Pregnancy follow-up is carried out to determine the gestational age from the beginning of the pregnancy to the postpartum period, to evaluate the health status of the mother and the fetus (baby), to create a pregnant care plan and to inform the parents, to prevent or treat the problems that may arise during pregnancy. regular controls.
How is Pregnancy Follow-up Performed in Our Country?
Every pregnant woman should be followed up by a healthcare professional or institution during pregnancy. It will be more accurate to start the examinations when pregnancy planning is done. Because the effects of the diseases existing in the mother before pregnancy on the pregnancy process, investigating the existence of a problem related to pregnancy or any other issue, planning the necessary medical treatments to prepare for pregnancy, informing the couple about pregnancy and starting a healthy pregnancy of the mother can be revealed by pre-pregnancy examinations.
Ministry of Health. According to the "Antenatal Care Management Guide", the doctor should give the patient 30 minutes for the first follow-up and follow-up within the first 14 weeks of pregnancy. time is recommended. If the pregnant comes after the 14th gestational week, it is considered as the first follow-up regardless of the gestational week. All the procedures that should be done in the first follow-up are applied. In addition, additional follow-up procedures are carried out according to the gestational week.
What are the Procedures in the First 14 Weeks of Pregnancy?
Contact information, personal information, family history, concomitant disease of the expectant mother Information about the history of obstetrics and gynecology, including the current pregnancy, is collected. In the physical examination, height, weight, blood pressure, and pulse values of the beginning of pregnancy are measured. General body and obstetric (gynecology) examination is done. Laboratory tests are requested.
These tests are:
- Urine test (proteinuria, bacteriuria),
- Blood tests (hemoglobin, ferritin, blood group, indirect coombs if necessary, HbsAg) , TSH,
- Fasting Blood Glucose (FAG) is between 100-126 mg/dl, oral glucose tolerance test (OGTT)= Sugar Loading Test),
- Chromosomal aneuploidy screening tests (11 -Combined test at 14th gestational week; if not done, triple or quadruple test between 16-20th gestational weeks. vi is started.
- Iron: If anemia is detected, iron treatment should be started immediately, otherwise after 16 weeks of gestation.
- Vitamin D: 9 drops/day as of 12 weeks of gestation,
- Tetanus and Hepatitis B Immunization: If necessary,
- Influenza vaccine: If the 2nd and 3rd trimester coincides with the flu season,
- Giving the necessary treatment in the presence of infection.
How to Screen for Diabetes During Pregnancy?
24-28. During their gestational weeks, they should have a diabetes screening test.
Postprandial glucose (PPG) Postprandial glucose is measured 1 hour after drinking 50 grams of pure glucose dissolved in water. An oral glucose tolerance test (sugar loading test) with 100 grams is applied to expectant mothers whose PPG test results are high. Then the blood glucose is measured at the 1st, 2nd and 3rd hours. If two or more of these four measurements are high, it will make a diagnosis of gestational diabetes (gestational diabetes mellitus). 32-34, even if the test results are normal. OGTT is repeated during gestational weeks.What are the Dangers for the Baby in Gestational Diabetes?
Since gestational diabetes (gestational diabetes mellitus) occurs after the completion of organ development in the baby, it does not cause anomaly in the baby. However, uncontrolled high blood sugar and untreated may cause sudden infant death.
The baby is born larger than normal, and amniotic fluid increases. Fetal distress and lack of oxygen in the baby are also common conditions during labor. >What is Triple Screening Test? What Does It Show?
� The triple screening test is usually done between 16-20 weeks of pregnancy. It cannot be done before or after these weeks.
An ultrasound examination is performed on the mother first. The mother gives blood on the same day. B-HCG, u-E2 (free estriol), alpha-fetoprotein (AFP) values are checked in the blood. The laboratory results and the values measured in ultrasound and the mother's profile (age, last menstrual period, weight, smoking history, etc.) are entered into the computer program.
Three different risk results are calculated for trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) and neural tube defect in the computer program.What is Quad Screening Test? What It Indicates?
The quadruple test is a test performed for the same purpose as the triple test, but with a higher success rate. The rate of detecting a fetus with Down syndrome in the quadruple test is 80%.
While in the triple test, B-hCG and free estriol (uE3), AFP levels are checked in the blood taken from the mother in the triple test, inhibin-A measurement is added to these in the quadruple test. The best test that can be recommended for expectant mothers who do not have dual test, combined test and NT measurements in the first trimester is the quad test. it just indicates that your risk is higher than normal. Therefore, amniocentesis is required for definitive diagnosis. Since the risk is high in pregnant women over the age of 35, amniocentesis is "usually" performed directly without quadruple testing.What Should Be Done in the Second Pregnancy Follow-up (18-24 weeks of gestation)?
Starting from the first visit developing complaints and developments should be questioned; Physical examination should be repeated with weight gain.
The patient's complete urine test, blood count (hemogram), glucose tolerance test (OGTT) should be repeated and obstetric ultrasonography should be performed.
Drug support, immunization and treatments: If iron and vitamin D have not been started, it is started; If tetanus immunization is required, it is done.
Information and counseling: What was done in the first follow-up should be reviewed again.What are the Procedures in the Third Pregnancy Follow-up (28-32 Weeks of Pregnancy) Visit?
Procedures in the first two follow-up visits are reviewed. In this visit, importance is given to edema and breast examination. If you have iron and If vitamin D has not been started, it is started. If tetanus immunization has not been done, tetanus vaccine is given.
The pregnant woman is informed about the importance of baby movements, information about birth, the importance of breast milk and breastfeeding, and family planning after birth.
Last pregnancy follow-up (36-38. In the procedures at the gestational week) visit, pelvic evaluation should be performed together with edema, breast examination. Whether the pelvic structures allow for normal delivery is determined by vaginal (bottom) examination. In the counseling part of this visit, the importance of baby movements, signs of onset of labor, and the method of delivery are focused on.What is Premature Birth Screening?
Especially those with increased risk for preterm birth. Preterm birth can be predicted by measuring the length of the cervix with transvaginal ultrasound in pregnant women (such as multiple pregnancy, pregnant women with a history of preterm birth, pregnant women with uterine abnormalities and those who have had cervical surgery before).
The risk of premature birth as the cervix gets shorter increasing. By measuring the length of the cervix with 2-dimensional ultrasound, it is aimed to catch the increased risk of preterm birth that may occur before 34 weeks of gestation.
In patients with increased risk for preterm birth, 11-14. Detailed anatomical examination is performed within weeks. 18-23. It is also beneficial to repeat the detailed ultrasound examination every week. This ultrasonography is ideally performed transvaginally. In cases where transvaginal ultrasound cannot be performed, transperineal ultrasound can be performed. Ideally, the measured cervix length of 25 mm or less is called "short cervix" and indicates an increased risk of preterm birth.
The length of the cervix above 27 mm is comforting. However, it should not be forgotten that the cervix, that is, the cervix, is dynamic and may shorten in case of contraction or over time. Therefore, serial follow-up may be required according to the history and condition of the pregnant woman. In recent years, when a short cervix is detected, many preterm births can be prevented by simply giving progesterone support.Read: 0
