First trimester pregnancy
Alternative names:
early pregnancy; first 3 months of pregnancy; pregnant
Treatment:
The vast majority of pregnancies in the United States are carried to term.
Pregnancy is a naturally occurring function and, prior to modern medicine, was allowed to follow its own course. Also, prior to modern medicine, infant and maternal mortality were high. It is now well understood that prenatal care results in significant improvement in the quality of the pregnancy and the outcome for the infant and mother.
Modern prenatal care includes: - Good nutrition and health habits before and during the pregnancy.
- Frequent prenatal examinations to detect early problems.
- Routine ultrasounds to detect fetal abnormalities and problems.
- Routine screening for:
Treatment during first trimester pregnancy depends on whether or not the pregnancy is desired.
Women who choose to have a legal abortion must do so in the very early stages of the pregnancy (usually before 8 to 12 weeks gestation). Abortion is a controversial issue in the United States and many women who make such a decision feel as if they cannot share that information with others. Therefore, it is important for women who are contemplating an abortion to examine their existing support system and identify those people who may be capable of helping them through what may be a difficult time. It is also important that they choose a reputable provider or clinic that advocates choice for women, and offers a safe environment in which they can obtain adequate counseling regarding all options for pregnancy resolution, have the procedure performed, and obtain the support and follow-up care that may be necessary after the abortion.
Women who plan to continue a pregnancy to term need to choose a health care provider who will provide prenatal care, delivery, and postpartum services. Provider choices in most communities include physicians specializing in obstetrics and gynecology (OB/GYN), certified nurse midwives (CNMs), some family practice physicians, and some family nurse practitioners (FNPs) or physician assistants (PAs) who work in conjunction with a physician. The family health care providers, or generalists, are proficient in managing women throughout normal pregnancies and deliveries. If an abnormal pregnancy is identified, a generalist will refer the patient to an obstetric specialist.
The principal goals of prenatal care are to monitor both the pregnant woman and the fetus throughout the pregnancy to identify any factors that could change the outlook for the pregnancy from normal to high-risk. Prenatal care also focuses on providing accurate information regarding the following: nutritional requirements throughout the pregnancy and postpartum period; activity recommendations or restrictions; and the management (preferably without medications) of common complaints that may arise during pregnancy (for example, backache, joint pain, nausea, heartburn, headaches, urinary frequency, leg cramps, and constipation). Pregnant women are advised to avoid all medications unless specifically deemed necessary and recommended by a prenatal health care provider. Potential substances and/or exposures (for example, alcohol/drug use, smoking, some herbal preparations, and common over-the-counter medications) that may interfere with normal development of the fetus should also be avoided.
The projected date for delivery is called the estimated date of confinement (EDC). The EDC may be calculated using Naegele's Rule. Subtract three from the month of the LNMP (last normal menstrual period) to determine month of EDC, then add seven to the first day of the LNMP to determine the day of the month for the EDC. If the LNMP was 6/29, then the EDC is 4/6. If the LNMP was 2/2, then the EDC is 11/9. Note: Naegele's Rule is based on a 28-day menstrual cycle. Therefore, dates may need to be adjusted for women who normally have shorter or longer menstrual cycles.
Prenatal visits are typically scheduled every 4 weeks during the first 32 weeks of gestation, every 2 weeks from 32 to 36 weeks gestation, and weekly from 36 weeks to delivery. Weight gain, blood pressure, fundic height, and fetal heart tones (as appropriate) are usually measured and recorded at each visit, and routine urine screening tests are performed.
Expectations (prognosis):
Approximately 10% of known pregnancies terminate by spontaneous abortion (miscarriage), usually during the first trimester. Estimates suggest that as high as 50 to 70% of all conceptions terminate spontaneously before the individual is aware of pregnancy. Nature is extremely conservative, and studies suggest that there is a much higher rate of spontaneous abortion in defective fetuses than in normal fetuses.
Complications:
Abnormal processes, which may prove dangerous to the health of the mother and/or fetus, may occur in up to 20% of pregnancies.
Calling your health care provider:
Call for an appointment if you suspect you are pregnant, are currently pregnant and are not receiving prenatal care, or if you are unable to manage common complaints without medication.
Call your health-care provider if you suspect you are pregnant and are on medications for diabetes, thyroid disease, seizures, or high blood pressure.
Notify your health-care provider if you are currently pregnant and have been exposed to sexually transmitted disease, chemicals, radiation, or unusual pollutants.
Call your health-care provider if you are currently pregnant and you develop fever/chills or painful urination.
It is urgent that you call your care provider if you are currently pregnant and notice any amount of vaginal bleeding, if your membranes rupture ("water breaks"), or you experience physical or severe emotional trauma.
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