Early pregnancy: how can I tell if my baby is OK?
In brief
In very early pregnancy, nothing you feel can tell you for sure whether the embryo is developing well: having nausea or not is not a reliable sign. An ultrasound scan is what checks this, by showing the embryo inside the womb and its heartbeat, usually visible at around 6 to 7 weeks of pregnancy (weeks of amenorrhoea). The scan between 11 weeks and 13 weeks + 6 days then gives a first detailed check. Severe pain or bleeding needs medical attention without delay.
What should I do when I find out I'm pregnant?
A positive urine test is reliable. The first steps are simple:
- Start or continue folic acid (vitamin B9) until 12 weeks of pregnancy (weeks of amenorrhoea).
- Stop alcohol and smoking, and do not take any medicine without advice.
- Review your usual treatments with your doctor: some need adjusting, others must on no account be stopped suddenly.
- Book a first appointment, ideally before 10 weeks.
Weeks are counted from the first day of your last period: by the time your period is late, you are already about 4 weeks pregnant. The full care pathway, up to the birth, is described on our Giving birth in Paris page.
Do pregnancy symptoms show that everything is fine?
No. Tender breasts, nausea, tiredness or needing to pass urine often reflect pregnancy hormones, but how strong they are varies a lot from one woman to another and from one pregnancy to another. Having no symptoms is not worrying, and having them does not guarantee the pregnancy is progressing well. Likewise, mild pulling pains in the lower abdomen are common and usually harmless.
A blood test for the pregnancy hormone (hCG) is not needed when all is well. It is useful if you have pain, bleeding or a previous ectopic pregnancy, to track how the level changes over 48 hours.
What does the first pregnancy scan show?
| Approximate stage | What the scan can show |
|---|---|
| 5 weeks | A small sac in the womb (gestational sac), sometimes hard to see |
| 5 to 6 weeks | The yolk sac, a small round structure that nourishes the embryo |
| 6 to 7 weeks | The embryo and its heartbeat |
| 11 weeks to 13 weeks + 6 days | Dating scan and first anatomy check, nuchal translucency measurement |
A very early scan may not yet show the embryo, especially if you ovulated late. This is not necessarily a bad sign. To avoid wrongly diagnosing a non-viable pregnancy, strict criteria are used, and a repeat scan 7 to 14 days later is offered if there is any doubt (Doubilet et al., 2013).
An early scan, before 11 weeks, is not routine. It is recommended if you have pain, bleeding, a previous ectopic pregnancy or miscarriage, or if you are unsure of the date of your last period.
What is checked at the first pregnancy appointment?
The first appointment, described in detail in our article on the first pregnancy appointment, covers:
- your history: medical, surgical, obstetric and family, including the father's side (genetic conditions, birth defects);
- your examination: blood pressure, weight and a gynaecological examination if needed;
- blood tests: blood group and rhesus factor, antibody screening, infection tests (toxoplasmosis, rubella, syphilis, hepatitis B; HIV offered), a cytomegalovirus (CMV) test, now recommended by the HAS as early as possible in the first trimester if you are not immune or your status is unknown (see the article CMV and pregnancy), and, depending on your situation, blood sugar;
- prevention: diet, vaccinations, medicines, infections to avoid.
In France, the pregnancy must be declared before the end of the third month of pregnancy.
What risks does pregnancy screening look for?
Antenatal care aims to identify early any situation that needs special care, in line with the guidelines of the French National Authority for Health (HAS, 2016):
- Chromosomal conditions, such as Down syndrome (trisomy 21): you are offered screening that combines the first-trimester scan and a blood test, followed if needed by NIPT, a highly accurate analysis of the baby's DNA in the mother's blood (Gil et al., 2017).
- Structural abnormalities: looked for during the three routine scans (first, second and third trimesters).
- Inherited genetic conditions: a genetics appointment is offered if there is a family history.
- Risks from medicines, alcohol, smoking and drugs.
- Infections: toxoplasmosis, rubella, cytomegalovirus, chickenpox, herpes, with prevention advice adapted to your immunity.
To find out more, see our article on prenatal diagnosis.
