Schedule of Prenatal Care

Schedule of Pregnancy Care

During pregnancy, regular visits with your OBGYN provider are important to help keep you and your baby healthy.

How Often to See your Doctor or Nurse Midwife

Each pregnancy is unique, but in general, you will see your doctor or nurse midwife every four weeks until you reach 32 weeks. You will then have appointments every two weeks until 36 weeks. After this, you will have an appointment every week. The first visit is usually the longest. You should allow 45 minutes. The remaining visits are usually 10 to 15 minutes.

What to Expect at Each Visit

If you will be delivering at UCLA Santa Monica Medical Center with our nurse midwives, most of your appointments will be with the midwife team. However, the first appointment will be with an obstetrician, who you will also see for a few other key visits during your pregnancy care.

First trimester (first 3 months of pregnancy)

8 – 13 weeks: Make your first appointment as soon as you think you’re pregnant. This will be your longest visit. Your partner may want to come to this visit. Your provider will ask about your medical history (menstrual cycle, birth control, past pregnancies, family history and medications) and will perform a physical exam and routine lab tests. They will provide a due date and they may conduct an ultrasound. Keep in mind that few women give birth on their actual due date, but it provides a timeline for tests and procedures. Your due date does not change and allows your care team to monitor the progress of your pregnancy.

Between 11 ­– 13 weeks: An ultrasound appointment is made with a doctor trained in maternal and fetal medicine. This ultrasound is a noninvasive test that will:

• Measure the back of baby’s neck and helps screen for Down syndrome and Edward’s syndrome
• Confirm your baby’s due date (this is the most accurate way to do so)
• Determine the number of fetuses you’re carrying and check the placenta
• Diagnose an ectopic pregnancy (when pregnancy develops outside the uterus) or miscarriage
• Examine the uterus and pelvic anatomy
• In some cases, detect fetal abnormalities

Noninvasive prenatal testing for birth defects:

• A safe, simple blood test that can be performed as early as 10 weeks
• May be recommended earlier if a blood test or ultrasound is abnormal
• All birthing parents receive this screening test

Genetic testing (carrier testing):

• Your care team may recommend genetic testing if you or your partner have a family history of genetic disorders or if you have given birth to a baby with a genetic abnormality
• Genetic disorders are often passed on from parent to child
• If your baby does end up having health issues, knowing in advance can give you time to prepare and can also help your doctor or midwife provide your baby with extra support at birth

Examples of genetic disorders that can be diagnosed before birth include:

• Cystic fibrosis
• Duchenne muscular dystrophy
• Hemophilia A
• Thalassemia
• Sickle cell anemia
• Polycystic kidney disease
• Tay-Sachs disease

If screening test results come back abnormal, your care team may recommend genetic counseling and further testing.

Chorionic villus sampling (CVS):

• May be offered to birthing parents who have an increased risk for carrying a baby with chromosomal abnormalities or who have a family history of a genetic defect
• Usually performed between 10 – 13 weeks of pregnancy
• Tests placental tissue for chromosomal and genetic abnormalities
• Doesn’t provide information on neural-tube defects, such as spina bifida; will also need a follow-up blood test for neural-tube defects between 15 and 20 weeks of pregnancy
• Some people aren’t suitable candidates or get incomplete results; a follow-up amniocentesis may be an option

Cell-free DNA and maternal serum alpha-fetoprotein (MSAFP) screening tests:

• Screen your blood for markers that may show your baby is at higher risk for certain genetic diseases and birth defects
• When used together, these screenings and blood tests are very effective at finding chromosome abnormalities, such as Down syndrome and Patau syndrome
• Can identify the fetal sex (optional)

Second trimester (3rd to 6th month of pregnancy)

During this time, you will have an appointment with your care team every four weeks. At each visit, you will have your blood pressure and weight checked, and your doctor or nurse/midwife will measure the baby’s heartbeat.

15 – 20 weeks: You will see your OBGYN doctor and have a blood test to screen for neural tube defects. This test is run through the State of California. Because of this, the results will not be available through the myUCLAHealth portal. Once the office receives a copy of your report, we will contact you.

