PRE-PREGNANCY COUNSELING

INTRODUCTION

Having healthy children is a couple's most important wish. For this reason, it is recommended to consult a gynecologist and obstetrician before getting pregnant. 'Pre-pregnancy counseling' is the process of identifying social, behavioral, environmental and biomedical risks to a woman's fertility and pregnancy outcomes, and minimizing these risks with education, counseling and possible interventions before pregnancy. Since the first organ development period of the unborn baby (fetus) is between 3-10 weeks of pregnancy, pre-pregnancy counseling is much more important and effective than counseling during pregnancy follow-up.

OBJECTIVES

●Identifying potential risks to mother, fetus and pregnancy

●Providing education, counseling and, if possible, intervention options regarding these risks

●Ideal mother, fetus and pregnancy Initiating initiatives that will provide results (such as guidance, disease treatment, referral to a specialist)

GOALS

• The best for the unborn baby (fetus). To provide a healthy environment,

• To minimize congenital structural anomalies,

• To prevent and reduce pregnancy-related health problems as much as possible.

Thus, the main goal is to have a smooth pregnancy and increase the chance of having a healthy child.

RISK ASSESSMENT

The most important issue in risk assessment is taking a detailed history. According to the data obtained in this way, patient education and medical interventions can be initiated.

 

 

Age

 

As you get older, especially over the age of 40, there is an increased risk of the following conditions: It is:

• Infertility

• Structural or numerical chromosomal anomaly in the fetus

• Miscarriage

• Diabetes during pregnancy

• High blood pressure during pregnancy

• Stillbirth

Advanced paternal age also has some risks for the baby:

• Infertility

• Low

• Some genetic diseases (new autosomal dominant mutations, X chromosome mutations)

• Some psychiatric disorders conditions (schizophrenia, autism)

• Childhood tumors

Medical History

It is a good start to understand both how pregnancy will affect your health and how your health will affect the pregnancy and your baby.

The issues that need to be emphasized are as follows:

●Chronic diseases: diabetes, hypertension. , such as thyroid disorder, phenylketonuria, autoimmune diseases, obesity.

●Drugs that are harmful to the fetus:

Can the medication be stopped if it is used regularly? Can it be changed? Can the dose or number be reduced?

The risk of harmful effects on the baby (fetus) of drugs approved for human use is not yet known in 98% of cases. However, approximately 30 of them are considered to be safe in pregnancy. Most of these are vitamins, minerals, electrolytes and hormones in physiological doses. Therefore, possible harmful drug use should be evaluated individually in each case, and genetic counseling should be obtained regarding the time the drug is used, the dose, and possible effects.

●Reproductive age history:

Birth History. :

Date of birth

Gestational week at birth

Place of birth

Gender of the child

Birth measurements (weighing scale, height, head � circumference)

Type of birth

Type of anesthesia

Duration of birth

Result: such as live birth, stillbirth, miscarriage

Details (such as presence of stitches, history of using vacuum)

Problems (mother, fetus, newborn)

 

Gynecological History

 

First menstrual age

Last menstrual date

Menstrual frequency, duration, amount

 

Birth control method

 

Sexually transmitted diseases

Operation (cervix, uterus, tube, ovary)

●Genetic conditions and family history

Patient, partner and family genetic history:

 

Congenital anomaly history:

Heart

Central nervous system

Cleft palate-lip

Other

Chromosomal anomaly:

Down syndrome

Low intelligence and developmental delay

Other

Advanced parental age

Hereditary diseases:

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Blood diseases: such as sickle cell anemia, Mediterranean anemia, hemophilia

Muscle diseases

Cystive fibrosis

Metabolic diseases: such as phenylketonuria, diabetes

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Kidney disease

Deafness

Marfan syndrome

Other

Ethnicity

Consular marriage

Recurrent miscarriage, stillbirth or early neonatal loss

Maternal metabolic diseases

●Substance use (such as cigarettes, alcohol)

● Infectious diseases and vaccination

●Nutrition, folic acid use, weight control

●Environmental toxins and harmful factors

Workplace, hobby, pet, home environment Related information may reveal exposure to potential toxins such as mercury, lead, chemicals that cause hormonal disruption. Additionally, mercury is found in fish and skin firming creams, as well as lead. It should not be forgotten that it is also found in paints, cosmetic products, food additives and clay.

