Controls and tests waiting for you during pregnancy
The controls and tests, which will start from the moment you first identify your pregnancy, will continue for 9 months. Being sloppy or ignoring your doctor's warnings may result to you. You will find in our file what reviews await you!
Finally, you received the news from your doctor: You are pregnant! Even though there is still a sesame seed in you, with some symptoms "I'm here!" development of your baby, your stomach will grow when you are curiously mixed with excitement. Of course, your doctor will tell you what to do in due course, but like many curious mothers, we are sure that you want to learn early what tests and tests you will go through during your entire pregnancy. Moreover, please do not deny the importance of first examinations and checks as soon as your pregnancy is determined. Because early examination is very important in terms of detecting negative situations and taking precautions! What controls are waiting for you, Gynecology and Obstetrics Specialist. We learned from Kagan Kocatepe. He shared all the details with our readers. Kagan Kocatepe warns the expectant mothers not to interfere with their routine controls even if they have no complaints. Importance of doctor checks during pregnancy Doctor checks performed at regular intervals by a gynecologist and obstetrician during pregnancy are called prenatal examinations. Even if there is no complaint, it is very important for the mother to visit the doctor at regular intervals for both her own health and the health of her developing baby. Most of the mothers have a healthy pregnancy without any problems and have a healthy baby after a completely normal birth. The reason why we gynecologists and obstetricians exist is not to intervene in a problem-free pregnancy, but to detect a possible problem at an early stage and to try to correct it before it reaches an irreversible stage. Mother and baby deaths were attributed to "fate" years ago. Now it; A significant number of cases of congenital defective or stillborn babies have now become controllable.
Early pregnancy diagnosis
For many diseases that can be easily treated when diagnosed early, actions to be taken in the late period will be limited and situations that endanger the prospective or infant health will arise. Although there are no complaints, there are many examples of an unhealthy pregnancy:
Ectopic pregnancy and mole pregnancy cases may not show any symptoms during early pregnancy. These two conditions are abnormal forms of pregnancy that can be treated successfully when diagnosed early and delayed diagnosis. A simple examination and ultrasound examination during early pregnancy is sufficient to diagnose and take precautions against abnormal pregnancy.
Certain bacteria in the urinary tract, especially during pregnancy, can reproduce insidiously without any symptoms and as a result of this reproduction can cause serious urinary tract infections. It is of great importance to detect this with a simple urine culture test. When this symptom is diagnosed in the non-symptomatic period, bacteria are easily removed from the body and precautions are taken before serious infections occur. Urinary tract infections with fever can present serious hazards to both the infant and the mother.
A baby with a disability that is absolutely impossible to survive at birth or with a physical disability that cannot lead a normal life (as in cases of infant's brain tissue development) can be diagnosed by an early ultrasound examination and this pregnancy can be terminated without risking the expectant mother. Without this examination, the baby may go to the end of pregnancy despite being severely disabled. When the baby is born, it either dies early or may be a serious problem for the family and society as long as it lives.
Preeclampsia (pregnancy poisoning), which is characterized by increased blood pressure, loss of protein in the urine and gradual deterioration of the functions of the organs, has much to be done before the life-threatening condition begins to fully affect and affect the functions of the organs. This condition, which can be detected in early periods by simple blood pressure measurement and some simple tests, is often more difficult to treat as soon as it starts to show symptoms. You should regularly go to prenatal examinations, even if you have no complaints for the early diagnosis of this condition, which seriously puts the life of the mother and the baby at risk.
Controls should begin as soon as your pregnancy is diagnosed
Ideally, if the expectant mother is suspicious of pregnancy, or if the pregnancy test is positive or performed by herself or in the laboratory, the doctor should be checked. The aim of starting the examinations in the earliest period is; The aim of this study is to draw a follow-up chart by revealing risk factors, to diagnose abnormal pregnancy conditions that can be detected in the early period such as ectopic pregnancy and mole pregnancy and to determine whether the gestational week determined by the last menstrual period and the pregnancy week determined by ultrasonography are compatible with each other. The importance of the first doctor check is less emphasized. For example; When the diagnosis of ectopic pregnancy is made in the early period, the possibility of drug treatment is extremely high. If surgery is necessary, laparoscopy provides less damaging treatment. In determining the gestational week, especially in the first trimester ultrasonography, the error margin is as low as ± 3 days, which enables the confirmation of the gestational week. This leads to cases where preterm birth should be decided. It provides accurate determination of the date when the labor should be initiated by the physician in cases such as myocardial infarction. Mothers who cannot apply in the early period should also apply for medical examinations as soon as they are diagnosed with pregnancy.
