates records for any issues since the last visit. The examination includes routine vitals, evaluation of maternal well-being and fetal growth, fetal heart tones, and targeted questions about changes and symptoms common during the second trimester. Ultrasounds are performed between 16 to 20 weeks for fetal anatomy and dating.  During the second trimester, women are offered additional genetic screening (quad screen) and amniocentesis if offered for women greater than 35 years old and women with a prior history of a child with a birth defect. The complete blood count may be repeated for those women with a history of anemia or at risk for anemia. Women are referred for visits with social services and specialists based on risk factors identified during the first trimester.

Women at risk for hepatitis B receive the second dose of the hepatitis B vaccine. Influenza vaccination is recommended during the flu season. 

Second-trimester education includes discussion about quickening that occurs around 21 weeks gestation. General education includes discussion about physiologic changes in pregnancy, heartburn, skin changes, bleeding gums, nose bleeds, breastfeeding, edema, and fetal growth. 

Low dose aspirin is recommended for women at risk for preeclampsia after 12 weeks gestation. ( Grade B Recommendation , USPTF)

Third Trimester: Evaluation, Testing, and Education

Third-trimester prenatal visits include a targeted examination and specific third-trimester screening. During each visit, the provider will inquire about common complaints during pregnancy such as nausea and vomiting, cramping, contractions, bleeding, headaches, back pain, vaginal discharge, swelling, hemorrhoids, weight gain, and urinary symptoms. During the third trimester, weeks 24 to 28, women are offered to screen for diabetes. This screening is beneficial for both low resource and high resource populations. [8] The United States Preventive Task Force recommends screening for asymptomatic pregnant women after 24 weeks gestation. ( Grade B recommendation, USPTF) The American Diabetic Association recommended initial screening using the two-hour 75 g glucose tolerance test (one-step test) or the one hour 50 g oral glucose solution followed by the 100 g glucose tolerance test for abnormal values (more than 140 mg/dl) on the initial screen (two-step test). Confirming the diagnosis with the one-step testing is fasting glucose of greater than 92 mg/dl, one hour greater than 180 mg/dl, and two-hour greater than 153 mg/dl. The confirmation of the diagnosis on step two of the two-step testing is a fasting glucose of greater than 95 mg/dl or 105 mg/dl, a one-hour of greater than 180 mg/dl or 190 mg/dl, and a two-hour of greater than 155 mg/dl or 165 mg/dl, or three-hour of greater than 140 mg/dl or 145 mg/dl. Women diagnosed with gestational diabetes should be referred to the dietician and appropriate support and specialty services. Recent literature suggests insulin as the first line of therapy but does not rule out sulfonylureas and metformin as options. [9]  Additional third-trimester testing includes repeating the screening for syphilis and other sexually transmitted infections for high-risk women. Rh-negative women should receive repeat Rh antibody testing between 24 to 28 weeks gestation. ( Grade B recommendation, USPTF) Group B Strep screening is recommended between 35 to 37 weeks gestation. Women with positive results are given an intrapartum prophylactic antibiotic. The antibiotic of choice is penicillin to prevent early-onset newborn infection. Alternative treatment for women allergic to penicillin is erythromycin or vancomycin.

Women with a negative blood type should receive Rho(D) immune globulin in the third trimester. Third-trimester vaccination includes influenza vaccination during flu season for women who have not previously received the vaccination, dose three of hepatitis B vaccine, and Tdap vaccination to prevent pertussis in the newborn. 

Third-trimester education includes information to help the woman distinguish between discomforts of pregnancy and more concerning issues such as intrauterine fetal demise, preterm labor, and preeclampsia. Common discussion during the visit include signs and symptoms of preterm labor (less than 37 weeks) and labor (more than 37 weeks), kick counts, family planning, childbirth classes, breastfeeding, pain management during labor and delivery, expectations in labor and delivery, postpartum care, and newborn care. Additional education must include planned antenatal testing for pregnancies that continue past the expected due date.

