When the pregnancy test becomes positive, the exciting pregnancy wait that lasts 9 months and 10 days begins. The common goal of every expectant mother and father and the doctors who follow the pregnancy is to complete this process in a healthy and trouble-free manner. Multiple tests and screenings are performed depending on the week of pregnancy in order to identify diseases that may negatively affect the pregnancy and to evaluate the health of the developing baby.
TESTS DONE AT THE FIRST VISIT: Purposes in evaluating the general health of the expectant mother: complete blood count, blood group, blood sugar. , liver and kidney function tests, complete urinalysis, thyroid screening are aimed at detecting diseases that can be transmitted to the baby through blood, such as hepatitis B and C and HIV. Many diseases of the mother that were not diagnosed before pregnancy can be detected. Among these, anemia, Mediterranean anemia carrier, hepatitis B carrier, HIV, hyper and hypothyroidism are common in the society and usually do not cause symptoms. In case of blood incompatibility, the indirect Coombs test, which shows the presence of antibodies in the mother's blood, should also be performed during this period.
GENETIC SCREENING TESTS:
There is a possibility of a genetically abnormal baby in every pregnancy. Although this possibility increases with advanced maternal age and the presence of genetic abnormalities in the parents, it can also occur in couples with no risk factors. The most common genetic disorder is Down syndrome. Children born with this syndrome may have short stature, slanted eyes, short nasal bones, mental retardation, and multiple deficiencies related to the heart, digestive and excretory systems due to the extra 21st Chromosome.
Screening tests provide definitive results. These are not tests that give The result of the screening test only shows the risk of the baby having a disease. If this risk is above a certain value (usually 1/250), invasive tests are needed to reach the diagnosis and determine the genetic structure of the baby.
FIRST TRIMESTER SCREENING TEST (COMBINED/DUAL TEST)
This test has two parts. The first is to measure the baby's nuchal translucency thickness and length using ultrasound. These measurements are made by vaginal or abdominal ultrasound. During ultrasound measurements, the baby's nasal bone is also examined. PAPP-A and free beta-hCG levels were measured in the blood within 24 hours after the measurements. Down syndrome risk is calculated by .
SECOND TRIMESTER SCREENING TEST (TRIPLE/QUADRUPLE TEST)
This test is performed to calculate the risk by measuring AFP, hCG, and estriol / INHIBIN A in the blood. AFP also screens for cases of incomplete closure of the spine (spina bifida), called neural tube defects. Before the test, it is necessary to ensure the gestational age by measuring the baby's head with an ultrasonography. Amniocentesis can be performed if the test risk exceeds 1/250 of the age.
FETAL DNA IN MATERNAL BLOOD
Extracellular free fetal DNA (cffDNA) in maternal blood is a new generation entering clinical practice. It is a test. It is still considered a screening test, so the diagnosis must be confirmed with invasive tests in the group whose test results are at risk. The fact that it can be applied from the 9th week of pregnancy provides the opportunity for early diagnosis. It is generally used as an advanced screening test for more common chromosomal anomalies such as Trisomy 21, Trisomy 18, and Trisomy 13. The detection rate of Down Syndrome with cffDNA is 99% and false positivity is 1%. The detection rates for trisomy 13 and 18 are lower, around 80%. Results cannot be achieved in 4-5% of patients. Currently, the biggest disadvantage is seen as high cost.
24-28. DURING THE WEEKS OF PREGNANCY: blood count and urinalysis should be repeated, oral glucose tolerance test should be recommended to every pregnant woman. Gestational diabetes rates are increasing due to increasing obesity in society, advanced maternal age, inactivity and malnutrition. Gestational diabetes is associated with adverse pregnancy outcomes such as large baby, traumatic birth, shoulder impingement, cesarean delivery, unexpected baby loss in the womb. Those with a family history of diabetes, those with a high body mass index, those who have experienced unexplained baby loss, and those who have given birth to large babies weighing over 4000 grams are at higher risk of gestational diabetes. Blood glucose levels are checked one and two hours after a liquid containing 75 g of glucose is taken orally. 75 grams of glucose taken at once does not have any negative effects on the mother and baby. this amount The glucose in food is not much different from the amount of glucose in meals taken during the day, for example, it is equivalent to two slices of baklava. . In patients diagnosed with gestational diabetes, bad pregnancy outcomes can be prevented by appropriate diet and exercise program, monitoring blood sugar and regulating drug therapy.
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