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Pregnancy Follow-Up

Pregnancy follow-up is the examination and regular controls of the mother by the obstetrician in the 9-10 month period from the beginning of pregnancy to delivery.
Pregnancy Follow-Up

What is Pregnancy Monitoring?

Pregnancy follow-up is the examination and regular controls of the mother by the obstetrician in the 9-10 month period from the beginning of pregnancy to delivery. Pregnant women must be followed up by a physician or health institution during pregnancy.

Keeping the mother and the baby healthy during pregnancy is ensured by the birth of a healthy baby, prenatal care and follow-up. Health problems that may occur during pregnancy follow-up are determined in advance and necessary precautions are taken. With the knowledge of possible health problems in pregnancy, the most suitable conditions for birth are prepared.

Tests and follow-ups during pregnancy;

  • First trimester (first 3 months) tests,
  • Tests performed in the second trimester (second tirmester),
  • Tests performed in the third trimester (third trimester).

The earlier the pregnancy follow-up is started, the better the results will be for the mother. A detailed history is taken from the expectant mother. General symptoms, background, family history, systemic diseases and consanguineous marriage are questioned. At each control, the height and weight of the pregnant woman are recorded. During pregnancy, a maximum weight gain of 10-12 kg is desired.

First Trimester Pregnancy Follow-up

Fetal heartbeat is detected by transvaginal USG at the earliest in the 6th week. The first control in pregnancy is carried out between 8-10 weeks. At the first check-up, the baby's initial weight and height are measured and recorded. The first check is important. Because at the first check-up, many recommendations are given to woman by the doctor.

At this first visit, laboratory tests and ultrasound are performed. In low and medium risk pregnancies, follow-up is once a month. Weight and blood pressure are monitored at each check-up.

The frequency of visits may be higher in high and very high risk pregnancies. Specific tests are ordered for each disease. The doctor determines the most appropriate follow-up in each case.

Blood tests: A blood test is usually done between 9 and 10 weeks. Blood group determination, Rh factor (eg: AB Rh+) determination, complete blood count to investigate anemia (hemoglobin, red cells, etc.),some serological tests for immune status are performed. Infectious diseases that can affect the fetus are investigated with a blood test.

The serology tests performed at the first control are:

1- Toxoplasmosis: Toxoplasma is a parasite that can affect the baby by crossing the placental barrier in case of pregnancy. It is a contagious disease. Contact with cat feces, the disease can be transmitted from raw or undercooked meat and raw vegetables contaminated with the parasite. Most women have antibodies to the parasite. The toxoplasma test is performed at the first blood analyzes. If it is negative, it is repeated in subsequent blood tests.

People who pursue the below suggestions and hygiene rules can be protected from infection;

  • Do not come into contact with cat feces.
  • Wash your hands thoroughly with soap before touching food.
  • Do not touch your eyes, nose or mouth with dirty hands.
  • Toxoplasma dies within 48 hours at a temperature of 75 ° C and a cold of -25 ° C. Avoid raw or undercooked meat and meat products, unfrozen or dried meats.
  • Wash and rinse raw foods, fruits and vegetables with water with vinegar.
  • Wash and disinfect tools, surfaces and refrigerator used in the preparation of food.
  • Be sure to use gloves when carrying out garden work and processing the soil. Then wash your hands.

2- Rubella: Rubella can pose a serious threat to the fetus during pregnancy. This virus is part of the triple virus vaccine that was included in the Turkey vaccination schedule. Pregnant women without immunity can get the vaccine after childbirth for their subsequent pregnancy.

3- Syphilis, Hepatit B, Hepatit C and AIDS: When this type of sexually transmitted disease passes to the fetus, it can seriously affect the development of the baby. In case of detection of the disease in the mother, treatment will be carried out to reduce the possible risks of the disease.

Urine culture: Urine culture is done at 16 weeks of age, even if you have no indications, to eradicate any infection that may affect the fetus.

Ultrasound: By measuring the embryo with ultrasound, the duration of pregnancy and the possible date of birth can be calculated. Ultrasound is performed between 11-14 weeks of pregnancy, to detect a morphological anomaly early. Nuchal translucency and nasal bone are measured by ultrasound.

Double Marker Test: A double marker test is performed to investigate fetal chromosomal anomaly. For the double marker test, a blood sample is taken from the mother between 11-14 weeks of pregnancy. In this blood sample, β-hCG homonum and Pregnancy-associated plasma protein-A (PAPP-A) levels are examined. The age of the mother and some other characteristics are formulated together and calculations are made with the help of a computer.

This test is called a dual screen test. If the baby's nuchal translucency (NT) is added to these calculations, the accuracy rate of the result is higher. This test, to which the nuchal translucency measurement is added, is called the combined test (double combined test).

The combined test is the combination of nuchal translucency with the double test. Approximately 60-70% of babies with Down syndrome can be detected with the dual screening test, while 80-85% can be detected with the combined test. These scans look for the fetus' risk of having chromosomal abnormalities for Down syndrome and Edwards syndrome.

In case of high-risk results, tests determining the exact karyotype (chromosome map) of the fetus are performed. These tests are amniocentesis and chorionic villus biopsy, which are invasive prenatal diagnostic tests.

Second Trimester Pregnancy Follow-up

Second trimester detailed ultrasound: Detailed ultrasound is done between 20-24 weeks of pregnancy. With detailed ultrasound, the baby's organs and external morphological structures are examined. Placental location and amount of amniotic fluid is evaluated. This is an important ultrasound. Because most of the organs are formed during this week of pregnancy. If a defect is detected in any organ, a more specific ultrasound examination is performed.

