The period from the moment pregnancy is diagnosed until birth is the period in which the greatest psychological and physical changes occur in a woman's life. During this period, the gynecologist evaluates the health of the mother and the baby and makes recommendations for the continuation of the mother's health. So, pregnancy tracking has two main elements; The first is the evaluation of the growth and development of the fetus, and the second is the evaluation of the effects of physical and psychological changes in the mother due to adaptation to pregnancy. Pregnancy is divided into 3 periods (trimesters), each consisting of 3-month periods. Each period has a different importance. For example, screening for baby-related anomalies is performed in the first two periods. Pregnancy-related high blood pressure and diabetes occur in the last three months. Ultrasound examination of pregnant women can also turn into a ceremony. Mother-in-law, siblings and close friends will also attend this examination and will want to satisfy their curiosity about seeing the baby. For this reason, a woman may skip her annual pap smear check, but she rarely forgets her pregnancy check-up.
Preconceptional examination: In fact, the ideal thing is to perform a pre-pregnancy examination of the woman when the couple decides to become pregnant. In this examination, a detailed history is taken and a systemic examination is performed. If it has not been done recently, a smear test is taken. Thyroid gland (Goiter) and breast examination are important during this period. Because thyroid gland (goiter) disorders cause serious problems during pregnancy. In addition, it becomes difficult to evaluate and perform mammography during pregnancy due to breast growth and edema. Women with a family history of premenopausal breast cancer should have a mammogram, even if they are under 40 years of age. The woman's vaccination status is determined, if missing, rubella, hepatitis-B and tetanus vaccines are administered. Women living in risk areas should be screened for tuberculosis.
One of the most important stages of the pre-pregnancy examination is the assessment of the patient's risks. Some of these risks cannot be changed, and some can be changed with various measures. The patient's height, age, race, education level, genetic structure and socioeconomic level are risk factors that cannot be changed. On the other hand, high blood pressure (hypertension), diabetes, thyroid gland disorder Goiter disease, asthma, epilepsy, extreme thinness and obesity are modifiable risk factors. The existing diseases of these women before pregnancy should be treated or controlled. Vitamin A (accutane), anticoagulant coumadin (coumadin), and some epilepsy medications, which we call teratogens that cause anomalies in the fetus, should be discontinued before pregnancy. Women who are exposed to heavy metals (mercury, lead) or volatile toxic substances in the work environment should be warned, and the presence of domestic violence should be investigated. Remedial measures should be taken on these issues. The harmful effects of alcohol on the fetus have been conclusively proven. This harmful effect increases in proportion to the amount of alcohol used. For this reason, women planning pregnancy are recommended to stop drinking alcohol. Smoking is also known to have negative effects on pregnancy. Known side effects include causing low birth weight in the baby, premature birth and infant death. Not only pregnant women but also other family members in the same household should be advised to quit smoking. Gingivitis in women is also important. Because these pose a risk of premature birth. Therefore, it should be treated before pregnancy. Women should be advised to use folic acid during the pre-pregnancy period. Because folic acid significantly reduces congenital brain and spinal cord anomalies in babies. This effect is especially important in women who have given birth to babies with brain and spinal cord anomalies in previous pregnancies. In these women, 4 mg per day during the first three months of pregnancy, starting 1 month before pregnancy. They should be advised to use folic acid. Women whose risk category is not high can use folic acid between 400 mcg and 1mg.
The existence of a skeletal system (orthopedic) problem that may prevent normal birth should be investigated. If available, birth is planned to be performed by cesarean section. Some risks of pregnancy increase with age. For example, women over the age of 40 have an increased risk of miscarriage, giving birth to a low-birth-weight baby, premature birth, and infant death. This information should also be shared with women.
Ideally, one of the issues that should be discussed before pregnancy is genetic diseases. In countries where consanguineous marriages are common, such as Türkiye, Unfortunately, the risk of genetic diseases also increases. There are also genetic diseases (such as Mediterranean anemia) that have increased frequency in society due to the geography we live in. Finally, the postponement of the age of childbearing due to women's education and work planning causes an increase in the rate of genetic diseases such as Down syndrome (Mongolism) that develop due to advanced maternal age. Therefore, it is necessary to take a detailed history, including the couple's families.
Read: 0