There is no convincing evidence yet that daily electromagnetic field radiation (computer screen, electric blanket, heated water bed, mobile phone, microwave oven) is harmful. .

●Family planning

●Social and mental health (such as depression, social support, exposure to violence, housing)

Physical Examination

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Things to be evaluated for maternal health and pregnancy outcomes in a healthy woman:

• Weight

• Blood Pressure

• Heart

• Lung

• Thyroid

• Abdomen

• Mouth

• Genital system

Examinations

In most countries, counseling and screening for the HIV virus is recommended for all those planning a pregnancy, as the risk of infection in the baby decreases with treatment in the presence of HIV infection in the mother.

Hepatitis B immune status should also be determined.

Screening for the following conditions should be done if the expectant mother is in a high risk group:

●Sexually transmitted diseases

●Immunity status for rubella

●Genetic disease carrier: This should be done in accordance with the couple's CV or family history, ethnicity or wishes.

●HgA1C, fasting blood sugar: It should be checked in those with diabetes.

●Tuberculin skin test (PPD): It should be screened if at risk for tuberculosis (TB).

●Toxoplasmosis: Its screening is controversial. It may be rational to determine the infection status before pregnancy in those who are veterinarians, keep cats at home, or consume raw meat in terms of follow-up during pregnancy.

●Cytomegalovirus (CMV): Screening is controversial. child yu It may be rational to determine the pre-pregnancy infection status in women who work during pregnancy, have children going to kindergarten, or work in the dialysis unit in terms of follow-up during pregnancy.

●Serum phenylalanine level: It should be checked if the mother has phenylketonuria.

 

 

PLANNED PREGNANCY RISK ASSESSMENT FORM

 

 

You can also use the sample form below. You can have an idea about your own risks by answering the questions:

Protection:

1.Do you plan to get pregnant within a year?

2.Are you currently trying to get pregnant? Are you currently attempting to conceive?

3.Do you use any birth control method regularly? Which method, if any?

 

Condoms and/or diaphragm

 

Intrauterine device

Birth control pill

Monthly/quarterly injections

Other

Medical History:

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4. List all chronic diseases and psychiatric conditions for which you are treated:

 

5. Is there any medication you use regularly? List any:

 

 

6. Do you have any known drug allergies? List if any:

 

 

Gynecological History:

7. Have you had any problems with the following situations?

a. Irregular menstruation

b. Abnormal cervical cancer screening test (pap smear)

c. Myoma

d. Ectopic pregnancy

e. Gynecological surgery

8. Have you had any of the following infections?

a. Chlamydia

b. Genital wart

c. Syphilis

d. Gonorrhea

e. Herpes

Previous Pregnancy and Birth History:

9. Have you had any problems with the following situations?:

a. Recurrent miscarriages

 

 

b. Stillbirth

 

 

c. Low birth weight

 

 

d. Diabetes or gestational diabetes

 

 

e. Phenylketonuria

 

 

f. Newborn with neural tube defect

 

 

g. Birth history with other congenital structural anomalies

 

10. List all pregnancies:

 

Date of Birth

 

 

Week of Birth

 

Type of Birth

 

 

Birth Weight

 

 

11. Have you had the following vaccinations? or have you had any diseases?

 

a. Rubella

b. Hepatitis B

c. Chickenpox

 

Family History

 

12. Does anyone in the family have this disease?

a. Mediterranean anemia (beta or alpha thalassemia)

b. Sickle cell anemia

c. Cystic fibrosis

d. Epilepsy

e. Mental disability (mental retardation)

 

Habits and Exposures:

 

13.Do you drink alcohol? ? If yes, how much per day (week or month)?

14. Do you smoke ? If yes, how much per day?

15. How much coffee do you consume per day?

16. Do you have substance addiction? Have you ever consumed substances such as cocaine or heroin?

17. Have you ever taken blood products? If yes, please state the date and what it is:

18. Do you follow a special diet? If yes, describe:

19. Do you take herbal or vitamin supplements? If yes, what?

20. Do you exercise regularly? If yes, what is the frequency and type?

21. Do you feed cats?

 

Professional Story:

 

22. Your profession?

23. Are you currently working?

24. What are your last three jobs and workplaces?

1.

2.

3.

25. Are you regularly exposed to the following at work?

a. X-ray or radiation

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