Prenatal Care after 40 weeks

Perinatal complications and mortality increase as pregnancy approaches 42 weeks of gestation. The rate of stillbirth and neonatal death doubles. In the United States, women who are not delivered at 40 weeks will most likely deliver before 42 weeks gestation. Labor induction at 41 weeks is recommended to decrease perinatal complications. ( Grade A recommendation ). At 41 weeks gestation, providers schedule a nonstress test and check the amniotic fluid index for assessing the well-being of the fetus. At the prenatal visit, the physician must review induction plans and indications, including setting a date. Women who are greater than 35 years of age have a higher risk of stillbirth after 41 weeks gestation.

Prenatal care is essential to improving perinatal outcomes. General education about content and visit schedules are standard recommendations based on the United States Preventive Task Force, the American College of Obstetrics and Gynecology, and evidence-based practices. The overall goal of prenatal care is to provide access to quality care based on recommended standards during pregnancy to result in good maternal and newborn outcomes.

• Other Issues

The United States Preventive Task Force recommends that clinicians provide or refer pregnant and postpartum patients at risk for depression for counseling and intervention. ( Grade B Recommendation , USPTF)

• Enhancing Healthcare Team Outcomes

Prenatal care recommendations are well established. Routine prenatal care is performed by family physicians, midwives, and obstetricians. Each clinician provides unique care requested or preferred by the patient and her partner (e.g., doulas, group visits, limited intervention in labor, etc.) It is necessary to have a team approach for evaluating women with high-risk preconception conditions during the preconception period or at the intake in every center. Nursing, educators, and clinicians should be aware of referral services both in the community and at the clinical site. The center or health system should have standardized guidelines and protocols on the core requirements for education, treatment, and management in prenatal care and pregnancy. Family medicine and midwives should have clear lines of communication with high-risk providers for high-risk patients during pregnancy. A collaborative approach improves doctor communication and increases the chance of identifying risks in pregnancy. [10]

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Disclosure: Josephine Fowler declares no relevant financial relationships with ineligible companies.

Disclosure: Heba Mahdy declares no relevant financial relationships with ineligible companies.

Disclosure: Brian Jack declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Fowler JR, Mahdy H, Jack BW. Pregnancy. [Updated 2023 Apr 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. [Int J Gynaecol Obstet. 2019] The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, McAuliffe F, da Silva Costa F, von Dadelszen P, McIntyre HD, et al. Int J Gynaecol Obstet. 2019 May; 145 Suppl 1(Suppl 1):1-33.
• Preconception and interconception health status of women who recently gave birth to a live-born infant--Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004. [MMWR Surveill Summ. 2007] Preconception and interconception health status of women who recently gave birth to a live-born infant--Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004. D'Angelo D, Williams L, Morrow B, Cox S, Harris N, Harrison L, Posner SF, Hood JR, Zapata L, Centers for Disease Control and Prevention (CDC). MMWR Surveill Summ. 2007 Dec 14; 56(10):1-35.
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• Review The use of folic acid for the prevention of neural tube defects and other congenital anomalies. [J Obstet Gynaecol Can. 2003] Review The use of folic acid for the prevention of neural tube defects and other congenital anomalies. Wilson RD, Davies G, Désilets V, Reid GJ, Summers A, Wyatt P, Young D, Genetics Committee and Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. J Obstet Gynaecol Can. 2003 Nov; 25(11):959-73.
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Maternity - Pregnancy, part 2: Prenatal Care: 1st, 2nd, and 3rd Trimester Visits

Pregnancy involves a lot of OB/GYN visits! This article gives an overview of all the appointments that need to happen during pregnancy—this article is an overview, and later on in this series, we cover some of these exams more in depth.

This series follows along with our Maternity Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Maternity Nursing - Flashcards

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First Trimester Visit(s)

The first trimester of pregnancy is the first 12 weeks (months 1, 2, and 3) and the first prenatal visit will take place during this time. A patient may have more than one visit in their first trimester, but it depends on when they realize that they may be pregnant.

During the first trimester visit, the provider will obtain the pregnant patient's obstetric history, calculate the estimated date of delivery, run important laboratory tests, perform a transvaginal ultrasound, and give the patient some initial maternal teaching.

Until approximately 28 weeks, the pregnant patient will have monthly visits.

Obstetric history

During the first trimester visit(s), the care team will gather the patient's obstetric history, meaning how many pregnancies and of what type. There is a special acronym for this, GTPAL . Check out our next video to learn more!

