The main problems encountered during this period are nausea, vomiting, groin pain, frequent urination, changes in the sense of smell and taste, tendency to sleep and forgetfulness.
Nausea complaints may be more intense, especially in the morning hours. It is usually not accompanied by complaints of vomiting. However, if vomiting is severe enough to disrupt regular nutrition and there is weight loss, the pregnant woman will definitely need to consult a doctor. In the case of infrequent complaints of vomiting and nausea, it is usually possible to overcome these problems with nutritional recommendations. For example, simple precautions that can be taken include eating small amounts at frequent intervals, consuming dry foods (salted crackers, grissini), avoiding watery, fatty, paste or sauce foods, keeping the kitchen well ventilated, and sometimes avoiding cooking. In cases where nausea and vomiting are severe, medication can only be used with the recommendation and permission of the doctor.
A pregnant woman who is found to have an intrauterine pregnancy and has no bleeding may have complaints of vague groin pain. Unless it gradually increases in severity, is not limited to a certain area, and there is no periodic pain, it is usually not due to a significant problem. In cases where this is not the case, a doctor should be consulted without delay.
Frequent urination is one of the most common problems faced by pregnant women. It occurs when the growing pregnant uterus puts pressure on the bladder, some hormones that rise during pregnancy, and the bladder cannot empty completely after urination. Unless accompanied by a burning complaint while urinating, it does not indicate a problem with the urinary tract. Inclination to sleep and forgetfulness are problems that occur as a result of some hormones that increase during pregnancy.
As in all periods of pregnancy, vaginal bleeding, limited and gradually increasing abdominal and groin pain, gushing vomiting, and burning sensation during urination are among the problems that require consulting a doctor during this period.
PREGNANCY MONITORING AND CARE
Antenatal care or pregnancy monitoring ideally aims to prevent possible medical, psychological and social problems of the pregnant woman in the process that starts with the planning of pregnancy and extends until birth; If they occur, it aims to treat them. The main purposes of pregnancy monitoring and care are to determine the health status of the mother and the fetus. to determine the gestational week accurately, to identify possible and avoidable risks that may cause pregnancy complications and to correct them, to prepare the mother for pregnancy, birth and breastfeeding.
Pre-Pregnancy Examination
Ideally, a couple planning a pregnancy should consult a physician before pregnancy. This first application becomes important especially in problems where the control of the disease determines the course of pregnancy, such as diabetes, asthma, hypertension, epilepsy (Epilepsy), thyroid diseases (Goiter). Again, if applied before pregnancy, blood thinners, hypertension drugs, some fat-soluble vitamins, and epilepsy drugs that may cause birth defects may be replaced with safer drugs. During this period, women who are not immune to rubella (rubella) and hepatitis B can be vaccinated. Folic acid supplementation should be started for women planning pregnancy. A woman planning pregnancy should consult a doctor in case of menstrual delay.
First Pregnancy Examination; It should be done within the first 6-8 weeks following the menstrual delay. At the first examination;
a-Diagnosis of pregnancy
*Urine and blood pregnancy tests
b-Determination of gestational week,
c-General physical examination,
*Height
*Weight
*Blood pressure
*Systemic examination
*Gynecological examination and smear taking.
d-Laboratory tests
*Complete blood count,
*Urinine examinations and urine culture,
* Blood type,
*Rubella (Rubella), Hepatitis B and C, Syphilis screening
The frequency of pregnancy follow-up examinations is shown below.
The first examination is the first following the menstrual delay. It should be done within 6-8 weeks. After that, monthly until the 32nd week of pregnancy, 32-36. Pregnancy checks should be performed every 2 weeks between weeks of pregnancy and weekly after the 36th week of pregnancy.
Examinations That Should Be Done Regularly During Pregnancy Follow-Up
At each examination, the baby's growth and well-being, maternal health, identification of possible risks, screening tests, within the scope of preventive medicine Vaccination practices should be carried out.
Measurement of Arterial Blood Pressure: Preferably after a rest of at least 20 minutes. It should be measured from the side and with the right arm at heart level.
Measurement of Body Weight: It is necessary to determine the weight gain course of pregnant women. A weekly weight gain of more than 1 kg, especially in the last 12-14 weeks of pregnancy, may be a warning sign for hypertensive disorders during pregnancy.
Fundus-Pubis Measurements: Sixteen-32. Between weeks of pregnancy, the height of the fundus, that is, the top of the uterus, indicates the week of pregnancy. However, in order to make accurate measurements, the bladder must be empty before measurements.
Fetal (Baby's) Heartbeats: Starting from 18-20 weeks of pregnancy, the heartbeats of a baby in the womb can be detected with special tools called fetoscopes. In a normal fetus, the heart rate varies between 120-160 beats/min,
Leopold Maneuvers: It is used to determine the posture of the fetus in term pregnancies and whether it has entered the birth path.