How often are prenatal examinations performed?
The most important factor that determines the frequency of prenatal examinations and the quality of examinations is the risk factors that are investigated and determined in the first examination of the mother. Even if the mother does not have any complaints, she is ideally up to four weeks of gestation until the 28th week of pregnancy, 28-36. between the weeks of two weeks intervals, 36 weeks from birth to weekly medical examination should come. In case of an additional complaint, a new doctor should not be expected and the doctor who follows the pregnancy should be informed about the situation and should be consulted for additional examinations if the doctor deems necessary. In the presence of risk factors in pregnancy, this follow-up scheme changes completely. According to the characteristics of the risk factor or risk factors, doctor checks are performed more frequently and in some cases different examinations are performed than the examinations performed for mothers without risk factors. Keep in mind; you will have the chance to benefit from early diagnosis and treatment methods if you have abnormal pregnancy-related conditions.
ROUTINE APPLIED REVIEW
Low-risk pregnancies are called low-risk pregnancies that do not have any disease before or during pregnancy, have not given birth before, or have given one or more healthy births, have no family disease, and have no problems with her baby or herself during pregnancy. In the course of low-risk pregnancies, it is unlikely that an abnormal condition will occur during and after delivery. In the follow-up of these pregnancies, the same basic examinations and tests are generally applied. Examinations performed in low-risk pregnancies are called routine examinations. In case of risk factors that exist before or during pregnancy, some different examinations are performed in addition to routine examinations for further examination. These examinations are also called advanced examinations during pregnancy.
Gynecological (pelvic) examination and Papsmear examination
If not performed in the pre-pregnancy period, a pelvic examination is generally performed at the first pregnancy examination and a possible genital mass, infection, congenital genital defects, pre-cancerous lesions and other abnormal conditions that may adversely affect pregnancy are revealed. Ultrasonography and papsmear examination is added to the examination and the evaluation is completed.
System examinations
In general, the first pregnancy examination of the digestive system, heart and circulatory system, respiratory system, muscles and joints, nervous system and mental condition complaints about the question and if necessary, these systems are examined by gynecologists and obstetricians.
In case of abnormal finding, the mother is referred to the relevant doctor. In the first examination, breast examination is performed when necessary and a possible mass, congenital breast defects and abnormal conditions that may prevent postnatal breastfeeding are detected and necessary measures are taken.
Blood pressure measurement
By using a suitable cuff length from the right arm of the expectant mother, the blood pressure value obtained while sitting in a calm state is recorded on the tracking card. Blood pressure measurement is repeated every pregnancy examination. Blood pressure value is the most important criterion in the early diagnosis of preeclampsia.
Weight measurement
It is more appropriate for the expectant mother to make her own weight measurement at home on an empty stomach in the morning and to inform her doctor at the examination. Excess weight gain, especially in a short time, may be a precursor to preeclampsia. Excessive weight gain over the long term (weeks) may be due to unnecessary intake of carbohydrate and fat-rich foods, or it can be a harbinger of diabetes. Of course, a large baby that grows very fast can cause the mother to gain weight fast.
Evaluation of abdominal growth
At the beginning of the second half of the pregnancy, the uterus reaches the level of the navel and is felt by hand. In the following weeks, when the bladder is empty, the distance in centimeters measured by the tape measure between the bone forming the pubis peak and the top level of the uterus in the abdomen gives pregnancy week with little margin of error. Twin pregnancy, obesity, bladder overloaded with urine may cause misleading results. Some doctors prefer ultrasonography for each pregnancy examination and do not do this measurement.
