PREPARATION AND CONSULTING BEFORE PREGNANCY
Before pregnancy planning, we need to have information about the health of the expectant mother and father. With the gynecological examination, it is understood whether there is a situation that will prevent pregnancy or put the pregnancy at risk.
What are the things to be considered before pregnancy?
● Medications and herbal supplements used should be reported to the doctor.
● Vaccination information of the expectant mother should be obtained
● Vitamin before pregnancy is required. Folic acid support should be started. 400 mg of folic acid daily should be taken one month before conception.
● If there is a disease in the mother or father-to-be, necessary precautions should be taken.
● Pre-pregnancy nutrition is very important. It is always healthier to get pregnant after getting rid of the extra pounds. With pre-pregnancy diet programs, the probability of a healthy pregnancy increases.
When should the first examination in pregnancy be?
The first test to be done after menstrual delay beta HCG in blood It is a pregnancy test called strong>. The urine pregnancy test done at home also gives accurate results, but its reliability is lower than the blood test. When the test result is positive, first examination should be done during pregnancy.
HOW IS THE FIRST PREGNANCY EXAMINATION PERFORMED?
Necessary information about the patient in the first examination is taken. Last menstrual period is calculated, estimated date of birth and gestational age at the time of examination are calculated.
Seeing a gestational sac on ultrasound is the most important criterion in terms of clarifying the presence of pregnancy. The question of When is the gestational sac seen at the earliest is the most frequently asked question by patients. In cases where Beta HCG is below 1200, the sac cannot be detected on ultrasound, it is at a very early stage. The first ultrasound is done from the abdomen, if the gestational sac cannot be seen from the abdomen, it is necessary to perform a vaginal ultrasound from the bottom. The correctness of the gestational sac and the number of sacs are the information obtained at the first examination. Vaginal ultrasound does not harm the baby or the mother. It doesn't cause.
What are pregnancy tests? How are pregnancy tests done?
The tests to be performed in the first pregnancy examination are:
● Blood group
● Blood count
● Vitamin levels
● Fasting blood sugar, liver and kidney function tests
● TSH, thyroid tests
● Parasite screening tests called TORCH
● Screening test for syphilis
● Urinalysis
● Smear test if not done before pregnancy
TREATMENT TESTS IN PREGNANCY
The purpose of screening tests is to understand if there is a suspected genetic disease in the baby, to detect situations incompatible with life, and to terminate the pregnancy if necessary. Screening tests are done by taking blood from the patient, there is no harm to the baby. The tests performed for this purpose are:
● Double test (combined test)
● Triple test
● Quadruple test
What is dual screening test? How to do a double test? What is checked in a double test?
Dual screening test is a blood test to investigate whether there is a genetic disease in the baby to be born. It scans for Down syndrome (Trisomy 21), Trisomy 18 and Trisomy 13. In this test performed with blood analysis, the baby's height and nape thickness are measured by ultrasound. All values are studied together, the result shows the risk of disease in the baby.
What to do if the dual test is defective?
If the dual test is defective, the procedure called CVS is recommended. In other words, it is necessary to take a piece from the baby's placenta and perform the examination. CVS is an invasive procedure that can harm the baby. While the risk is very low, it is not completely risk-free.
What is a fetal DNA test? Since Maternal blood test for Down syndrome
Amniocentesis or CVS has a low risk, newly developed technologies were needed. Fetal DNA test, Down syndrome test in maternal blood, NIPT test, is used for this purpose. From the blood taken from the mother, the baby's genetic screening is done. during pregnancy The baby's cells circulate in the mother's blood. From a simple blood sample taken from the mother, these cells are filtered and genetic analysis can be done.
What is triple screening test? When is the triple scan done? What is checked in the triple screening test?
The triple test is also one of the genetic screening tests. It's an old test. It is performed between 16-19 weeks. It scans Down syndrome (Trisomy 21), Trisomy 18 and Trisomy 13.
What is quadruple screening test?
It is checked between 16-19 weeks liketriple test. Unlike the triple test, another assay called Inhibin-A is looked at.
DETAILED ULTRASOUND
What is detailed ultrasound? How is detailed ultrasound done?
The ultrasound performed between 18-24 weeks in pregnant women is called detailed ultrasound or screening ultrasound. This analysis is very important, all internal and dental organs of the baby are examined, any disability is detected, and common genetic diseases, especially Down syndrome, are investigated. In the weeks where double and triple test is performed, the baby is very small, most of its internal organs are not sufficient for examination, so after 20 weeks of pregnancy, the scanned ultrasound examination tries to see what is missing.
