Routine Examinations and Tests in Pregnancy
In this section, we will talk about the tests and follow-ups we perform during pregnancies that we define as ‘low risk’ in pregnancy.
The definition of “low risk pregnant” is as follows:
- Having pregnancy above 16 and under 35
- Have not had a miscarriage of 2 or more before
- No preterm birth history
- Does not have chronic disease such as diabetes, hypertension and thyroid diseases
- There is no congenital anomaly in the womb
- No previous gynecological disease or history of gynecological surgery
- Those who did not give birth to a baby with chromosomal anomaly during their previous pregnancy
- No family history of hereditary disease (chromosomal anomaly or infant with congenital anomaly)
- Marriage of non-related couple
- Without obesity
- The mother body height is not short
- High sociocultural level
- Without heavy working conditions (occupational group is also a risk factor)
- Without addictions such as smoking, alcohol and drugs
- No psychiatric illness or predisposition
- Mothers who are under the age of 40 are considered low risk.
It should be emphasized that entering your pregnancy in the low-risk group indicates that pregnancy will go largely without any problems. However, of course, in the course of pregnancy, problems in high-risk groups can be encountered and pregnancy will be monitored considering these possibilities. Being included in the high-risk group also requires more detailed monitoring and necessary measures are taken during the follow-up depending on what the risk is. Starting a pregnancy with high risk does not necessarily mean that pregnancy will go problematic.
1) Gynecological Examination:
It is one of the most basic steps of pregnancy examination during the first application during pregnancy. Only ultrasonography can never cover adequate basic examination principles. It only allows us to determine whether we can see the gestational sac in the womb or to determine the gestational week. However, infection and cervical evaluation cannot be done by ultrasonography. In our country, the wrong belief that vaginal examination during pregnancy is still low still prevails, and pregnant women avoid vaginal examination due to this fear. This causes the risk of infection that can lead to miscarriage or premature failure to be determined and cervical cancer screening cannot be performed when the cervix is observed and pap-smear is not performed. Listening to your doctor’s scientific recommendations and providing your necessary and sufficient conditions for your examinations will fulfil a very important condition for your pregnancy to be healthy. There is no medical evidence that scientifically vaginal examination causes miscarriage.
It is known that evaluation of cervix with vaginal ultrasonography is important in evaluating risk factors of preterm birth, while detailed ultrasonography is performed between 18-23 weeks in the following weeks except pregnancy. This is not a routine clinical practice. However, some doctors use it as a routine practice. Although there is no risk of application, its benefit in determining the risk of preterm birth is quite evident.
Apart from this, the complaint of pain during pregnancy, the presence of coloured, fragrant discharge or risk of amniotic water discharge may also require vaginal examination besides the usual discharge. In these examinations, tests such as vaginal ultrasonography and culture can be added.
In addition to gynecological examination, respiratory, digestive, muscular-joint, central nervous system and urinary system examinations can be performed in necessary conditions and in the presence of complaints, and necessary consultations can be requested.
2) Blood pressure and weight measurements:
Blood pressure measurement and weighing follow-up are performed starting from the first application of pregnancy. Blood pressure measurement must be done with the classical method, using the sleeve suitable for the arm, while the pregnant woman is in a sitting position and rested, on the right arm. This measurement is done in every examination of the pregnant woman and is the most important guide in the hypertensive diseases of pregnancy. Weight gain should be directed in line with the ratio of the current weight to ideal weight at the beginning of pregnancy. Although the ideal weight is between 9-13.5 kilos, it is not possible to standardize this ratio. Because, it may be appropriate for a woman who is pregnant well below her ideal weight to gain a little more weight for the healthy development of her baby, while 9-10 kilos may be sufficient for the woman who is pregnant above her ideal weight.
The fact that weight gain during pregnancy is a cause for anxiety will make things more difficult and should not be a cause for anxiety. Normally, staying away from two people and being able to walk enough will sometimes give an opportunity to escape. The most appropriate follow-up takes place in the woman’s home with her own scales in the morning with a measurement on her empty stomach, naked and after the toilet. Weighing once in 2-3 days a week will be sufficient. Apart from that, your scale will be checked at the doctor’s controls and necessary communication will be provided regarding adequate and balanced nutrition.
3) Routine tests done in early pregnancy:
Routine blood and urine tests, which are usually done within the first 12 weeks of pregnancy, but ideally between 5-8 weeks, are primarily for the routine control of the mother. Because the expectant mother serves her baby free of charge for weeks and months.
* fasting blood sugar for early diabetes screening
* TSH to evaluate thyroid hormone release
* hemogram for preliminary assessment of anemia and other blood diseases
* Complete urine and urine culture for the evaluation of urinary tract infection and other urinary tract problems (urinary tract infections during pregnancy can be unfavorable and may lead to miscarriage and premature births, pregnancy should definitely be done in the early period of pregnancy. does not rule out)
* Infection screening: Rubella, Toxoplasma, Cytomegalovirus, Hepatitis B and hepatitis C, Anti HIV and VDRL. Here, in the first 12 weeks and maybe later, it will be planned to determine and treat infections that may harm the baby, if necessary, further investigations regarding the presence of infection in the fetus, in case of hepatitis B carriage, hepatitis vaccination will be given to babies immediately after birth.
