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Early Stages
of Pregnancy

Early Stages of Pregnancy...

You are encouraged to see your doctor (GP) as soon as you think that you may be pregnant.

Your doctor may confirm your condition by doing a simple urine test for HCG (human chronic gonadotrophin).
Early Stages of Pregnancy

It is important to see your doctor as early as possibe in pregnancy so that...

  • a baseline of recordings and observations can be made. It is much easier then to see if any abnormalities occur later.
  • advice can be given about health and lifestyle to promote a healthy pregnancy.

Your doctor should explain to you about the choices available to you regarding antenatal care and where you want your baby to be born.

A general health check may be performed (weight, blood pressure and urine test) and advice given about diet, smoking and lifestyle.

Blood tests may be performed for rubella antibodies, haemoglobin estimation and grouping.

If you choose to have a hospital delivery, your doctor will refer you to the local maternity unit, and you will be sent an appointment to attend the booking clinic.

Booking Clinic

The booking clinic is the first visit to the hospital antenatal clinic (ANC). A bed is booked for the time the baby is due.

Several observations, tests and recordings are made and information is put into your hospital notes.

History Taking

General Particulars
Accurate records of your name, age, address, GP and midwife are taken during early stages of pregnancy.

Present Pregnancy
Calculation of the expected date of delivery (EDD) - You are asked the date of the first date of your last menstrual period (LMP). Nine calendar months are counted forwards and seven days added, for example...

LMP: 1.1.99, add 9 months and 7 days = EDD: 8.10.99.

Health during your early stages of pregnancy is accessed, for example you may report excessive sickness, vaginal bleeding or any other abnormality.

Previous Pregnancies
Details of previous pregnancies are recorded, because this may affect the care given during this pregnancy, for example...

  • date of birth of previous children
  • type of delivery
  • weight and sex
  • method of feeding
  • miscarriages, terminations, stillbirths, abnormal babies.

Medical History
Any illnesses affecting you is recorded, especially if they may affect the baby, for example diabetes or heart disease.

Family History
Twins, multiple births, genetic conditions or medical problems are recorded.

The Midwife's Examination

Weight
Weight is recorded as a base measure for future weight gain. The average gain in pregnancy is 12-15kg.

Height
Height may indicate the size of the pelvis.

Urine Test
The urine is tested for protein, ketones and sugar. These substances are not usually found in the urine; if they are present further investigation will be required.

  • protein - possibly an early sign of toxaemia of pregnancy, or it may be caused by an infection or contamination of the specimen.
  • ketones - produced by the breakdown of body cells to provide energy. Dieting or constant vomiting may be the cause.
  • sugar - not uncommon in pregnancy because the kidneys are less efficient than usual; it could, however, be an early sign of diabetes.

Blood Pressure (BP)
This provides a baseline for future recordings. High BP in pregnancy may be the first sign of toxaemia of pregnancy.

Medical Examination

A full medical examination will be performed by an obstetrician. This will include the examination of...

  • teeth
  • breasts
  • heart and lungs
  • abdominal examination
  • lower limbs, for varicose veins or swelling (oedema)
  • internal vaginal examination to check the size of the uterus; an ultrasound scan will give an even more accurate assessment. A cervical smear will be done if neccessary.

Blood tests

At the first visit to the ANC (antenatal care clinic), a sample of blood is taken for a variety of tests...

  • Rhesus factor - with information from this test, blood can be cross-matched without delay in the case of anaemia or bleeding during pregnancy, when a transfusion may be needed.
  • Serology - to detect syphilis (a veneral disease), which can be treated to prevent damage to the baby.
  • Haemoglobin - the iron content of the blood is recorded and is taken at monthly intervals thereafter.
  • Rubella - blood test is tested for rubella antibodies.
  • Serum alpha-fetoprotein (SAFP) - this test is taken at 16 weeks of pregnancy when a raised level of SAFP indicates that the baby may have spina bifida; this high level could mean that it is a multiple pregnancy or that the date of the LMP is incorrect. An amniocentsis is offered if you have a raised SAFP, and a detailed ultrasound scan will usually be performed to check for twins and to examine the spine.
  • Triple test - this test may be offered to women over 35 years of age, or it may be requested. It measures levels of serum alpha-fetoprotein (SAFP), human chorionic gonadotrophin (HCG) and oestriol (placental hormones). In conjunction with maternal age, the test calculates the risk of the baby having Down's syndrome and spina bifida. An amniocentesis may be offered to you if necessary.

The Co-operation Card

Every pregnant woman is given a co-operation card to record every antenatal assessment made by the hospital, GP or midwife.

As its name implies, the card is to enable co-operation between all the providers of ANC as well as you.

You should carry it with you at all times because pregnancy is not predictable - a problem could occur at any time, even when out for the day or on holiday.

Whoever cares for you will need to know the progress of your pregnancy so far, so that the best treatment can be offered. As the pregnancy progresses, it will be possible to record the fetal heart and feel the fetal parts when you are examined.

You will begin to feel the baby move, at about 20 weeks for a first baby, and earlier for subsequent pregnancies because an experienced mother will recognise the sensation of fetal movement.

These observations will be recorded at each antenatal visit together with records showing...

  • weight
  • urinalysis
  • blood pressure
  • height of the fundus
  • fetal heart
  • oedema.

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