Listening to the baby's heartbeat
During pregnancy examinations without ultrasound, the doctor listens to the baby's heartbeat with the help of special instruments. One of these instruments is a simple plastic or metal instrument called a child's heart sounds (EQS) tube. The doctor puts one end of the device on the mother's abdomen and rests the other end on his ear to hear the baby's heart beat. With this device, the doctor can hear the baby's heartbeat usually from the 20th week onwards. Another instrument used for this purpose is a small battery-powered hand-held device called the Doppler device. This device, which allows the baby's heart to be heard during the weeks of pregnancy, is placed on the stomach of the expectant mother. The speaker can also hear the baby's heartbeat through the loudspeaker.
LABORATORY EXAMINATIONS
Determination of blood groups
If it is not known before, the blood groups of the mother and father are generally determined in the first pregnancy examination and recorded on the follow-up card. Blood type can be determined in the blood taken from the finger. Rh incompatibility is mentioned when the blood type of the mother is Rh (-) and the father is Rh (+).
Complete blood count
In general, blood counts are performed once during the first pregnancy examination and once or twice during the following weeks of pregnancy. If necessary, this examination may be carried out in a larger number. In its simplest form, a blood count determines the hemoglobin concentration of the blood, and thus determines whether the mother has anemia. In addition, blood red blood cell density, white blood cell count, platelet count, the size of the red blood cells and some other features that automatically determine the speed of blood can be informed about the various features. White blood cell count gives important information about the diagnosis of infectious diseases, hemoglobin density, hematocrit and red blood cell count in the diagnosis of anemia, red blood cells' average hemoglobin content and size determine the cause of anemia, and platelet count provides important information about the adequacy of these cells to stop bleeding.
Complete urinalysis (TIT)
Urine is a mirror of the body. Therefore, urine analysis is frequently used during pregnancy, and perhaps this is the most commonly used examination throughout the entire pregnancy. In the complete urine analysis, as well as the density of the excreted substances from the body, the urine sediment called urine sediment looks for living cells such as white blood cells, red blood cells and bacteria, and substances that may indicate urinary tract stones. Urine protein (albumin), acetone (ketone), the presence of bilirubin, urodynogenesis to be found to be extremely increased always requires further examination. The presence of glucose in urine is considered normal to a certain degree in pregnancy, but requires further examination. With full urinalysis in pregnancy:
Urinary tract infections may be detected (more than normal red blood cells or white blood cells are seen in the urine sediment) and this is confirmed by urine culture.
The general nutritional status of the expectant mother with excessive nausea and vomiting during early pregnancy can be evaluated (acetone (ketone) output in the urine indicates hunger and ketone positivity increases in proportion to the degree of hunger).
Preeclampsia can be diagnosed with the presence of protein in the urine with the rise of blood pressure in the later stages of pregnancy.
It can be assessed whether the mother is drinking enough water (when insufficient water is drunk, the color of the urine becomes darker and the density increases).
Urine culture and antibiogram
Pregnancy facilitates the development of urinary tract infections. The presence of white blood cells, red blood cells and bacteria in the urine sediment indicates urinary tract infection and requires antibiotic treatment. However, since antibiotics do not affect all kinds of bacteria, it is more appropriate to treat the infection by determining the genus of the bacteria by urine culture. The bacteria present in the urine sample taken under appropriate conditions are produced by adding special nutrients ("cultured") and the sensitivity of the bacteria to some antibiotics is measured. If there is no growth in culture, it is referred to as "sterile", that is, urine that does not contain bacteria to require treatment.
Blood infection screening tests
Blood toxoplasmosis, rubella and syphilis screening tests, if necessary, are preferably performed at the time of pregnancy. For this purpose, IgG and IgM type antibodies specific for toxoplasmosis in blood taken from mothers; Rubella-specific Rubella IgG and IgM antibodies and syphilis are usually referred to as VDRL. When these three types of infection are passed during pregnancy, it is more appropriate to identify them in the pre-pregnancy period because they can cause birth defects.