What is Examined in Detailed Ultrasound?
In detailed ultrasound, that is, scanning ultrasound, the measurements of the baby according to the week are checked. Head, leg and abdomen circumferences are measured. Brain structure, brain fluid, neck region, backbone are examined. The facial structure is checked, whether there is a cleft palate or cleft lip. All bone structures are analyzed, hand, arm, leg bones are counted, the number of fingers is determined. Foot structure is examined. All internal organs are examined, kidney diameter is measured, and a detailed heart analysis is performed. The 4 chambers and vessels in the heart are seen in detail. The length of the baby's placenta, water, cord, and cervix are measured. Doppler analysis of the uterus and the vessels of the baby is performed.
SUGAR LOADING TEST
What is a sugar loading test?
Hormone changes during pregnancy With this effect, blood sugar rises, sugar excretion in the urine increases. If the pregnant woman has a tendency to diabetes, has hidden sugar level or has a high family risk of diabetes, gestational diabetes, called gestational diabetes, may develop. sugar loading test is done after 24 weeks to detect risks.
When is sugar loading done?
24-30 weeks done between.
How to do sugar loading test?
Patient does not need to be hungry, glucose is drunk for 50 g sugar loading, one hour later blood is taken. It is normal for blood glucose to be below 140 mg/dl. For higher values, 100 g sugar loading is required, this test is also called glucose tolerance test. The test that shows pregnancy diabetes is the 100 g challenge test.
What to do in sugar overload test disorder?
The pregnant woman is put on a diet immediately. It is tried to keep blood sugar at a certain level. Patients who do not improve despite diet are consulted with an endocrinologist, and insulin injections are administered throughout pregnancy if necessary.
What is done in a patient who cannot have a sugar test?
Hunger and 2nd hour postprandial blood sugar can be checked. The fasting value should be below 95 mg/dl and the satiety value should be below 125 mg/dl.
AMNIOCENTHESIS
What is amniocentesis?
It is the process of taking the baby's water with a needle inserted through the mother's womb.
When is amniocentesis performed?
It is done between 16-18 weeks of gestation.
What are the indications for amniocentesis?
● If Down syndrome is suspected, for definitive diagnosis
● For the diagnosis of other genetic diseases
● If there is a suspicion of infection in the fetus for detection
● Is the baby's lung development sufficient strong> to get information
● To find out the baby's blood group before it is born
How is amniocentesis done?
Amniocentesis no anesthesia is used in the procedure. Mother lays on her back The abdomen is wiped with a batikon and covered with a sterile drape. It is entered through the abdomen with a thin needle under ultrasound guidance. A slight pain is felt, like an injection in the hip. Approximately 20 ml of amniotic fluid is withdrawn. The mother is put to rest, the baby's heartbeat is checked with ultrasound. The collected fluid is sent for examination. Rarely, sufficient fetal cells may not be produced in the fluid, in such a case it may be necessary to repeat amniocentesis.
Is amniocentesis harmful?
It is an invasive procedure, there is a 1/300 risk of the baby falling. This risk is almost nonexistent in expert hands.
What are the things to do after amniocentesis?
● There may be bleeding and pain after the procedure, it is usually mild and goes away with rest. It is recommended that the patient rest for a day.
● The patient's blood type is very important. If the mother-to-be is negative and the father-to-be has a positive blood group, blood incompatibility injection is definitely done.
● If the bleeding increases, water comes out, or the groin pain gets worse, it is necessary to consult an emergency doctor
● If there is a fever, if it is higher than 37.5 degrees, an emergency doctor should be consulted.
When will the result of amniocentesis come out?
It takes 21 days on average. Some diseases that are studied quickly, called preliminary results, can be learned within 48 hours.
CORION VILLUS SAMPLING (CVS)
What is chorionic villus sampling?
From the baby's placenta part removal process.
When is chorionic villus sampling done?
It is done between 11-14 weeks.
Why is chorionic villus sampling done?
● To investigate whether there is any disability in the baby in patients with double test p>
● In early pregnancy ultrasound, if disability is suspected
● Mothers over 35
● Genetic family history if there is a disease, to investigate whether the baby also has it
● If the parents have a history of a disabled child, especially in diseases with chromosomal disorders
Chorionic villus sampling
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