What happens in pregnancy care after the first trimester?
Once the pregnancy is confirmed, care follows a regular schedule. Appointment after appointment, it checks that your baby is growing well and that you stay in good health.
- One appointment a month from the 4th month: blood pressure, weight, urine test, measurement of the womb and listening to the baby's heart.
- Three scans recommended: between 11 weeks and 13 weeks + 6 days, 20 to 25 weeks and 30 to 35 weeks. They check growth, anatomy, amniotic fluid and the placenta.
- Blood tests depending on your situation: a monthly toxoplasmosis test if you are not immune, screening for gestational diabetes if you have a risk factor, a blood count in the 6th month.
- An early antenatal interview with a midwife or doctor, to talk about your plans, your needs and any worries.
At around 18 to 22 weeks, you feel your baby move, often earlier if this is not your first pregnancy. Regular movements then become a reassuring everyday sign.
What happens if a problem is found on a scan?
If a test shows an abnormality, you are referred to a multidisciplinary prenatal diagnosis centre (CPDPN in France). A team of obstetricians, sonographers, geneticists, paediatricians and psychologists clarifies the diagnosis, how serious it is and the care options, and supports you in your decisions.
Depending on the abnormality, closer monitoring and care for the baby after birth are arranged. In particularly serious situations, a termination of pregnancy for medical reasons may be discussed, within the framework set by French law.
It is also important to know the limits of screening: normal results greatly reduce the risk of an abnormality, but cannot rule it out 100%.
When should I seek urgent care in early pregnancy?
Go to the maternity unit's gynaecological emergency department, or call 15 (SAMU) or 112 in France, or your local emergency number, if you feel faint, or if you have:
- severe pain in the lower abdomen, especially on one side, or shoulder-tip pain: this may be a sign of an ectopic pregnancy;
- heavy bleeding, with clots, or bleeding with pain;
- feeling faint, dizziness or looking pale;
- a temperature of 38 °C or higher;
- vomiting that stops you keeping fluids down.
Light, isolated, painless bleeding is common in the first trimester; it calls for prompt medical advice, without panic. See our article on bleeding in the first trimester. For a first appointment at the practice: the average waiting time is one week to 10 days (except during holiday periods); book on Doctolib or call 01 43 79 59 79.
Frequently asked questions
When can you hear the baby's heartbeat?
The heartbeat can be seen on a vaginal ultrasound at around 6 to 7 weeks. It can usually be heard with a Doppler through the abdomen from 10 to 12 weeks.
Do I need a blood test to confirm my pregnancy?
Not if your urine test is positive and all is well. A blood hCG test is useful if there is doubt, pain or bleeding.
Can stress cause a miscarriage?
No, everyday stress does not cause miscarriage. Most early miscarriages are due to a chromosomal abnormality in the embryo that happens by chance.
Can I exercise in early pregnancy?
Yes, moderate activity is beneficial if the pregnancy is progressing normally. Avoid contact sports, sports with a risk of falling and scuba diving, and discuss it at your first appointment.
When should I have my first pregnancy scan?
The first recommended scan takes place between 11 weeks and 13 weeks + 6 days: it dates the pregnancy and gives a first check of the baby's anatomy. An earlier scan is offered only if you have pain, bleeding, a previous ectopic pregnancy or miscarriage, or if you are unsure of the date of your last period.
References
- Haute Autorité de santé (HAS). Suivi et orientation des femmes enceintes en fonction des situations à risque identifiées. Good practice guideline, 2007, updated May 2016. https://www.has-sante.fr/jcms/c_547976/fr/suivi-et-orientation-des-femmes-enceintes-en-fonction-des-situations-a-risque-identifiees
- Doubilet PM, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med, 2013. doi:10.1056/NEJMra1302417 — PMID 24106937
- Gil MM, et al. Analysis of cell-free DNA in maternal blood in screening for aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol, 2017. doi:10.1002/uog.17484 — PMID 28397325
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
A question about your situation?Appointments at the practice or by video consultation, usually within one week to 10 days.
Book an appointmentGeneral information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.