If the above examinations are not performed in the pre-pregnancy period, some of the doctors believe that the same examinations can be performed at the beginning of pregnancy, while some doctors believe that these examinations should only be carried out for mothers with symptoms specific to the above disease. Which opinion is more valid is still controversial. Some doctors will examine TORCH to expectant mothers ("Torch" and toxoplasma, others ("others"), Rubella (rubella), CMV (cytomegalovirus) and HSV (Herpes simplex virus) is a word under the name of a review) recommended. This examination, which was conducted to identify the abovementioned infectious agents in the blood of the expectant mothers, has become more and less frequently applied since it is expensive and its interpretation is full of contradictions. HIV (AIDS) causative screening tests should be performed towards the end of pregnancy in prospective mothers with hepatitis B and risk.
Triple Test and the new version Quad Test
Your pregnancy is 16-20. is a blood examination between the weeks. The risk of Down syndrome, Trisomy 18 and neural tube defect is determined in the baby by determining the level of various substances in the blood taken from the mother. The most important point to note is that the triple test does not diagnose the risk of carrying babies with NTD, Trisomy 18 and Down syndrome by screening only. The purpose of screening tests is to identify people at high risk for a particular disease, that is, to determine who is required to apply the test to establish a true diagnosis of a disease. The definitive diagnosis of Down syndrome is made by examining the chromosomes of fetal cells obtained by amniocentesis. Since we cannot apply amniocentesis to every expectant mother, we need to know who we should apply. Here the triple test helps us to distinguish it. In recent years, in order to increase the sensitivity of the Triple Test, the Quadruple Test, which was developed by adding one more hormone to the Triple Test, has been introduced. This test is expected to replace the Triple Test quickly.
Comparison of triple test and 11-14 test (Binary Test)
In determining the risk of Down syndrome, especially the most important features of the 11-14 test, which has been applied with increasing frequency since the end of 2000, are 11-14. The second important feature is that the sensitivity of the test is significantly higher than the Triple Test.
Diabetes screening test
Pregnancy is a condition that increases the risk of developing diabetes, especially in sensitive individuals (overweight mothers, mothers who have diabetes in their families). That is why mothers are 24-28. they are subjected to a sugar screening test between weeks of pregnancy. In this test called PPG (postprandial glucose = satiety blood sugar), the mother is given 50 grams of glucose ("pure sugar") regardless of whether she has eaten or not at any time of the day and after one hour the blood sugar is measured. If the test result is found above a certain value, then a sugar loading test with 100 grams of glucose is performed. In the presence of some risk factors, the sugar screening test with 50 grams may be performed at an earlier stage of pregnancy or the sugar loading test may be used directly instead of the sugar screening test.
Blood biochemistry
Many approaches to requesting blood tests to evaluate the functions of organs, especially the liver and kidney, during pregnancy, especially in the early stages of pregnancy, are common among doctors. It is still a matter of debate whether it is necessary to request these examinations from a mother who does not have a specific disease. Once the pregnancy begins, blood biochemistry has undergone significant changes. Consequently, the normal values of the substances in the blood vary and may be difficult to interpret, and even misinterpretations can be made. In my opinion, "blood biochemistry measurements" should preferably be performed in the pre-pregnancy period. Measurements made during pregnancy should be interpreted very carefully. The examinations should be in the form of blood counts (described above), creatinine (to assess renal function), SGOT and SGPT (to evaluate liver function), blood glucose at any time taken into account when eating, and TSH (to evaluate thyroid gland function). will be enough.
IDC (Indirect Coombs Test)
It is an examination conducted only for mothers with blood mismatches. Antibodies that are likely to develop against the red blood cells of the baby at regular intervals are determined by this method. When antibodies are positive, further investigation may be required.
