Physical Assessment at First Prenatal Visit (11 Weeks 5 Days)
A pelvic examination is not necessary at this first prenatal visit for an asymptomatic patient at 11 weeks 5 days gestation. 1, 2, 3
Essential Physical Assessment Components
Blood Pressure Measurement
- Measure blood pressure using standardized technique in left lateral recumbency with an appropriately sized cuff 4
- This is the single most critical physical assessment before initiating any prenatal care 4
Weight and BMI Documentation
- Document current weight and calculate BMI for risk stratification 4, 5
- Establish baseline for monitoring gestational weight gain 6
General Physical Examination
- Perform thorough auscultation for cardiac murmurs, as physiological changes during pregnancy can create new murmurs or alter existing ones 4
- Assess for signs of heart failure (edema, dyspnea) 4
- Oximetry should be performed if patient has known congenital heart disease 4
Urinalysis
- Check for proteinuria, especially with any history or family history of hypertension or pre-eclampsia 4
Why Pelvic Examination Is Not Indicated
The evidence clearly demonstrates that pelvic examination adds no value in asymptomatic pregnant patients with confirmed intrauterine pregnancy. 3
Supporting Evidence
- A prospective study of 50 pregnant patients (mean gestational age 8.6 weeks) with bedside ultrasound-confirmed intrauterine pregnancy found that pelvic examination resulted in zero management changes 3
- All patients were safely discharged without pelvic examination influencing disposition decisions 3
- The American College of Obstetricians and Gynecologists recommends pelvic examinations only when indicated by medical history or symptoms, not routinely 2
Specific Indications That Would Require Pelvic Examination
A pelvic examination would be indicated only if your patient has: 1
- Vaginal bleeding or discharge
- Pelvic pain or cramping
- Dyspareunia
- Symptoms of sexually transmitted infection
- History of cervical dysplasia requiring surveillance
- History of gynecologic malignancy
- In utero diethylstilbestrol exposure
Cervical Length Assessment
Do not perform transvaginal cervical length measurement at this visit. 4
- Routine transvaginal cervical length assessment in the first trimester has not been shown to predict preterm labor or improve outcomes, even in twin pregnancies 4
- Cervical length screening, if indicated, should be deferred to 16-20 weeks gestation 4
Laboratory Assessment Priority
Rather than performing a pelvic examination, focus on: 7
- Confirming pregnancy with serum hCG if not already done
- Standard first-trimester prenatal laboratory panel
- STI screening can be performed with non-invasive urine-based testing for chlamydia and gonorrhea in asymptomatic patients 1
Common Pitfalls to Avoid
- Do not perform routine pelvic examination "just because it's the first visit" - this adds patient discomfort without clinical benefit 2, 3
- Do not require pelvic examination before prescribing prenatal vitamins or initiating routine prenatal care 4, 2
- Do not confuse cervical cytology screening requirements with need for bimanual examination - these are separate considerations 1