FAMILY MEDICAL CARE: FIRST VISIT DURING PREGNANCY

If your own doctor carries out the total care of the confinement himself, he will no doubt perform a complete examination at the first visit. Or if you are referred to the obstetrician, he will most likely perform the full routine on the first occasion.

This is what you could expect to take place:

(1)  History of the Present Pregnancy. The doctor will check your L.M.P. He will ask about details of symptoms you may be experiencing, in an effort to pinpoint whether you are or are not pregnant. In many cases it is quite clear and fairly obvious that you are pregnant.

(2)  History of Previous Pregnancies. The doctor will be interested to know about previous pregnancies, whether they proceeded to full term, or ended up as miscarriages or abortions. He will want to know about any special difficulties that occurred during the pregnancy, or afterwards. Also, if the babies were normal, weighed the normal weight, and the approximate duration of each labour. All this will assist him when it comes to assessing the present case. He will also question you about blood transfusions.

(3)  History of Past Illnesses. As certain diseases may be of significance, he will query you on past and present illnesses. Diabetes, heart and kidney disorders may be very important.

(4)  Physical Examination.  The doctor will then carry out a full physical examination. Each system is checked. The heart, lungs and intestinal system are examined, as well as each other system in brief. The breasts and nipples are checked. The doctor will be keen to know your average weight before you became pregnant. He will weigh you, check your height and blood pressure. In fact, the regular blood pressure readings form one of the most important checks thereafter. It is essential that the doctor have a "base-line" reading with which he can later compare subsequent readings.

(5)  Pelvic Examination. The doctor will insert an instrument called a speculum into the vagina. This gives him an excellent view of the vaginal passageways, and the cervix, the part of the womb that juts into the upper part of the vagina.

He will inspect each part thoroughly. If there are discharges, he will probably take a specimen for pathological examination.

A cervical smear test will probably also be done, and this too will be later sent to the pathological laboratory for examination.

This is followed by a manual examination. In this way, the womb can be felt by the examining fingers. Abnormalities may be detected which could play an important part later on in the pregnancy. The size and position of the womb is felt and recorded.

(6)  Laboratory Tests. Besides the tests already mentioned, the doctor will arrange for certain important tests to be carried out. These will usually include various blood tests. A hemoglobin estimation is performed. This indicates the quality of the blood. If reduced, it may require treatment.

The blood group must be known, for this could be vital later on in the event of abnormal bleeding. It is called the "ABO" grouping. In addition, the Rh (or Rhesus) factor must be known. This is also very important for all women, but especially in the cases of mothers pregnant for the first time. Today, it is possible to prevent many of the disasters of yesteryear when serious complications occurred due to this blood factor. Modern medical progress has now virtually eliminated these serious problems from arising by treatment before they occur. More will be told about this later on. The key factor is the need to know the patient's Rh factor.

The Wasserman or Kahn test (to check against venereal disease) is performed, and a urinalysis carried out. This is a simple urine test for certain elements   that   could    adversely   affect   the pregnancy (mainly albumen and sugar). Some­times a special culture of the urine may be ordered if the doctor has any suspicion that infection is present in the urinary tract.

Some of these tests will be carried out at the doctor's office. Others may necessitate a visit to the pathology department of the hospital or to the rooms of a private pathologist. Sometimes the doctor may take the blood sample himself and have these sent to the pathologist.

If there is any doubt about pregnancy, the pregnancy test may be carried out as well. This is the check for H.C.G., which has already been explained.

(7) The Next Visit. An appointment will be made for your next visit which will be in four weeks' time. Subsequent visits will be quite a deal briefer than the initial one.

They will chiefly entail a check on the blood pressure, a urine check (mainly for the presence of albumen, which if present is an indication of abnormal kidney function), and weight gain.

The mother-to-be will have the opportunity of telling the doctor of any abnormality that she has noted. He will offer appropriate advice.

After the twenty-eighth week, examinations tend to be more comprehensive. The doctor will carry out an abdominal check as well as the foregoing procedures. He will assess the height of the fundus, and this gives a good indication of the rate at which the infant is growing.

He will also check the position of the foetus as it lies in the womb. He can readily work out where each part of the body is, where the head is located, the back, and breech (or rump). He will listen for the foetal heart sounds through a special obstetrical stethoscope, and check on its degree of activity. All these are important features, and variations from the normal may need to be followed through with other investigations.

Every doctor, of course, sticks to the routine he has found most practical over the years. So if your doctor has a routine which differs from this one, do not be alarmed. There is little doubt that all the important features will be covered bit by bit. He may elect to carry out certain examinations earlier or later. It depends on his individual feelings at the time, so go along with his suggestions at all times.

Later on, certain additional blood tests may be ordered. If the blood count or haemoglobin levels were unsatisfactory at the first assessment, then it is certain these will be rechecked once or twice later on.

If there is any question about Rh factor problems, later checks may be required for this as the pregnancy moves on.

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GENERAL HEALTH