Today’s urine pregnancy test kits are sensitive enough to detect the pregnancy hormone with about 98% accuracy by the time you would have started your next period. By 7 days after the first day of your expected period the result of the test is near 100% reliable. So, a positive test tells you that a fertilized egg has implanted (hopefully in the uterus), and the placenta is starting to form. The placental cells begin to produce the hormone hCG which triggers the positive test. Because hCG in the blood or urine is the only sign of pregnancy at this point, we call this a “chemical pregnancy.”
In a successful pregnancy, the small ball of cells will continue to grow. However, in this very early stage, as many as 20 or 30% of fertilized eggs will simply stop developing. When pregnancy tests were not so sensitive, a woman with a pregnancy loss in the first few weeks after fertilization might never have known a pregnancy occurred.
If the pregnancy continues to develop, the cells begin to separate into different structures. Around 4 weeks after fertilization, ultrasound can detect an embryo forming within a small sac. This is considered 6 weeks of pregnancy, because we count from the first day of the last menstrual period. Over the next few days, ultrasound can detect fetal heart activity. Seeing on ultrasound that the pregnancy is continuing to develop inside the uterus allows us to confirm a “clinical pregnancy.” It is still possible that the embryo stops developing, but the chance of miscarriage is much lower than during the first few weeks.
Of course, you will be excited at the early positive test if you have been trying for a pregnancy. The waiting time between your test and the ultrasound appointment to confirm a clinical pregnancy will test your patience! You will be naturally be very disappointed if your chemical pregnancy does not continue to develop. Try to be reassured that this is very common, and most women who experience this will go on to have a successful pregnancy.
These first few weeks are stressful as you wait for each new bit of information. If you were not expecting to be pregnant, confide in someone who can offer you support. Even women who have been trying to get pregnant sometimes feel strangely mixed emotions. If you feel overwhelmed, turn to a mental health professional. Your doctor can refer you for care.
2. Schedule an Appointment With Your Gynecologist.
A prompt appointment is important to confirm your pregnancy dates especially if your menstrual cycles have been irregular. We usually schedule your first visit around 7 or 8 weeks after the first day of your last period, when we expect an ultrasound to show a developing embryo in the uterus. If you have bleeding or pelvic pain before the first appointment, contact your doctor promptly. An ultrasound is necessary to assure that the pregnancy has not implanted within the fallopian tube. A tubal pregnancy is a serious problem that requires immediate treatment. The ultrasound at this visit, along with a blood test to measure hCG, will be compared with repeat testing the next week to document that the pregnancy is still progressing.
Most women turn to their regular gynecologist for their first appointment. If your doctor does not provide obstetric care, that person can refer you to an obstetrician. When choosing your obstetrician, also think about the hospital facility where that person practices. Obstetricians are usually associated with one specific hospital. Are the office and hospital near enough to your home or workplace to be practical? Are facilities and specialists available there to provide care for you and your baby if your pregnancy becomes high-risk?
At Sparks & Favor, we provide obstetric services only at Brookwood Women’s Medical Center. Brookwood offers an OB Emergency Department, a Level 3 Neonatal Intensive Care Unit, a Maternal-Fetal Medicine Specialist on staff, 24/7 anesthesia coverage dedicated to the Labor and Delivery service, and an exceptional Lactation Center. We believe these are important elements of comprehensive pregnancy, labor, delivery, and postpartum care. Brookwood is Alabama’s only recipient of the Joint Commission Perinatal Care Certification, which demonstrates its commitment to achieving integrated, coordinated, patient-centered care for mothers & babies. Brookwood is also the only hospital in Alabama to be recognized on Newsweek’s “Five-Ribbon” list of Best Maternity Hospitals in the U.S. We are confident in the care are obstetric patients receive. Read more about Brookwood’s services for expectant families.
3. Think About Medications and Vitamins.
If you have been planning a pregnancy, you may already be taking prenatal vitamins and folic acid. Folic acid is an important nutrient that reduces the risk of certain birth defects of the brain and spinal cord. A prenatal multivitamin containing iron will help you to meet your nutritional and the needs of your growing baby. If you are taking any medications, prescription or over-the-counter, or any dietary supplements, contact your doctor to see whether or not to continue taking these while you are pregnant. You should get your obstetrician’s recommendations about vitamins, folic acid, and medications as soon as you learn you are pregnant and begin following that advice immediately.
4. Consider Healthy Choices and Lifestyle Changes You May Need to Make.
Avoid all tobacco, vaping, and marijuana use. Smoking harms your baby. The CDC strongly recommends that pregnant women avoid CBD products. Do not consume alcohol. Alcohol use during pregnancy increases the risk of birth defects. No amount of alcohol can be considered safe. Consider exposures in your home environment or workplace, such as chemicals or radiation, that may cause risk to your baby. Avoid handling animal waste (like the kitty litter box).
From the beginning of your pregnancy, protecting yourself from food-borne illness (food poisoning) is especially important. Avoid raw or undercooked meat, eggs, fish, (including raw sushi), or seafood. Listeriosis (caused by a type of bacteria) is especially harmful to pregnant women and their unborn babies. Avoid refrigerated deli meats like hot dogs, lunchmeats, store-bought, prepared meat salads, pate or meat spreads, unpasteurized milk and soft cheeses. Wash fresh fruits and vegetables well. (Find more information about Listeria).
Sexual intercourse is generally safe during your early pregnancy unless you are having bleeding or painful cramping. Protect yourself from the possibility of sexually transmitted infection. You will receive guidance about a healthy diet, weight gain, exercise, and other activities at your first prenatal appointment.
5. Learn to Recognize What Is Normal During the First Trimester vs. What May Need Medical Attention.
Symptoms of a developing pregnancy begin gradually. In the first few weeks, some women experience no symptoms. Women commonly notice breast swelling and tenderness, nausea and/or vomiting, fatigue, and frequent urination. Morning sickness can occur at any time of day, but not all women have this discomfort. It is most common during the first trimester, between 9 and 14 weeks. It usually—but not always—improves later in the pregnancy. Contact your doctor if you are not tolerating liquids. Do not allow yourself to become dehydrated. Some women experience mild cramping in the very early weeks, often around the time of implantation in the uterus. Contact your doctor if cramping is painful or if bleeding occurs. Pregnancy is associated with significant physical changes. You should be aware of changes in any existing medical conditions like diabetes, hypertension, or asthma, and report them to your doctor.
6. Pamper Yourself a Bit.
Unlike a century or two ago, women and their doctors no longer view pregnancy as a fragile state. During the early weeks of your pregnancy, you may experience the discomforts of nausea and fatigue, but your usual activities are unlikely to cause any risk for you or your baby. This fact is important to keep in your mind. Early miscarriages are so common, but it’s natural for a woman to wonder what she might have done better. The answer is probably nothing. A high percentage of these miscarriages are associated with genetic defects in the embryo. In short, the embryo did not have the genetic potential to continue developing.
On the other hand, take care of yourself physically and mentally to enjoy these early weeks as much as possible.