Recommended Procedures and Screenings for First Antenatal Visit
The first antenatal visit should include comprehensive screening and assessment procedures to establish baseline health status, identify risk factors, and develop an appropriate care plan for the pregnant woman, with a minimum of 8 antenatal visits recommended throughout pregnancy. 1
Timing of First Visit
- First prenatal visit should ideally occur as early as possible in pregnancy, preferably in the first trimester 2
- Delaying the first visit beyond 8 weeks of gestation increases risks, as miscarriage rates decrease significantly after this point (9.4% at 6 weeks, 4.2% at 7 weeks, 1.5% at 8 weeks) 3
- Office-based delays in scheduling first prenatal visits are common, with average scheduling at 6.37 weeks gestation 4
Essential History and Risk Assessment
- Complete medical, surgical, and obstetric history to identify pre-existing conditions 2
- Family history to determine need for genetic screening and counseling 2
- Medication review including prescription, over-the-counter, and supplements 1
- Substance use assessment (tobacco, alcohol, drugs) with appropriate counseling 1
- Psychosocial assessment for mental health conditions, intimate partner violence, and social support 1
- Venous thromboembolism (VTE) risk assessment, as risk remains elevated for up to 6 weeks postpartum 5
Physical Examination
- Complete vital signs including blood pressure to screen for hypertension 1
- Height and weight measurement to calculate BMI and establish baseline for weight gain monitoring 1
- Comprehensive physical examination including cardiac, respiratory, abdominal, and pelvic assessment 6
- Measurement of symphysis-fundal height if beyond first trimester 7
Laboratory Testing and Screening
- Complete blood count to screen for anemia 1
- Blood type, Rh status, and antibody screening 2
- Urinalysis and urine culture to screen for asymptomatic bacteriuria 2
- Screening for sexually transmitted infections including HIV, syphilis, hepatitis B, and chlamydia 2, 8
- Cervical cancer screening if due according to guidelines 6
- Diabetes screening using either universal or risk-based approach 8
- Screening for gestational diabetes in women with risk factors (marked obesity, personal history of gestational diabetes, glycosuria, strong family history of diabetes) 8
Ultrasound Assessment
- Dating ultrasound to confirm gestational age and viability 7
- Early ultrasound (before 12 weeks) for more accurate dating 1
- Screening for fetal anomalies with detailed ultrasound at 18-22 weeks should be scheduled 1
- Assessment for urinary tract dilation if detected on ultrasound, with appropriate follow-up planning 8
Preventive Measures and Supplementation
- Folic acid supplementation (400-800 mcg daily) to prevent neural tube defects 2
- Iron supplementation if indicated by hemoglobin levels 2
- Calcium supplementation (1200 mg/day) for populations with low calcium intake to reduce preeclampsia risk 1
- Low-dose aspirin (100-150 mg/day) before 16 weeks for women at risk of preeclampsia 1
- Influenza vaccination recommendation regardless of gestational age 2
- Administration of Rh(D) immune globulin for Rh-negative women if indicated 2
Patient Education
- Nutrition counseling and appropriate weight gain recommendations based on pre-pregnancy BMI 1
- Discussion of expected pregnancy course and timing of future visits 6
- Warning signs requiring immediate medical attention 1
- Discussion of aneuploidy screening options with risks and benefits 2
- Preparation of a birth plan and discussion of delivery options 1
Common Pitfalls to Avoid
- Failing to accurately date the pregnancy, which can lead to unnecessary interventions later 2
- Overlooking psychosocial risk factors that may affect pregnancy outcomes 1
- Inadequate screening for gestational diabetes in high-risk women 8
- Missing opportunities for preventive interventions like folic acid supplementation 2
- Neglecting to provide adequate patient education about pregnancy warning signs 6
- Insufficient attention to mental health screening during initial assessment 1