The pregnant woman’s first prenatal visit should be the building block of a healthy, happy pregnancy. Everything is established during the first visit, such as the assessment, whether the pregnancy is confirmed, and a little bit of planning for the future. It’s time to focus on the woman herself and the details that could make or break her pregnancy glow.
- 1 Initial Interview
- 2 Gynecologic History
- 3 Obstetric History
- 4 Systemic Assessment
- 5 Laboratory Assessment
- The first prenatal interview could take a long time, so the person who is scheduling appointments for the visits should make the woman aware to avoid cancelling of appointments or rushing of the interview because the woman has an errand to attend to.
- It is important that the healthcare provider should establish rapport even on the first visit because information such as what the woman feels about her pregnancy and if she has any fears can only be taken once the woman trusts her healthcare provider.
- Personal interviews can also make the woman feel important and that she is not just one of the patients that would immediately be forgotten after the visit.
- The interview must take place in a private, quiet environment because it would be difficult for the woman to answer all the questions when you are in a sitting room full of waiting patients or on the hallway.
- The woman must also understand your role in the assessment, because if she views you only as the interviewer you would only get superficial information from her.
- One of the purposes of the initial interview is to assess the health history of the pregnant woman.
- Establishing a baseline health data is crucial especially when there is a new symptom that arises from the woman and it could only be identified as new based on the data gathered from her health history.
- The demographic data are the superficial data that can be obtained from the woman.
- These include the name, age, address, telephone number, and health insurances.
- The chief concern of the woman when she visits the clinic is she thinks she might be pregnant.
- Assess the first day of the last menstrual period of the woman.
- Assess any early signs of pregnancy such as nausea and vomiting, fatigue, and breast tenderness.
- Inquire if she has tried any home pregnancy test kit or had a pregnancy test from a clinic to establish her pregnancy.
History of Past Illnesses
- It is important to assess any past illness because it might become active during or after the pregnancy.
- Assess if there are any infections from the past, especially sexually transmitted diseases so you could educate the woman and suggest any vaccines available.
- There are vaccines that are not friendly for a pregnant woman; however, vaccines such as influenza and poliomyelitis can be administered.
- Assess any allergies present even before pregnancy to avoid triggers that could also affect the fetus.
History of Family Illnesses
- Assess the presence of family illnesses such as hypertension, diabetes, or asthma on both the father and mother.
- There are illnesses that could become a potential problem during pregnancy or one that could be transferred to the fetus.
- Assess the woman’s current nutrition profile, or ask her to have a 24-hour recall to obtain nutrition information.
- Assess the frequency, type, and amount of exercise she does to determine if her pattern of activities is still recommended during pregnancy.
- Assess if the woman smokes or drinks, its frequency, and amount because these vices could cause fetal alcohol syndrome or preterm birth.
- Assess history of medication intake and what medication the woman is taking during pregnancy to determine its possible effects on the fetus.
- Obtain the age of the woman’s menarche, her usual cycle, the duration, and the amount of menstrual flow.
- Assess any past reproductive tract surgery as it can affect the present pregnancy, such as tubal surgery from ectopic pregnancy.
- Assess the reproductive planning method that the woman used or will be using after pregnancy, and also her sexual history to educate her about safe sex practices.
- Assess the woman’s pregnancy history using GTPALM.
- G is the gravid classification or the number of times the woman became pregnant.
- T is the number of full term infants born.
- P is the number of preterm infants born.
- A is the number of miscarriages or therapeutic abortions.
- L is the number of living children.
- M refers to multiple pregnancies.
- Assess the woman’s respiratory system, if she is currently experiencing cough, asthma, pain upon breathing, or any serious respiratory illnesses such as tuberculosis.
- Assess the cardiovascular system and any history of heart murmurs, heart diseases, hypertension, and if she knows her blood pressure level and any experience of blood transfusion.
- Assess her gastrointestinal system; ask about her pre-pregnancy weight, any discomforts such as vomiting, diarrhea or constipation, hemorrhoids, and changes in bowel habits.
- Assess her genitourinary system and ask about any urinary tract infections, STIs, PIDs, any difficulties in conceiving, and hematuria.
- Assess any breast lumps, secretions, pain upon palpation of the breast, or tenderness.
- Assess the woman’s last dental exam, the use of any dentures, the condition of the teeth, and if she is experiencing any difficulty in swallowing.
Papanicolaou Smear (Pap smear)
- Pap smear is performed to detect and diagnose the presence of precancerous and cancerous conditions of the cervix, vulva, or vagina.
- The test also reveals infectious diseases and inflammation.
- The classification of Pap smear can be seen in the Bethesda classification of Pap smears.
- Women who have multiple sexual partners, smoke cigarettes, have a history of HPV, and sexually active before 21 years old should have Pap smear done more frequently.
- Complete blood count should be taken to assess the hemoglobin, hematocrit, and red cell index and determine the presence of anemia.
- White blood cell count and platelet count must also be obtained to assess for infection clotting ability.
- Blood typing with Rh factor is also important because blood needs to be available if ever the woman experiences bleeding during pregnancy.
- Maternal serum alpha fetoprotein detects birth defects such as neural tube defects if elevated and chromosomal anomalies if decreased.
- Antibody titers for rubella and hepatitis B or HBsAG determine whether the woman is protected against rubella and if the newborn would have a chance of developing hepatitis B.
Glucose Tolerance Test
- A woman with a history of diabetes, large for gestational age babies, obese, or has glycosuria should undergo glucose tolerance test.
- A 50-g oral toward the end of the first trimester should be performed to rule out gestational diabetes.
- The plasma glucose level should not exceed 140mg/dl at 1 hour.
- Urinalysis is performed to assess proteinuria, glycosuria, and pyuria.
- These can be done through test strips or microscopic examination of the urine.
- To confirm pregnancy, an ultrasound must be scheduled especially if the woman is unsure of the date of her last menstrual period.
- Ultrasonography would also determine the growth of the fetus, but only the gestational sac would be seen at this stage.
Many couples are excited for their first prenatal visit, especially those who are having their first baby. Compliance of all the instructions of the healthcare provider is essential so the woman could achieve a smooth and healthy pregnancy and delivery. A mother would only want the best for her child, starting from her womb until she is already cuddling her little angel in her arms.