ULTRASONOGRAPHY IN PREGNANCY
The importance of ultrasonography during pregnancy
Nowadays, it is recommended that every prospective mother should undergo an ultrasound examination at least twice, but in most cases the entire pregnancy is performed several times. Ultrasonography is of great importance in the first pregnancy examination and preferably in the first weeks of pregnancy. This ultrasound confirm the accuracy of the "last menstrual (menstrual) date" (SAT); Determining the week of pregnancy among mothers who do not know SAT; ectopic pregnancy; early detection of conditions such as mole pregnancy; It is extremely important to detect genital mass lesions such as uterine fibroids or ovarian cysts that may have a negative effect on pregnancy and to reveal a possible multiple pregnancy. Some doctors prefer to perform an ultrasound examination at each pregnancy examination. This application is not absolutely necessary and is not possible in our country's economic conditions, but the first ultrasound scan for birth defects in babies 19-23. It is important to perform a detailed ultrasound examination once between weeks of pregnancy. Determination of abnormal pregnancy conditions (ectopic pregnancy, mole pregnancy, etc.), detection of congenital defects incompatible with life (such as anencephaly (absence of brain tissue)), monitoring of the development and well-being of the baby, and monitoring of pregnancy detection, leading to a placenta diagnosis that does not allow for normal birth) and the baby's health. Therefore, pregnancy and ultrasonography are now inseparable. In all cases where the baby is suspected to have survived, except routine ultrasound examinations (such as the threat of miscarriage, no baby movements being felt, stopping the growth of the abdomen); when intrauterine growth retardation is suspected; ultrasound examination is repeated in all cases (feverish infection, high blood pressure, pain). Ultrasonography is part of the training of obstetricians and gynecologists, and therefore, in most cases, each specialist prefers to perform the ultrasound examination of the pregnancy she is following. Since it works with sound waves, no harmful effect of ultrasound examination on living tissue has been detected so far.
ADVANCED EXAMINATIONS IN PREGNANCY
11-14 test
In Turkey, Trisomy 21 (Down's Syndrome) is still the most common test used to predict the risk of Triple Test. However, the baby's 11-14. The risk of Down Syndrome can be determined more precisely than Triple Test by measurement of nuchal translucency thickness and bladder distance (BPM) between the weeks of pregnancy, measurement of some substances in blood taken from the mother and accompanying by entering the values obtained from them into a computer and using a special program. 11-14 test is a new study that has just started to be used in our country. Although it is expected that the Triple Test will replace the risk of Down Syndrome in the following years, it is not possible to perform this test for all mothers in our country for the time being. Nowadays, some doctors only perform the 11-14 test, while some only perform a Triple or Quadruple test, and some perform both the Dual Test and the Triple or Quadruple test together.
Second level ultrasound
In cases where there is a high risk of congenital defective babies (eg: having a baby with a birth defect, having diabetes, having a history of birth defect in close relatives) or in cases of suspected birth defect or congenital defect on first level ultrasonography ultrasound examination performed in an upper center to confirm the diagnosis. In this upper center, a definite diagnosis is made after the evaluation or evaluations made by the perinatologist. In some cases, additional diagnostic procedures (such as amniocentesis) may also be required for diagnosis.
Doppler screening test
Made works; 20-24. In the following weeks, preeclampsia, intrauterine growth retardation, premature separation of the placenta and sudden death of the baby in the uterus can be identified. Based on these data, blood flow of both uterine arteries ("uterine artery") is measured by Doppler device and visualized blood flow waveforms are visualized on the ultrasonography screen.
Should the Doppler screening test be applied to every expectant mother?
Doppler examination requires the presence of a special and expensive device connected to the main unit of the ultrasound device and the examination probe, and the person performing this examination must be trained. Therefore, it is not possible to apply Doppler screening test to all expectant mothers either in our country or in other countries. For the time being, the most sensible one is to apply the Doppler screening test to mothers who are at high risk for the development of the abovementioned abnormalities.
Interventional diagnostic tests
These methods are used to confirm the diagnosis, especially in the presence of suspected chromosomal defects in the baby and in some other cases. Amniocentesis is the most common procedure.
amniocentesis
Amniocentesis is the most common diagnostic test that requires intervention. Most often for advanced maternal age, the diagnosis of Down's syndrome and 11-14 test or triple test when the risk of further investigation and diagnosis is usually to 16-20. weeks. Amniocentesis is also used in cases where neural tube defect is suspected, in the diagnosis of some infectious diseases in the infant, in cases where some metabolic diseases are suspected in the infant and in the measurement of some substances in amniotic fluid.
What is amniocentesis?
Amniocentesis (AS) is the name given to the process of reaching the uterus and the amniotic fluid in which the baby is swimming with a needle through the abdominal skin of the expectant mother. In addition to the above reasons, AS can be used for therapeutic purposes in cases where the amniotic fluid is more than normal in order to relieve the expectant mother, or for diagnostic purposes such as investigating the lung maturity of the baby. With the development of genetic science, not only obvious chromosome number defects but also diseases related to single gene defects can be recognized in the baby and the number of single gene diseases that are recognizable is increasing.