SCREENING TESTS
Screening tests are tests applied to pregnant women who do not have any risk factors. Definitive diagnostic tests are applied to pregnant women who are determined to be at high risk through screening tests. Similarly, pregnant women in high-risk groups (for example, those who have given birth to babies with anomalies in previous pregnancies, who have a family history of hereditary diseases, who have a history of diabetes in first-degree relatives, where one of the mother and/or father has a hereditary blood disease or is a carrier) can be tested with screening tests. Diagnostic tests are performed without wasting time. The main screening tests that come into routine practice during pregnancy are urine examinations requested at the first application and blood tests to investigate immunity for some special infectious agents (Hepatitis B and C, Toxoplasma, rubella or syphilis). Apart from these, various tests are used to screen for genetic problems (where the number of chromosomes is less or more than normal) called aneuploidy (Down Syndrome, Trisomy 13 or 18, Turner Syndrome). The most well-known of these is the first trimester screening test (double test). 24-28. The glucose (sugar) challenge test, which we recommend to all pregnant women followed in our clinic during their gestational weeks, is one of the tests we use during follow-ups.
Double Test
11-14. It is a screening test performed between weeks of pregnancy. It is a screening test that takes into account some hormone values measured in maternal blood, ultrasonographic measurements and maternal age. Ultrasonographically measured nuchal transparency (nuchal transparency, NT) measurement is an indispensable part of this screening test.
Extracellular DNA Tests in Maternal Blood
Can be applied starting from the tenth week of pregnancy. It is an advanced screening test for Down syndrome and trisomy 13 and 18. If positive, suspicious findings should be confirmed by chromosome analysis in cells obtained by a traditional genetic diagnosis method such as amniocentesis (AS). For this reason, the method is considered a screening test and is called "non-invasive prenatal test" (NIPT).
NIPT is generally used as a screening test for more common chromosomal anomalies such as Trisomy 21 (T21), Trisomy 18 (T18), Trisomy 13 (T13).
Trace Element and Vitamin Support During Pregnancy
Ideally, 0.4 mg of folic acid should be given daily to the expectant mother along with pregnancy planning. is necessary. This folic acid support should continue until the 12th week of pregnancy. Folic acid supplementation becomes more important in women with a history of neural tube defects (brain and spinal cord anomaly) and women using antiepileptic drugs. Vitamin D supplementation should be started at the end of the first trimester and continued until the 12th week after birth. Similarly, pregnant women are 16-20 weeks old. It is necessary to take iron preparations containing 30-60 mg of elemental iron starting from the week of pregnancy and continue until the 3rd month after birth.
Vaccination During Pregnancy
Live viral vaccines should not be administered during pregnancy. Vaccinations against infections such as typhoid and yellow fever should be administered taking into account the risk-benefit ratio. Influenza (seasonal flu) vaccine can be applied after the 1st trimester, it should start in October and November, and vaccination should be completed by the end of December. The application conditions for the toxoid of the rabies and tetanus vaccine, hepatitis A and B vaccines, and capsule vaccines (meningococcal, pneumococcal and H. Influenza vaccines) are the same as before pregnancy. Among these Tannosis vaccine should be administered to pregnant women together with the diphtheria vaccine in two doses, administered at 4-week intervals, starting from the 20th week of pregnancy. The vaccination schedule should be completed by applying the determined intervals after birth.
Frequently Asked Questions During Pregnant Monitoring
a.Exercise: There is no need for exercise restrictions during pregnancy. However, it is not recommended to do sports that may cause injury to the pregnant woman and the fetus. The patient who exercised regularly before pregnancy may be advised to continue doing so during pregnancy. Pregnant women can do sports such as walking, jogging (except in recent periods), and swimming. However, exercise should not be done for weight control.
The relative contraindications of exercise during pregnancy are as follows;
Vaginal bleeding,
Threat of premature birth,
Cervical insufficiency
Water breaking
Preeclampsia
Presence of risk factors for premature birth.
b.Travel: Related to general health or the course of pregnancy Unless there is a problem, air travel is possible until the 36th week of pregnancy. There is no concrete data showing that seat belts in automobiles increase the frequency of fetal injuries during accidents. The most important cause of fetal (baby) death in traffic accidents is not trauma due to seat belts, but maternal death. Seat belts should be worn on the upper part of the pregnant woman's abdomen, tangentially and perpendicular to the body axis at the hip level. Deploying airbags during an accident in automobiles does not have any negative effects on the mother and fetus.
c. Alcohol and Smoking: Fetal alcohol syndrome and growth retardation are known negative effects of alcohol and smoking. For this reason, both should never be used during pregnancy.
d. Constipation: The tendency to constipation increases during pregnancy. Constipation and related cracks in the anus and hemorrhoids can impair the pregnant woman's quality of life. Sometimes it can cause bleeding. Sitz baths, increasing the consumption of fibrous foods in the diet, increasing daily fluid intake
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