After experiencing either infertility or pregnancy losses many women are understandably anxious about their pregnancies and desire close follow-up during the first trimester. By convention, the gestational age of pregnancies is counted from last menstrual period (LMP) with ovulation occurring at the gestational age of 2 weeks, i.e. on day 14 of cycle. The first trimester spans the initial 13 weeks from LMP. It is during these first three months that the vast majority of pregnancy losses occur adding greatly to the emotional roller-coaster faced by many of our patients.
Obstetricians usually do not see pregnant women until 9-10 weeks so they are often unfamiliar with active management of early pregnancy. We have found that patients clearly benefit from close monitoring during the first trimester of their much-desired pregnancies. In fact, many already pregnant women have sought out our practice specifically for the first trimester care and management.
The goals for first trimester care are threefold:
- to accurately determine as soon as possible whether the pregnancy is progressing normally;
- to provide hormonal and other support to potentially viable pregnancies;
- to offer emotional support and a scientific explanation when pregnancies fail.
Our protocol includes sequential tests of hCG, which is secreted by the placenta, as well as progesterone hormones. Rapid rise in hCG with doubling of levels at least every 2 days is the earliest indicator of a healthy pregnancy. Progesterone hormone, which is secreted by the ovary after ovulation, relaxes uterine muscle and thus permitting the pregnancy to growth. In normal pregnancies progesterone level is at or above 25 ng/mL.
High resolution vaginal ultrasound is invaluable in following early pregnancies. First and foremost ultrasound allows us to determine the location of pregnancies either within the uterine cavity or outside the uterus (ectopics). In addition to localizing the pregnancy, the initial scan at 5-6 weeks shows the number of sacs and the presence of either yolk sac or early fetal heart activity. Later ultrasounds follow fetal development by measuring the CRL (crown-rump length in mm) and fetal heart rate in bpm (beats per minute). Most of the pregnant patients in our practice have 2-4 scans during the first trimester.
In the frequent cases of bleeding or spotting in the first trimester, ultrasound can be reassuring when fetal growth continues. In some cases a collection of blood can be seen within the uterus (sub-chorionic hemorrhage) usually in proximity to the placenta. Patients with a large sub-chorionic hemorrhage benefit from pelvic rest and restricted activities until the hemorrhage resolves.
Once your pregnancy has progressed to 11-12 weeks, the chance of a pregnancy loss diminish dramatically to less that 5%. At that point you are referred back to your obstetrician. If you do not have an obstetrician we will help you find one within your health insurance plan and geographic area. Many patients initiate early prenatal genetic testing during the transition from our office to their obstetrician (Genetics and PGD).