Blood tests: Some blood tests are done around 25 weeks. Detailed results are obtained about hepatitis B, a sexually transmitted or blood-contact disease. In the event that Hepatitis B is detected in the mother's blood, a vaccine and gamma-globulin are given to the baby after birth.

Triple or Quad screening test: These test is done between 16-18 weeks of gestation. In triple test, the levels of AFP (alphaphotoprotein),estriol, beta-Hcg in the mother's blood is examined. In quad test, inhibin-A is added to previous parameters.  AFP is increased in the case of neural tube defects. A neural tube defect is an opening in the baby's back. So it is a problem with the spinal cord and nervous system.

Amniocentesis: Amniocentesis is the taking of a sample from the fluid in which the baby is in for chromosomal examination. The triple screening test is performed for the diagnosis of mothers over the age of 35 and with high risk (1/270 and above). The risk of amniocentesis (1/2000) is very low when performed under sterile conditions and by experienced doctors.

The most common risks associated with amniocentesis are chorioamnionitis (infection of the uterus and its membranes) and miscarriage. With amniocentesis, the chromosomes of the baby are examined. Down syndrome can be detected with nearly %100 accuracy.

O'Sullivan test: Done to see how the body reacts to sugar. A certain amount (50 gr. glucose test) of sugary liquid is drunk and blood sugar is checked one hour later. During the test, nothing, including cigarettes, is eaten or smoked. Because it can affect the results. If the result is abnormal, the next step is the Oral Glucose Tolerance Test.

Oral Glucose Tolerance Test (OGTT): This test requires special preparation. This preparation is told to you by your doctor. On the day of the test, a fasting blood sample is taken. Then the woman is given a drink of water containing certain amounts of glucose. Three blood samples are taken, with a interval of one hour between each.

A total of 4 samples are taken. Blood sugar levels are measured at 1, 2, 3 and 4 hours. Thus, the test takes about four hours. While the test is being done, you should sit down without smoking or eating anything. Because they can affect the test values. The results are given to you by the doctor at the next visit.

Third Trimester Pregnancy Follow-up

Blood tests: Routine blood tests are done during the 32nd week of pregnancy. The blood clotting status, which is important during birth, is examined.

Ultrasound: It is done in the 34th week of pregnancy. Fetal growth, the amount of fluid, and the position of the baby are evaluated. The length of the cervix is measured by ultrasound. Gestational hypertension and preeclampsia can mostly appear in this period. Therefore, the blood pressure and weight of the pregnant woman should be closely monitored.

Urine and vaginal culture: The vaginal discharge condition of pregnant women is questioned. If there is a change in the character of vaginal discharge, vaginal culture is performed. The most important cause of premature labor before the 36th week is infection. For this reason, urine culture should be performed at regular intervals throughout the whole pregnancy even if the patient has no complaints. Vaginal culture is also performed from at-risk patients. With vaginal culture, some bacteria in the birth canal can be detected.

Anti-D Gamma-globulin: If the maternal blood group is RH (-) and paternal blood group is Rh (+),anti-D Gamma-globulin is given to mother at 27-28 weeks of pregnancy. The baby's blood group is checked at birth. If the baby is Rh (+),one more dose of anti-D Gamma-globulin is made before the mother is discharged from the hospital. This injection is routinely administered after vaginal bleeding and amniocentesis in any period since 7th week of pregnancy.

NST (Non stress test): Nonstress test (NST) is performed with the 36th gestational week. NST is a simple and easy test that shows the baby's well-being in the womb. A special device is used for this test. This test is repeated intermittently until birth. NST shows the physiological state of the baby. During labor, the baby's heart rate is monitored with this device and its relationship with uterine contractions is evaluated.

Controls at the End of Pregnancy

Vaginal examination: A vaginal examination can be performed at 40 weeks of pregnancy control. However, if there is a suspicion of amniotic sac rupture, it is performed at a previous check-up. If labor does not start spontaneously, the waiting period is maximum 1 week.

Only about 5% of all pregnant women go into labor on the expected date of delivery. In pregnant women whose delivery time has passed, if the pregnant woman is seen every 2-3 days and the delivery does not start, the pregnant woman is hospitalized for artificial pain and delivery is started. In artificial pain, oxytocin hormone in the mother's blood is given to the pregnant woman in a controlled manner. This hormone triggers uterine pain and initiates labor.

It is no different from normal labor pain. In pregnant women who do not have cephalopelvic incompatibility or umbilical cord problems, this process largely results in delivery.

Cardiotocography record: It is done at about 40 weeks. Sensors placed around the abdomen are connected to a monitor or screen. The device records the fetal heartbeat and uterine contractions. It is repeated every 48-72 hours at 41 weeks and then until the time of delivery.

Other Tests That Can Be Done During Pregnancy

Looking for fetal DNA in maternal blood: It is used to look for any chromosome disorder, such as Down syndrome or Edwards syndrome. It is a blood test that can be done from 10 weeks of pregnancy. Fetal cells in the blood taken from the mother are examined.

The main difference with invasive tests (such as amniocentesis or chorionic biopsy) is related to risk. There is a slight risk of abortion in invasive tests. However, there is no risk of abortion in the blood test. The final results are different. In invasive tests, a complete gene map is obtained. In the blood test, only certain chromosomal diseases can be evaluated.

3D and 4D Ultrasound: In 3D ultrasound, a fixed three-dimensional image of the baby is obtained. Moving images can be obtained in 4D ultrasound.

GynecologistFunda Yazıcı Erol MDGynecology and Obstetrics
+90536 439 6621