Calculating estimated date of delivery

During the first trimester visit(s), the provider or care team will calculate the patient's estimated date of delivery—when baby is expected to arrive! One useful way of calculating this is with Naegele's rule .

First trimester visit labs and diagnostics

During the first trimester visit(s), the patient will have some important labs and diagnostic testing done, including the following:

• Complete blood count
• STI & HIV testing
• Blood typing, including Rh factor
• Rubella titer
• Hepatitis B
• HCG (for high risk patients).

Transvaginal ultrasound

A transvaginal ultrasound is a test that gives a view of the patient's uterus, ovaries, fallopian tubes, cervix, and the surrounding area. During the first trimester visit(s), the patient may get a transvaginal ultrasound to confirm pregnancy, site of implantation (to ensure it's a safe pregnancy, not ectopic). Transvaginal means across or through the vagina, so the ultrasound device is placed inside the vagina, as opposed to an abdominal ultrasound wherein the device is against the abdomen.

A transvaginal ultrasound makes it much easier to get detailed imagery of the uterus and fallopian tubes than an abdominal ultrasound. Catching an ectopic pregnancy in the earliest stage of pregnancy is crucial to prevent harm to the patient.

First trimester maternal patient teaching

During the first trimester visit(s), you will give the pregnant patient some patient teaching about what to expect during their pregnancy. This includes nutritional guidance , weight gain, warning signs of complications, and expected side effects. In our Maternity Nursing Flashcards we cover patient teaching in detail. You can check out Part 4: Maternal Teaching: Nutrition/Weight Gain, Warning Signs, Unpleasant Side Effects which follows along with our flashcards.

Second Trimester Visits

The second trimester of pregnancy is from week 13 - 24 (months 4, 5, and 6) and there will be some important visits during this time.

Starting in the second trimester, the fetal heart rate will be assessed via doppler and fetal vital signs and weight will be obtained at each visit.

14 - 18 weeks (month 4)

During 14 - 18 weeks of pregnancy, the patient will get MSAFP testing done, followed up with amniocentesis if anything abnormal is found, and a gestational diabetes screening.

MSAFP testing

During 14 - 18 weeks of pregnancy, the patient may get a maternal serum alpha-fetoprotein (MSAFP) test , which is a test for genetic abnormalities like neural tube defects and Down syndrome.

Amniocentesis

During 14 - 18 weeks of pregnancy, if a patient has an abnormal result on their MSAFP test, they may require an amniocentesis , which is an invasive procedure wherein some amniotic fluid is removed from the uterus with a long needle and tested for genetic abnormalities.

Gestational diabetes test

If a patient is at high risk for gestational diabetes , they may be tested during 14 - 18 weeks of pregnancy with an oral glucose tolerance test . If a patient does not have higher risk, this test happens later.

18 - 22 weeks (month 5)

During 18 - 22 weeks of pregnancy, the patient will have an ultrasound to assess for any fetal abnormalities, and the fundal height will start to be measured during this time.

During 18 - 22 weeks of pregnancy, a patient will have an ultrasound as a standard part of prenatal care and to check for abnormalities that may require additional testing. By the time the patient has reached the second trimester of pregnancy, their ultrasounds will usually be abdominal rather than transvaginal.

Fundal height measurement

During 18 - 22 weeks of pregnancy, the patient will begin to need a fundal height assessment. Beginning at 18 weeks of pregnancy, the gestational age of the pregnancy should correlate to the fundal height in centimeters plus or minus two weeks

What is the fundus?

The fundus is not just a word that some nursing students and nurses find hilarious; it's the topmost part of the uterus. Fundal height is measured from the fundus to the pubic symphysis (middle anterior pelvis, above the vulva).

22 - 24 weeks (month 6)

During 22 - 24 weeks of pregnancy, the patient will need a glucose tolerance test, and for first pregnancies and those at risk for preterm labor, cervical length will start to be measured during this time.

Glucose tolerance tests

While it was only high-risk patients who were tested in month 4, in month 6 (22 - 24 weeks) of pregnancy, all patients will be given a 1-hour glucose tolerance test to test for gestational diabetes . If it is needed, it will be followed up with a 3-hour glucose tolerance test.

