Transcript for:
OB/GYN Visits During Pregnancy Trimesters

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. 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. 28 weeks. 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. I invite you to subscribe to our channel and share   a link with your classmates and friends in nursing  school. If you found value in this video, be sure   and hit the like button, and leave a comment and  let us know what you found particularly helpful.