When is amniocentesis performed?
Diagnostic AS is usually 16-22. applied between weeks of pregnancy. The reason that the diagnostic AS is administered between these weeks of gestation and is not suitable for further weeks of pregnancy is that the result can be reported from the genetic laboratory in as long as 2-3 weeks. Because the small number of cells belonging to the baby in the liquid taken (cultured) and the number that can be examined requires reaching this period. In this case, when the diagnosis of genetic disease comes from the laboratory, pregnancy also progresses. In recent years, a chromosome analysis technology called FISH can provide information about the chromosomes of the baby in amniotic fluid within 24-72 hours. However, FISH technology is relatively expensive and cannot give definite results. Therefore, FISH is not used as a definitive diagnostic method, but as a pre-diagnostic method. For the final result, the results of the examination of the infant cells obtained from amniotic fluid cultures are expected.
Chorionic villus biopsy
It is the process of taking a biopsy from the structures called the villus of the baby either vaginally or from the abdomen in the early stages of pregnancy. It is used in the diagnosis of chromosomal anomaly. The advantage of amniocentesis is that it can be performed much earlier in pregnancy and thus can be diagnosed earlier.
KS (Cordocentesis)
15-17. It is the process of reaching the baby 's cord with a needle from the mother' s abdomen and taking the blood. It is often used for the diagnosis of rapid chromosomal defect in cases that are late for amniocentesis. In addition, cordocentesis is also used in the early diagnosis of infant's blood and metabolic diseases and infections, and in assessing the anemia of the infant in cases of blood incompatibility. Blood flow can also be applied to infants who are highly bloodless due to blood incompatibility by entering the baby's vein through cordocentesis.
Fetal echocardiography
Second level ultrasonography is a special form of ultrasonography used in cases where there is a suspicion of a heart defect in the infant or when there is a high risk of developing a heart defect in the baby (such as when the mother is a diabetic). It is usually applied from the 22nd week.
TESTS EVALUATING THE BABY'S WELL
These tests are used to determine whether the baby is in good condition before birth. In general, they are used to examine whether it is inconvenient for the baby to continue to live in the uterus.
Non Stress Test
It is a test used as a first step in determining whether the baby is in distress based on the course of the baby's heartbeat and its relationship with the baby's movements (Non stress: a concept used to mean no labor).
In which cases is it applied?
Although NST is currently a candidate for routine testing, it is used as a first-line test in the assessment of infants who are likely to become distressed, and in all cases where the baby is suspected of having distress (such as decreased baby movements). Usually it is administered weekly, but once every three days when the baby is at high risk of distress, such as lapses, intrauterine growth and preeclampsia, and when the baby's condition changes rapidly, such as early arrival of the water, and often in all these cases, amniotic fluid can be used for examination. Volume evaluation is also added.
NEW DEVELOPMENTS
Four-dimensional ultrasound
Four-dimensional ultrasonography is a type of ultrasound developed in recent years. The operating principle is the same as with conventional ultrasonography.
Methods on the horizon
Detection of the baby's cells in the mother's blood: During pregnancy, very few of the baby's cells pass into the blood of the expectant mother and this is normal.
A method in the maturation stage: The purpose of the amniocentesis and other interventional diagnostic tests mentioned above is to obtain the cell of the baby. Although these methods are highly effective in obtaining detectable cells, each has a risk of losing the baby at various rates. In order to reduce this risk to zero, the baby's cells are tried to be obtained from the blood of the expectant mother. However, this method is not as easy as it seems. First of all, the current technology is insufficient to investigate and investigate these cells, which are present in a very low number of mothers. Another problem is that the cells passing from the baby to the expectant mother can sometimes remain in the mother's blood for years. This is a serious problem that can lead to a misdiagnosis if the cell obtained belongs to one of the previous pregnancies, not the current baby. Another problem is the ability of the expectant mother to effectively distinguish between her own cells and the baby's cells. To summarize briefly, this method, which is expected to replace the interventional diagnostic methods in the future, is still in its maturity stage and is not currently available for clinical use.
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