Cervical length

During 22 - 24 weeks of pregnancy, patients who are on their first pregnancy may have a transvaginal ultrasound done to have the length of the cervix assessed. This can help to identify risk factors for preterm labor. As long as the result of this test is normal, and the patient does not have preterm labor on their first pregnancy, this exam won't be repeated in the future.

Third Trimester Visits

The third trimester of pregnancy is from week 25 - 40 (months 7, 8 and 9) and there will be some important prenatal visits that take place during this time. After approximately 36 weeks, prenatal visits will be weekly until delivery.

At 28 weeks of pregnancy, Rhogam will be administered to Rh-negative patients, and visits will begin to happen every 2 weeks.

In the first trimester, patients were tested for Rh factor , which checks for maternal-fetal blood type incompatibility. If a pregnant patient is Rh negative (blood type incompatible), they will be administered Rhogam at 28 weeks and within 72 hours of delivery.

30 - 32 weeks

During 30 - 32 weeks of pregnancy, patients will need to begin kick counts, receive a TDaP, and undergo non-stress tests if they have a high-risk pregnancy.

Third trimester maternal patient teaching

At 30 weeks, patients should be taught to perform kick counts, which is exactly what it sounds like—How many times does the baby kick? This is important knowledge as it helps to assess the fetal well-being.

TDaP vaccine

At 30 weeks, patients can be given the tetanus, diphtheria, and acellular pertussis (TDaP) vaccine. If it is given in the third trimester, it can impart some protection to the baby. If not given then, it will be given after delivery.

Non-stress tests

A nonstress test is a non-invasive test done in the third trimester to measure fetal heart rate response to fetal movement.

35 - 37 weeks

During 35 - 37 weeks of pregnancy, patients may need to have a vaginal/rectal Group B Strep swab obtained, and at approximately 36 weeks, their visits will need to occur weekly until delivery.

Group B strep swab

Group B streptococcus beta-hemolytic (GBS) is a bacterial infection that can be passed to a child during the birthing process that can cause life-threatening newborn infections. During 35-37 weeks, a patient should have a rectal and vaginal swab for this bacteria. If the patient has Group B strep, they can be treated at the time of delivery.

Full Transcript: Maternity - Pregnancy, part 2: Prenatal Care: 1st, 2nd, and 3rd Trimester Visits

Hi, I'm Meris, and in this video, I'm going to be talking about what happens at OB/GYN visits in the first, second, and third trimesters. I'm going to be following along using our maternity flashcards. These are available on our website leveluprn.com. And if you already have a set of your own, I would absolutely invite you to follow along with me.

So let's go ahead and jump right in with what happens at the first-trimester visit.

So I say visit because typically there's only one. However, it just depends on when a patient realizes that they may be pregnant. So the first visit, the initial visit, should be done before 12 weeks of gestation. However, if that patient does come in and they're very early, let's say six weeks, they'll probably come back again four weeks later. But for most people, they have just the one.

Now, this is a really big visit for a lot of reasons.

First is, baby is too small for us to use a Doppler to assess the heart rate. So instead, we have to do an ultrasound. That's the only way to confirm cardiac activity at this point. So there will be an ultrasound to assess that the fetus has a heartbeat and what that rate is.

And then going forward, the heart rate will be assessed with a Doppler from the outside.

The other thing is that this is where a lot of labs and diagnostic testing is performed. So on this card, you can see that there is a heading called labs. And on here, we have a lot of big ones.

I want to call your attention to CBC [complete blood count]. Do we already have a problem with anemia? Do we already have an infection? We want to know that.

STI testing. In a lot of states, this is mandatory. So be familiar with your state's laws.

A Pap test. If my patient has not had a Pap test recently or is due for one, then we're going to do it at this visit.

Blood typing. Blood typing, including Rh factor. This is very important. And we will talk about that in a little bit.

And then we're going to be testing for hepatitis B, or hepatitis B immunity, for HIV.

And then if your patient is high risk, as in they may have had multiple miscarriages or something along those lines, they may also have serial, meaning in a row, a few HCG, which is the pregnancy hormone levels drawn to be sure that the pregnancy seems to be developing appropriately.

