Visits in pregnancy trimester by trimester

What are the most important visits to do during pregnancy? How many are there and how do they take place?

Although pregnancy is not a disease, it is important for expectant mothers to undergo some checkups. In fact, visits during pregnancy are essential for monitoring the health of mother and child and verifying that everything is going well.

In addition, these appointments allow you to schedule exams and ultrasounds to be performed in advance , and offer expectant mothers the opportunity to express doubts and concerns , in order to face the birth process with greater serenity and awareness.

How many visits are to be made during pregnancy?

According to the guidelines of the physiological pregnancy of the Istituto Superiore di Sanità , the number of visits offered to pregnant women  should not be less than four .

The World Health Organization (WHO) , for its part, recommends a number of eight visits and at least one ultrasound over the nine months.

In Italy, it is usually the practice to have one visit a month . In addition, our National Service offers two free ultrasounds (in the first and second trimester), in addition to ultrasound for the study of the nuchal translucency of the fetus. In the third trimester , on the other hand, ultrasound is free of charge only in the presence of risk factors for the mother or for the child.

Internal gynecological visit during pregnancy: is it always necessary?

Internal visits in pregnancy are not necessarily done at every appointment .

It is important to perform one at the first meeting , to check the conditions of the neck of the uterus. Subsequently, however, in the absence of complications or complaints, it may be sufficient to palpate the abdomen from the outside and, starting at the 24th ^week , measure the fundus to check the growth of the uterus .

Visits to be made during pregnancy in the first trimester

The first trimester ends at 12 weeks + 6 days .

The first gynecological visit during pregnancy (also called first obstetric visit ) should be performed within the first 10 weeks , also to facilitate a better dating of the pregnancy.

Compared to subsequent meetings, this appointment lasts longer , to allow for an in-depth assessment of the woman’s state of health. During the first visit, in fact, the clinical history of the future mother is investigated and, in the presence of risk factors , specific tests are scheduled .

During the meeting, an internal gynecological visit is performed , blood pressure is measured and the body mass index is evaluated . In addition, a vaginal cytological examination (Pap test) is proposed , if not performed in the previous three years.

All the information obtained is recorded in the pregnancy record . This very important document will be delivered to the expectant mother and   must be brought to each visit , as well as at the time of delivery .

How are visits carried out in the first trimester of pregnancy?

During this meeting, the expectant mother should receive a whole series of information that will allow her to have a clear idea of ​​the entire process to follow, including the number of visits expected , the timing and content of the meetings.

In addition, the gynecologist or midwife should provide guidance on:

• the diet and lifestyle to follow;
• possible pregnancy symptoms and their management ;
• screening tests and prenatal diagnosis to identify any congenital anomalies of the fetus ;
• birth support courses  ;
• the laws that protect maternity and paternity .

In addition, the expectant mother should be reminded to schedule the morphological ultrasound in time , which takes place between the 19th and 21st week ^of pregnancy ^.

Also in this meeting, the expecting woman should have the opportunity to express her uncertainties and to ask all those questions which, for a woman who is about to face a pregnancy (it does not matter if the first or the following ones), are fundamental for feel calmer .

Exams and checks to be scheduled

At the first visit or after a short time , the tests to be done at the beginning of pregnancy should be illustrated and planned .

In this regard, the ISS guidelines underline that all checks and analyzes should be organized in such a way as to reduce any possible discomfort for the expectant mother.

For this reason, whenever possible, the recommended tests and assessments should be performed during scheduled meetings . Furthermore, the exams to be done should be scheduled in such a way that the results are available for the next appointment .

During the first visit, it will be investigated even if the expectant mother has already received the anti SARS-COV-2 / COVID-19 vaccination . Otherwise, it will be evaluated whether and when to proceed with the administration, which will be performed with mRNA vaccines .

Visits to be made during pregnancy in the second trimester

The second trimester begins at 13+0 weeks and ends at 27+6 weeks of pregnancy.

The visits during this period have the purpose of evaluating and discussing the results of the analyzes performed in the first trimester with the expectant mother .

Based on the exam results:

• women who do not fall within the parameters of a physiological pregnancy are identified and the care plan is reviewed;
• if the hemoglobin levels in the blood are lower than 10.5 g/100 ml, a possible iron integration is evaluated ;
• in case of risk for gestational diabetes , a glycemic curve is programmed , with different times and methods depending on the risk factors;
• in non-immune women , tests for rubella , toxoplasmosis and cytomegalovirus (CMV) are requested again

During your second trimester appointments, you also continue to monitor your blood pressure and weight .

How are visits carried out in the second trimester of pregnancy?

The gynecologist or obstetrician should offer adequate information on morphological ultrasound , its objectives and the interpretation of the results . In this regard, it is important that the expectant mother has the space and time to express her doubts and concerns and to discuss with the professional .

It would also be advisable to remind the women concerned to enroll in childbirth support courses . In some facilities, in fact, pre-natal courses begin around mid-pregnancy.

Exams and checks to be scheduled

If morphological ultrasound shows that the placenta completely or partially covers the cervix (placenta previa), a further ultrasound should be planned at 32 ^weeks .

Visits to be made during pregnancy in the third trimester

The third trimester begins at 28+0 weeks and ends at the end of the pregnancy.

During the check-ups of this period, the gynecologist or midwife will continue to examine and illustrate the results of the tests performed to the expectant mother , paying particular attention to any signs of anemia , blood pressure and weight gain . If the pregnancy can no longer be considered physiological , the care plan will be modified .

When an ultrasound is not performed, the symphysis-fundus distance (ie the distance between the symphysis pubis and the fundus of the uterus) will also be measured, to evaluate the growth of the fetus and the amount of amniotic fluid .

How are visits carried out in the third trimester of pregnancy?

As in the meetings of the previous trimesters, it is important that the expectant mother is set aside time to ask questions and clarify her doubts about pregnancy and childbirth.

Exams and checks to be scheduled

During this period, various routine tests are planned, including those for HIV and toxoplasmosis , and the execution of a vaginal-rectal swab to search for beta-haemolytic streptococcus (usually performed after the 35th ^week ).

In addition, pertussis vaccination should be offered between 28 and 36 weeks to protect the newborn from the risk of infection.

Furthermore, according to the ISS guidelines :

• at 28 ^weeks , anti-D prophylaxis should be offered to all Rh (D) negative women , to prevent the possible production of maternal antibodies against the red blood cells of the fetus ;

• at the 32nd ^{week a} new ultrasound should be performed , if the previous ones have shown that the placenta covers all or part of the uterine cervix;

• at 32 ^to -33 ^weeks , if the fetus is breech , it is possible to evaluate the use of the moxibustion technique , to favor the cephalic position;

• At 34 ^weeks , the expectant mother should be counseled on how to prepare for delivery , recognize labor symptoms and manage pain .

• at  36 ^weeks the position  of the fetus should be re-verified; moreover, if the baby is still in the breech position, the expectant mother should be informed about the external turning maneuvers , which are usually performed starting from the 37th ^week of pregnancy . Also during this period, the woman should be informed about breastfeeding , baby care , screening tests and vitamin K prophylaxis for the newborn and how to take care of herselfafter the birth of the child; in general, however, it is more frequent that these topics are dealt with during the birth support course rather than during obstetric visits.

• finally, at the 40th ^week , the expectant mother should be informed on how to manage the pregnancy beyond the term .