First Antenatal Appointment and Pregnancy Dating: What Happens and How Are Dates Determined?

The first pregnancy check-up is the first consultation, in which the pregnancy is confirmed, your health history is taken, your week of pregnancy and estimated due date are determined and the follow-up is planned. The week of pregnancy is generally calculated from the date of your last period; a measurement on an ultrasound done in the early period can confirm or update this calculation. The doctor who follows you decides which date is taken as the basis. After your pregnancy test is positive, it is appropriate to plan your appointment for the first consultation early. The information below is for general information; it does not replace an individual assessment.

What is the first pregnancy check-up done for?

The basic aims of the first consultation are to confirm the pregnancy, to assess the risks relating to pregnancy by looking at your state of health, to determine your week and estimated due date and to plan the follow-up. Current antenatal care recommendations also cover areas such as the assessment of the mother and baby and diet. In the follow-up of pregnant women in Turkey, a risk assessment form is used in the antenatal care practices linked to the Ministry of Health.

Who does the first check-up?

Which health professional will run the first consultation depends on the institution you attend and the situation; a doctor and a midwife can both take part in this consultation.

What is asked about your health history at the first check-up?

The consultation generally starts with questions. Your menstrual history, your earlier pregnancies and births, any pregnancy losses, your chronic illnesses, the medicines you use and illnesses in your family may be asked about. This information is used both in calculating your week and in the risk assessment. A pregnancy may be planned or unplanned; it is a period in which feelings vary from person to person. If you have uncertainty or concern about the pregnancy, you can talk about it directly with your doctor.

How are the physical assessment and laboratory tests done at the check-up?

At the examination your general condition is looked at; measurements such as blood pressure and body weight may be taken. If thought necessary, blood and urine tests are requested. Which tests are requested varies with your history and examination findings; the same group of tests is not applied to everyone. The interpretation of the pregnancy test and following the hCG are headings discussed separately with your doctor.

Is ultrasound a part of the first check-up?

Ultrasound may be a part of the first consultation or may be planned at a separate appointment. Your doctor determines its timing and scope according to your complaint, your history and the stage of your pregnancy. Research done shows that routine early ultrasound makes pregnancy dating more accurate. The timing and scope of later ultrasounds and screening tests are also planned by your doctor. In IVF pregnancies, the doctor carrying out the treatment plans the timing of the first ultrasound.

How are your risk assessment and monitoring plan determined?

The risk status of your pregnancy is assessed by considering your history, your examination findings and your test results together. The plan for your monitoring is made according to this assessment. Finding a risk factor may lead to your check-ups being planned differently; this does not have to mean that the situation is serious, and the details are explained to you by your doctor.

How is your week of pregnancy calculated?

The most common method is to start from the date of your last period. This method rests on the date of the period being remembered correctly and your cycle being regular. For this reason it is important that you give your period date as accurately as possible at the consultation.

Why can the calculation of the week be updated with ultrasound?

A measurement made by ultrasound in the early period helps to confirm or correct your week. If there is a difference between the week found by the period date and the week found by measurement, your doctor decides which date is taken as the basis.

What happens if your periods are irregular or you do not remember the date?

If your periods are irregular, your cycle length varies or you do not remember the date of your last period, a calculation based only on the period date may not be reliable. In this case the ultrasound measurement becomes more decisive in determining your week. Not knowing the date is not a failing; telling your doctor that you do not know helps your doctor to choose the right method.

How are weeks counted in an IVF pregnancy?

In pregnancies formed by assisted reproduction, the week is calculated from the date of the procedure, because that date is known. The doctor carrying out your treatment will tell you how the week is counted; take the date they give you as the basis when you make your own calculation.

Is the estimated due date a definite day?

No. The estimated due date is an estimate; it does not show that birth will take place on that day. Knowing that the date is an approximation can help protect you from unnecessary anxiety if the date approaches or passes. The timing and mode of birth are separate subjects and are discussed with the doctor who follows you according to the course of your pregnancy.

How should you prepare for the check-up?

The following preparations can make the consultation more productive.

• Bring the date of your last period and, if you have one, your period calendar or cycle record; if IVF or insemination was done, note the date of the procedure.
• Write down the names of the medicines and supplements you use regularly.
• Summarise your chronic illnesses, the operations you have had and your information on earlier pregnancies and births.
• Take your earlier test results and, if you have it, your vaccination card with you.
• Write down in advance what you are curious about.

The following questions may be useful at the consultation:

• By which method was my week calculated, and can my estimated due date change later?
• Which blood tests and ultrasounds are being considered for me?
• What is the result of my risk assessment, and how is my monitoring being planned accordingly?
• When is my next consultation, and in which situations should I seek care without waiting?

What does follow-up look like after the first check-up?

After the first consultation, your check-ups are planned according to your results and your risk assessment. The frequency of check-ups is not the same for everyone; you should follow the schedule when it is given to you, and when you notice a new symptom, seek care without waiting for the next check-up.