First Obstetric Visit

Aka: First Obstetric Visit, Initial Prenatal Care Visit

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II. Timing

  1. Perform First Obstetric Visit at approximately 8 weeks gestation (range 6 to 10 weeks)
    1. Initiation of care before 10 weeks is associated with improved pregnancy outcomes
    2. Identifies and allows intervention for conditions impacting pregnancy outcomes (e.g. Diabetes Mellitus, Hypertension)

III. History: Obstetrics

  1. See Pregnancy Risk Assessment
  2. See Pregnancy Symptoms
  3. Establish firm due date early
    1. See Pregnancy Dating
    2. Last Menstrual Period is inaccurately calculated by 40% of women
      1. Obtain First Trimester Ultrasound for dating if any doubt of timing
  4. Mental Health disorders
    1. Mood Disorders
      1. See Antepartum Depression
      2. Screen in first trimester (and again in third trimester)
      3. Major Depression screening (PHQ-9)
      4. Generalized Anxiety Disorder screening (GAD-7)
      5. Consider Bipolar Disorder screening
    2. Substance Abuse
      1. See Substance Abuse in Pregnancy
      2. Alcohol Use Disorder
      3. Tobacco Abuse
      4. Illicit Drug Use
        1. See Cocaine Abuse in Pregnancy
      5. Opioid Use Disorder
        1. See Opioid Use Disorder in Pregnancy
  5. Screen for Social Determinants of Health (at least once during pregnancy)
    1. See Teenage Pregnancy
    2. Food Insecurity
      1. See Hunger Vital Sign Screen
    3. Intimate Partner Violence
      1. See Intimate Partner Violence Screening

IV. Exam: General

  1. See Pregnancy Dating
  2. See Pregnancy Signs
  3. Vital Signs
    1. Weight
    2. Height
    3. Blood Pressure
    4. Body Mass Index (BMI)
      1. See Weight Gain in Pregnancy
      2. BMI >25 kg/m2 risks preterm delivery, Gestational Diabetes and Gestational Hypertension
      3. BMI >30 kg/m2 risks Miscarriage, Stillbirth and Obstructive Sleep Apnea
  4. Complete physical examination with pelvic exam
    1. Breast Exam is optional (but may predict later Lactation Problems for the Mother)
    2. Pap Smear
    3. Sexually Transmitted Infection screeing as indicated
  5. Dental exam
    1. See Dental Problems in Pregnancy
    2. Periodontal Disease (treatment deferred until second trimester)

V. Exam: Specific components that are no longer recommended (but were performed historically)

  1. First trimester Cervical Length
    1. Does not predict Preterm Labor risk
  2. Pelvimetry
    1. Pelvimetry is a poor predictor of who will deliver vaginally
    2. Not routinely performed nor recommended in the U.S.

VI. Labs

  1. See Prenatal Labs
  2. See Aneuploidy Screening
  3. Blood Type with Rh
    1. Rh Negative status is associated Rh Sensitization risk
  4. Hemoglobin
    1. Iron Deficiency Anemia is associated with IUGR, preterm delivery and perinatal depression

VII. Imaging

  1. See Second Trimester Fetal Survey
  2. First Trimester Obstetric Ultrasound Indications
    1. Unsure Last Menstrual Period
    2. Confirm intrauterine pregnancy
    3. Irregular menstrual periods
    4. Uterine Size-date discrepancy

VIII. Management

  1. See First Trimester Education
  2. Start Prenatal Vitamins with Folic Acid if not already started
    1. Prevent Neural Tube Defects

IX. Prevention

  1. See Preconception Counseling
  2. See Pregnancy Risk Assessment

X. References

  1. Ramirez (2023) Am Fam Physician 108(2): 139-50 [PubMed]
  2. Zolotor (2014) Am Fam Physician 89(3): 199-208 [PubMed]

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