The First Trimester

The first prenatal visit 

When you come in for your first prenatal visit, you can expect your health care provider to be very thorough. It will likely include a complete medical history, a physical exam, and certain tests and procedures to assess the initial health of you and your unborn baby. The first prenatal visit may include the following:

• Personal medical history, which may include taking a record of any of the following:
  • previous and current medical conditions, such as diabetes, high blood pressure (hypertension), anemia and/or allergies
  • current medications, both prescription and over-the-counter
  • previous surgeries
• Maternal and paternal family medical history, including illnesses, such as diabetes or intellectual or developmental disabilities, and genetic disorders, like sickle cell disease or Tay-Sachs disease
• Personal gynecological and obstetrical history, including past pregnancies — stillbirths, miscarriage, deliveries and terminations — along with menstrual history (typical length and duration of menstrual periods)
• Education, including a discussion regarding the importance of proper nutrition, regular exercise, the avoidance of alcohol, drugs, and tobacco during pregnancy, along with a discussion of any potential concerns related to domestic violence
• Pelvic exam, which may be done for one or all of the following reasons:
  • note the size and position of the uterus
  • determine the age of the fetus
  • check the pelvic bone size and structure
  • perform a Pap test (also called Pap smear) to detect the presence of abnormal cells
• Laboratory tests, including the following:
  • urine tests to screen for bacteria, sugar and protein
  • blood tests to determine blood type

All pregnant women are tested for the Rh factor during the early weeks of pregnancy. A mother and fetus may have incompatible blood types, and the most common incompatibility is Rh incompatibility. Rh incompatibility occurs when the mother's blood is Rh-negative and the father's blood is Rh-positive and the fetus' blood is Rh-positive. The mother may produce antibodies against the Rh-positive fetus, which may lead to anemia in the fetus. Incompatibility problems are monitored and appropriate medical treatment is available to prevent the formation of Rh antibodies during pregnancy. Women may also have:

• blood screening tests to detect diseases (such as rubella, an infectious disease also called German measles, that can be dangerous during pregnancy)
• genetic tests to detect inherited diseases (such as sickle-cell anemia and Tay-Sachs disease)
• screening tests to detect infectious diseases (such as sexually transmitted diseases)

The first prenatal visit also provides you with an opportunity to ask any questions or discuss any concerns that you may have about your pregnancy.

What to expect during the first trimester

A healthy first trimester is crucial to normal development of your baby. Although your pregnancy may not be showing much on the outside, inside your body, all the major body organs and systems of your baby are forming.

As the embryo implants itself into the uterine wall, several developments take place, including:

It is during this first trimester that the fetus is most susceptible to damage from substances such as alcohol, drugs, certain medications, and illnesses, such as rubella (German measles).

During the first trimester, both the mother's body and the fetus are changing rapidly.

Fetal development during the first trimester

The most dramatic changes and development occur during the first trimester. During the first eight weeks, a fetus is called an embryo. The embryo develops rapidly, and by the end of the first trimester, it becomes a fetus that is fully formed, weighing approximately 1/2 to 1 ounce and measuring, on average, 3 to 4 inches in length.

First trimester growth and development benchmarks

Just as each child grows and matures at different rates and at different times, so does that same child as it begins its life in the womb. The chart below provides benchmarks for most normal pregnancies. However, each fetus develops differently.

By the end of four weeks	All major systems and organs begin to form. The embryo looks like a tadpole. The neural tube (which becomes the brain and spinal cord), the digestive system, and the heart and circulatory system begin to form. The beginnings of the eyes and ears are developing. Tiny limb buds appear (which will develop into arms and legs). The heart is beating.
By the end of eight weeks	All major body systems continue to develop and function, including the circulatory, nervous, digestive and urinary systems. The embryo is taking on a human shape, although the head is larger in proportion to the rest of the body. The mouth is developing tooth buds (which will become baby teeth). The eyes, nose, mouth and ears are becoming more distinct. The arms and legs are clearly visible. The fingers and toes are still webbed but can be clearly distinguished. The main organs continue to develop, and you can hear the baby's heartbeat using an instrument called a Doppler. The bones begin to develop, and the nose and jaws are rapidly developing. The embryo is in constant motion but cannot be felt by the mother.
From embryo to fetus	After eight weeks, the embryo is now referred to as a fetus (which means offspring). Although the fetus is only 1 to 1 1/2 inches long at this point, all major organs and systems have been formed.
During weeks nine to 12	The external genital organs are developed. Fingernails and toenails appear. Eyelids are formed. Fetal movement increases. The arms and legs are fully formed. The voice box (larynx) begins to form in the trachea. The fetus is most vulnerable during the first 12 weeks. During this period of time, all of the major organs and body systems are forming and can be damaged if the fetus is exposed to drugs, German measles, radiation, tobacco, or chemical and toxic substances. Even though the organs and body systems are fully formed by the end of 12 weeks, the fetus cannot survive independently.

Changes in the mother's body

• During pregnancy, many changes are also occurring in the mother-to-be's body. Women experience these changes differently. Some symptoms of pregnancy continue for several weeks or months while others only last for a short period of time. Some women experience many symptoms while other women experience only a few or none at all. The following is a list of changes and symptoms that may occur during the first trimester:
• The mammary glands enlarge, causing the breasts to swell and become tender in preparation for breastfeeding. This is due to an increased amount of the hormones estrogen and progesterone. A supportive bra should be worn during this time.
• A woman's areolas (the pigmented areas around each breast's nipple) will enlarge and darken, and they may become covered with small, white bumps called Montgomery's tubercles, which are enlarged sweat glands.
• Veins become more prominent on the surface of the breasts.
• The uterus is growing and begins to press on the woman's bladder, causing the need for her to urinate more frequently.
• Partly due to surges in hormones, a pregnant woman may experience mood swings similar to premenstrual syndrome (a condition experienced by some women that is characterized by mood swings, irritability and other physical symptoms that occur shortly before each menstrual period).
• Increased levels of hormones to sustain the pregnancy may cause morning sickness, which includes feelings of nausea that are sometimes accompanied by vomiting. However, morning sickness does not necessarily occur just in the morning, and it rarely interferes with proper maternal and fetal nutrition.
• Constipation may occur as the growing uterus presses on the rectum and intestines.
• The muscular contractions in the intestines, which help to move food through the digestive tract, are slowed due to high levels of progesterone. This may, in turn, cause heartburn, indigestion, constipation and gas.
• Clothes may feel tighter around the breasts and waist as the size of the abdomen begins to increase to accommodate the growing fetus.
• A woman may experience fatigue due to the physical and emotional demands of pregnancy.
• Cardiac volume increases by about 40 to 50 percent from the beginning to the end of the pregnancy, causing an increased cardiac output. An increased cardiac output may cause an increased pulse rate during pregnancy. The increase in blood volume is needed for extra blood flow to the uterus.