* When the mother blood group is negative and the father blood group is positive, there is blood incompatibility, and the test of blood incompatibility, called indirect coombs, is carried out periodically. However, it is beneficial to perform an incompatibility test since antibodies may develop to the red blood cells of the baby without blood incompatibility.
4) 11-14 weeks screening test (dual test):
It is a screening test for the screening of Down Syndrome and other trisomy diseases. 11-14 of pregnancy. It is based on the principle of obtaining a risk screening value by combining the head-butt distance measurement, nape skin thickness and nasal bone measurement between the weeks of the fetus and the papp-a and HCG values obtained in the blood taken from the mother with the maternal age and family history.
5) Quad screening and integrated testing:
These tests, which are done between 15-19 weeks and whose screening value increases according to the order of spelling, are performed in line with the searches that will be given by the doctor on the basis of the woman’s history and risk determination and it is not routine. Of course, it will increase the screening rate and comfort of trisomy anomalies, especially Down syndrome, but will also increase the rate of amniocentesis due to false positivity rates. The decision to take these tests should be made together by the patient and the physician, taking into account the patient’s age and history.
6) AFP (Alpha feto protein):
Alpha fetoprotein screening used for screening of central nervous system defects called neural tube defect, screening for Down syndrome and screening risk factor for preterm labour is one of the blood values examined in the blood tests mentioned in article 4. Since the central nervous system can be evaluated very well with high resolution ultrasonography assessments, some physicians do not prefer to look at AFP and this attitude is not wrong. However, in the absence of triple, quadruple and integrated tests, it is beneficial in determining academic risks and it is useful to look at. Because small defects may not be observed in ultrasonography and AFP can easily diagnose them. I also find it convenient to do AFP evaluation in my practice.
7) Free Fetal DNA in Maternal Blood:
* Advanced maternal age,
* Detection of screening positivity in screening tests including double, quad test and integrated test,
* There is a numerical chromosome anomaly in the mother or father candidate,
* Translocation carriage in terms of chromosome disease in mothers or fathers,
* Family history of chromosome anomaly,
* It is the determination of chromosome anomaly marker in ultrasonography.
Invasive methods such as amniocentesis can give an idea about the numerical anomalies of chromosomes without the possibility of fetal loss and other complications.
8) Routine Ultrasonography:
It is used in the early period of pregnancy to rule out ectopic pregnancy and then to determine the gestational week correctly. Then, ultrasonographic data of screening tests at 11-14 and 16-19 weeks are taken there and screening of chromosomal and structural anomalies is performed by detailed ultrasonography between 18-23 weeks.
In the evaluation of fetal growth and well-being, ultrasonography can be safely applied by increasing the frequency a little more frequently in the monthly and later weeks of pregnancy. It is easily applicable because it does not contain radiation. However, since heat is produced during Doppler applications, these applications should be performed less frequently and only when necessary, taking into account the heat damage that the fetus may be exposed to. In Doppler measurements, the adequacy of blood circulation to the fetus, fetal growth and weight gain limitation and the risk of preeclampsia can be determined.
In cases where the fetus’s weight gain is low, the mother can be helped to review her rest and diet. In addition, in cases where the fetus gains a lot of weight, it may be aimed to conduct a pregnancy diabetes screening earlier and in detail.
9) Sugar loading:
Sugar loading during pregnancy is a routine practice according to current requirement 12-28. It can be applied in weeks. It is for screening gestational diabetes, which occurs when the placenta is normally exaggerated by the physiological condition based on keeping the blood sugar high for the fetus to grow.
1 hour loading with 50 g glucose which is only screening test applied in routine. However, in cases of routine loading of 50 g, maternal candidates whose satiety blood sugar is above 140, 3-hour loading test can be performed with 100 g glucose in cases where high weight, advanced maternal age, having given birth to a large baby, or if the current baby is large in ultrasonography.
I share with every couple that the expectant mothers should stay away from media criticism and suggestions that are not experts in the subject and that the gestational diabetes should be screened very carefully due to the serious risks brought to the baby.
10) Non stress test (NST):
The non-stress test, which evaluates the well-being of the fetus in the womb, also gives the uterine contractions in the form of a chart simultaneously with the heartbeat of the fetus. It can be applied routinely after 36 weeks. However, it does not have to be applied. Although it can only be applied in any risk suspicion, it can be used much earlier in cases such as preeclampsia and diabetes. The threat of preterm birth is actively used in follow-up during diagnosis and treatment.
11) Other blood tests:
Sensitive pregnancy test in the blood can be performed at one or regular intervals to diagnose pregnancy per pregnancy and, if necessary, to rule out ectopic pregnancy. Blood test should be done for blood group determination and if necessary, it should be done for the father. In case of gestational diabetes, hba1c and blood biochemistry can be checked if necessary. Blood biochemistry preeclampsia is also widely used during diagnosis, follow-up and treatment. In the presence of a thyroid problem, it may be necessary to repeat thyroid tests periodically. In case of suspicion of infection, blood tests may be required for the agent. I also care about taking vitamin D during pregnancy due to the effects of replacing the deficiency on maternal-infant health and I try to take care of every patient.
The differences in the follow-up of high-risk pregnancies are all about what the risk is and whether several of them are together, and high-risk situations related to pregnancy are described individually under separate headings.