When should you see a doctor, midwife, and scan during pregnancy? Guide to when and what happens for visits and scans

Congratulations with your pregnancy. This article tells a little about when you have to see a midwife and a scan during pregnancy. Here you will also be able to read more about what happens during the various visits. During pregnancy, various complications can arise, such as too high blood pressure, too low fetal weight, etc., all of which can mean that there will be additional visits or that some of the visits described below will be changed.

Overview

In week 6+0-10+0 is the first doctor's visit.

Here you will take a pregnancy test. You will be measured and weighed and have a blood sample taken to determine your blood type and test you for HIV, syphilis, and hepatitis. You will also talk about hereditary diseases in the family, and you will be given a journal.

In week 8+0-13+6 You must have a blood test, also called a double test

The double test must be used for your risk calculation later during the neck fold scan. The blood tests measure two things: 

Pregnancy Associates Plasma Protein A (PAPP-A) It is a growth-promoting enzyme that is necessary for fetal development. The concentration doubles approximately every 6 days. A low level in the pregnant woman's blood can lead to malformations in the child. 

Chorionic gonadotropin beta chain (β-hCG) In women with fetuses with trisomy 21, the concentration of β-hCG is approx. twice as high, and the concentrations of PAPP-A are often less than half of what it is in women with healthy fetuses of the same gestational age. In women with fetuses with trisomy 13 or 18, the concentration of β-hCG and PAPP-A is significantly below the values ​​of women with healthy fetuses of the same gestational age. 

The blood test therefore helps to investigate whether everything seems to be okay with the fetus. The blood test is based on the results of the neck fold scan, and the two things together give a risk number for the neck fold scan. The double test must be done no later than 4-5 days before the neck fold scan. Remember that the numbers must be held up against the scan, so if you look at the answers to your double test before the scan, you must not conclude that there is something wrong, even though the numbers may look skewed compared to the average.

In week 11+1 to13+6 neck fold scan

For the nuchal fold scan, you will first of all examine whether there is life. It will be checked whether there are one or more fetuses and finally you will be given a final due date based on the measurements of the fetus. 

If you or you and your partner want it, you can find out during the scan whether the fetus has a chromosomal abnormality such as Down's syndrome. It is examined by, among other things, measuring the child's nape. Together with the double test, the measurements can show the probability of a chromosomal abnormality. This is done by giving you an overall risk figure. For example, 1:5000. In this case, it would mean that the probability of having a child with Down syndrome is more than 1 in 5000.

If your number is below 1:300, the hospital will offer a placenta test/amniocentesis or a NIPT blood test, which can determine whether the fetus has Down syndrome. Remember that 1:300, 1:200, 1:50, even 1:10 are still numbers where the probability that the fetus is fast is far greater than the opposite. That's why the vast majority of people who have a placenta test done also get a response that shows that everything is just as it should be. 

 Weeks 13-15 Time for first midwife visit 

You will have a conversation without physical examinations, where the midwife talks to you about your lifestyle and recommendations on diet, vitamin, and iron supplements. Here it is also normal to talk about any previous pregnancies and births and your expectations and wishes for this pregnancy and birth process. The vast majority of midwives will not listen for a heartbeat yet at this point. 

Week 20-22 malformation scan 

All pregnant women in Denmark are offered a malformation scan of the fetus around week 20. The purpose of the scan is to investigate whether the fetus has any congenital malformations. During the scan, the fetus's head, heart, abdominal wall, stomach and intestinal system, kidneys, bladder, back, arms and legs are examined. In addition, the fetus is measured in relation to whether it is growing as expected. It is also examined where the placenta is located and whether the amount of amniotic fluid is normal. 

Week 25 2nd medical examination

Here, many will find that part of the conversation is the same as at the first midwife visit. But while with the midwife it was very much about wishes for the upcoming birth, the doctor here will be more aware of your possible illness. You will experience this by the doctor asking you about concerns, pain, and signs of illness.

For this doctor's visit, you will yet again be weighed and have your blood pressure measured, as well as a urine sample. Among other things, the urine test must show whether you have egg whites in your urine, which can be a sign of preeclampsia. So is high blood pressure if you didn't already have it at the beginning of pregnancy. If you were diagnosed with rhesus negative blood type at the first doctor's visit, you will now have another blood test taken to show the fetus's blood type. If the child is also rhesus negative, you will be treated with an injection to ensure that your blood does not react against the child's blood at birth. 

Week 29 2nd midwife examination

This midwifery examination will start with a chat about how you are feeling right now. Your midwife will ask about your well-being and talk from there. 

In addition, the midwife will ask you about your thoughts on the child's nutrition - i.e. whether you want to breastfeed or give the child a bottle. 

Most people have an opinion about breastfeeding, but not everyone has discussed it with their partner or family. It may be sensible to familiarize yourself with breastfeeding and discuss your own attitudes with those closest to you at this stage in the pregnancy.

If you don't want to breastfeed, they talk about bottle feeding and the process around this instead.

After this, we will talk about the birth and your options immediately after the birth in relation to maternity leave or ambulatory birth. You will be asked how often you feel life, and then you will be weighed and have your blood pressure measured.

Either you will be asked to bring a urine sample to the midwife visit or you will be asked to make one. The urine will be examined for protein (sign of pre-eclampsia) and sugar (sign of gestational diabetes)

Finally, the midwife will do an external examination, where she feels your abdomen to determine the size of the uterus and how the baby lies inside. She will also give an estimate of the child's size. If the child is judged to be too big or small compared to the average, you will be offered an ultrasound scan. The child's heartbeat will also be listened to with a listening tube or dop tone 

 Week 32 3rd medical examination

It is time for the last medical examination. Here you will again be measured and weighed. You will be because a sudden weight gain could be a sign of preeclampsia. A rising blood pressure can be the same, which is why you will also have your blood pressure measured at this visit. The doctor will ask you about vaginal delivery and examine the size of the uterus and assess the baby's weight, as well as listen for the heartbeat

Week 35 midwife visit

For this midwife examination, there is a particular focus on the upcoming birth, which you will talk about. Many pregnant women make a wish list for the upcoming birth, and it will also be discussed at this meeting. The midwife can write the wish list in your medical record so that the staff in the delivery room can read it when you give birth/have a caesarean section. You can also choose to bring the note with your wishes when you give birth.

You will also have your blood pressure measured to ensure that you are not developing pre-eclampsia and because high blood pressure can affect the blood supply to the placenta. You will furthermore be weighed, as a sudden increase in weight due to fluid in the body can be an indicator of pre-eclampsia. Your urine will be checked for protein and egg white, and then the midwife will listen for your heartbeat and feel your stomach. She will come up with an estimate of the baby's weight and make sure it is facing down. If the child lies with the bottom downwards or lies crosswise, you will be offered a scan and subsequently a turning attempt.

Week 38 or 39 Midwife visit

You will have your urine checked for protein and egg white and we will have your blood pressure taken. You will be asked how and how often you feel life and then you will talk about the impending birth/caesarean section. The midwife will feel your stomach to assess the size of the baby, and then she will check if the baby is lying head down.

Week 40+3-41+3 Midwife examination

If you haven't given birth yet, you will come to the midwife again. This time you will have the same examination as in week 38 or 39, and then you will be offered the initiation of labor. 

Source: sundhed.dk, Rigshospitalet, Regionshospitalet Horsens, Herlev Hospital