Also, maternal teaching will be done, and we'll talk about that in a later video.

And then, until 28 weeks - we have a line on here - but until 28 weeks, these visits will be monthly, so every four weeks. There's not a lot to see or do at these visits in the early days because baby is very little.

So let's move on to the second trimester. Now, when you look at the second-trimester card, whoo-hoo-hoo, there is a lot of bold red text on here. And to me, that means I should really know this card, and probably want to star and highlight this card because it might be really important for me to know.

So, from 14 to 18 weeks, anywhere in that time, MSASP, maternal serum alpha-fetoprotein testing will be done. We'll talk about that in a later video. But that is when that will occur.

If there is an abnormal MSASP, then we can progress to an amniocentesis. Again, we'll talk about that later.

And then gestational diabetes screening happens at this early time for patients who are high risk, as in they had gestational diabetes in a prior pregnancy. Maybe they were prediabetic before getting pregnant. Maybe they have a strong family history. We're going to test them much earlier than everybody else.

Now, from 18 to 22 weeks, we have a lot.

We will have an ultrasound. This is commonly called an anatomy scan because it is looking for abnormalities in the fetal anatomy. So we're going to check everything out with baby, see if we have any sort of congenital heart defects, neurological defects, anything that can be seen on the ultrasound.

Fundal height assessment will begin at this point. This is very important. Fundus height means I'm measuring from the pubic symphysis all the way up to the fundus. The fundus is the topmost part of the uterus.

And we're going to measure this in centimeters. The gestational age of the pregnancy should correlate to the fundal height in centimeters plus or minus two weeks, beginning around 18 weeks, so from 18 to 32 weeks. Let's say I'm 24 weeks pregnant. My fundal measurement should be about 24 centimeters. Anything drastically less or more is cause for further investigation.

And then, from 22 to 24 weeks, this is where a routine gestational diabetes screening will happen. This is going to be a one-hour oral glucose tolerance test. And then follow up with a three-hour if needed. We'll talk about that in a later video.

And for first-time pregnancy, it's very commonly there will be an ultrasound done, a transvaginal ultrasound, to assess the length of the cervix. This can help us to identify risk factors for preterm labor. But as long as that is normal and the patient does not have preterm labor this pregnancy, that won't be repeated in the future.

Now, let's talk about the third trimester. Again, we can see a lot of bold red text on here. So let's go through it.

If the patient is Rh-negative, which we know because we did the blood type at the first visit, if our patient is Rh-negative, they will receive RhoGAM, or the RhoGAM is the anti-D antibody. So this is going to help to suppress that. That will be administered to Rh-negative patients at 28 weeks.

From this point on, all visits are going to be every two weeks. So now, 28 weeks. We're going to be seen at 30 weeks, and then 32 and 35.

So then, 30 to 32 weeks, this is going to be huge education for your patients. At 30 weeks, your patient should be performing kick counts. They are what they sound like. It's counting how many times the baby kicks. This is important. It helps us to assess the fetal well-being. So that's going to be something that we want to start at 30 weeks.

Also, at thirty weeks, we can give TDaP vaccine to the pregnant patient. So that's the tetanus, diphtheria, and acellular pertussis vaccine. If given in the third trimester, it does impart some protection to the baby.

And then, NSTs. Nonstress test may be performed at this time if they are indicated from 35 to 37 weeks.

Really, really important. Listen to me. 35 to 37 weeks, we are going to do a vaginal and rectal swab for group B, beta hemolytic strep. So you will hear this just called group B strep. And it's a swab of the vagina and rectum. This is a bacteria that some people just carry. But if the patient has it, we need to treat them at the time of delivery.

And then starting at 36 weeks, visits with the provider will be weekly. So 36, 37, 38, 39, 40, and beyond until the patient delivers, just depending on when that baby comes.

So I hope that review kind of comprehensively of what happens throughout the three trimesters of prenatal care was helpful. We're going to talk a lot more about what all of those things are and what they mean in future videos. So be sure that you subscribe so that you're the first to know when they are alive on our channel. If this review was helpful for you, I would love it if you could like this video so that I know. And if you have a great way to remember something or a really good story, I would love to hear it below. Please leave us a comment so we know. All right. Thanks so much, and happy studying.

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