15 – 22 weeks: A different sample of your blood, taken between 15 and 22 weeks of pregnancy, checks your risk of having a baby with certain genetic conditions or birth defects. Abnormal test results may mean you’ll need additional testing. You may have this blood test more than once during your pregnancy, as it can much more accurately detect an abnormality than just a single screening.

Additional screening tests that may be recommended to you during this time include:

Amniocentesis:

• Offered to birthing parents between weeks 15 and 20 of pregnancy who have a high risk of carrying a baby with chromosomal abnormalities.
• Involves inserting a long, thin needle through your abdomen into the baby’s amniotic sac to withdraw a small amount of fluid.
• The sample is checked for chromosomal disorders and open neural tube defects, such as spina bifida.
• Some women feel a bit of cramping during or after the procedure.
• Avoid any heavy activity for 24 hours after an amniocentesis.
• If you are carrying twins or other multiples, your doctor may need samples from each amniotic sac.
• In some cases it’s not possible to complete an amniocentesis due to the positions of the baby or placenta, the amount of fluid, or other reasons.

18 – 22 weeks: You will have an ultrasound with a maternal fetal medicine doctor to look at your baby’s anatomy and determine the baby’s sex, if you would like to know. This ultrasound will:

• Assist in prenatal tests, such as an amniocentesis
• Check the amount of amniotic fluid
• Check blood-flow patterns
• Check fetal growth
• Check for any abnormalities
• Measure the length of the mother’s cervix
• Observe fetal behavior and activity

24 – 28 weeks: During this time, you will continue to see your care team every four weeks. We also recommend that you have a glucose test to check for gestational diabetes. Please allow 1 hour for this blood test.

Third trimester (last 3 months of pregnancy)

Once you reach this stage, your visits will happen every two weeks until 36 weeks of pregnancy, and then every week until you deliver. At each visit, your provider will measure your blood pressure, weight and the baby’s heartbeat. They will also check the position of your baby. You may also have an ultrasound to check the growth of your baby.

28 – 34 weeks: You will talk to your care team about childbirth, breastfeeding and care after your baby is born. We will offer the tetanus, diphtheria and pertussis vaccine around this time. Depending on your Rh blood type, you may also need a Rhogam shot. Please ask your care team if you have questions about this shot.

36 – 37 weeks: Your provider will test you for Group B streptococcus, a bacteria that can cause serious infections in newborns if not treated during labor.

About 1 in 4 people have a bacteria called Group B streptococcus that normally lives in the vagina and rectum. Rarely, newborns can get seriously ill if exposed to this bacteria during delivery.

You’ll be tested for Group B Streptococcus with a swab of the vagina and rectum between weeks 36 and 37 of pregnancy. If you test positive, your doctor may give you antibiotics during labor to help protect your baby from infection.

After 37 weeks: Weekly visits will happen with your OBGYN doctor or nurse midwife. They may check your cervix for dilation and to see if your baby is in the head-down position.

After 40 weeks: Your OBGYN doctor or midwife may recommend testing between 40 and 41 weeks to check your baby’s well-being. This includes a quick ultrasound to measure the amniotic fluid around the baby and 20 minutes of monitoring the baby’s heart rate. If you are still pregnant at this time, your care team may also discuss options for inducing labor.

Regardless of what stage of pregnancy you are in, the flu vaccine is offered throughout flu season while supplies last for pregnant and lactating mothers.

Screening during this phase may include:

Fetal monitoring, which checks the heartbeat of the fetus. During labor, your care team may use a continuous fetal monitor that is placed on your abdomen. Your baby’s heart rate may change depending on what’s happening inside your uterus. An abnormal fetal heart rate may indicate that your baby is having a problem, such as not getting enough oxygen; if this happens, your doctor will talk to you about options to keep the baby healthy, such as a cesarean (c-section) delivery.

Your UCLA Health OBGYN care team is here to help you through your pregnancy. These visits are an ideal time to discuss any pregnancy-related concerns.