Prenatal Care

Pregnancy is a 40-week-long process involving physiological changes in our bodies. In order to successfully complete this process, we need to ensure that we are healthy at the beginning and that our bodies are prepared for the hormonal changes.

To do this, we should consult our gynecologist and make sure that our general examination, smear test, routine blood tests, and ultrasound (to evaluate conditions such as ovarian cysts and uterine structure) are done, and even a breast examination to ensure our overall well-being.

If the expectant mother is overweight, it is recommended to lose weight before pregnancy. Investigations for anemia, jaundice, rubella, toxoplasmosis, and other infectious diseases are conducted, and treatment is planned accordingly. If the mother has diabetes, her blood sugar should be regulated before pregnancy. The expectant mother is informed about the risks of medication, smoking, and alcohol consumption. All women planning for pregnancy are advised to start taking the recommended dose of folic acid vitamin for neural tube defect prophylaxis. General information about nutrition, misconceptions, and facts is provided. Carriers of conditions such as hemoglobinopathies and cystic fibrosis are tested, especially for those living in high-risk areas.

Pregnancy Monitoring

Pregnancy monitoring involves regular examinations to assess the condition of the mother and the baby, provide information to the parents, and prevent or detect potential problems related to the mother and baby.

During the first 8 months, unless advised otherwise by the doctor, monthly check-ups are recommended, followed by biweekly visits after the 8th month, and weekly visits in the last month.

First Pregnancy Check-up

Ideally, the first check-up should be planned as soon as we realize our menstrual cycle has been missed or when the pregnancy test results are positive.

Although pregnancy is a natural process, it is a complex one in which many complications can occur.

***General complaints and discomforts should be evaluated, and a detailed medical history should be taken.

***Weight and blood pressure should be measured, and initial pregnancy findings should be recorded.

***Systemic examination and gynecological examination should be conducted, and if necessary, a vaginal culture and smear test should be performed (Vaginal examination during pregnancy does not pose any harm, contrary to popular belief, it does not cause a risk of miscarriage).

***Ultrasound is used to determine if the pregnancy is in the normal position within the uterus and to assess signs of viability. In the early stages, if the gestational sac is not visible, a vaginal ultrasound can be performed (again, contrary to popular belief, vaginal ultrasound does not pose any harm to pregnancy). If the pregnancy is still not visible, appropriate tests and ultrasound appointments recommended by the doctor should be scheduled to confirm the pregnancy and check if it is developing properly. It is crucial to differentiate ectopic pregnancy, which is one of the most important early pregnancy complications.

(Sometimes, despite a positive pregnancy test, the pregnancy cannot be detected, and there may be a loss due to a decrease in pregnancy hormones in the blood. This is called a chemical pregnancy and does not indicate any disease or pathology; it is simply the termination of an embryo that cannot develop further due to its inability to survive.)

Initial Check-up Tests:

– Complete blood count (CBC)

– Fasting blood sugar

– Blood groups of the mother and father

– Indirect Coombs test (IDC) if there is blood incompatibility

– Complete urine analysis (urine culture if necessary)

– Thyroid-stimulating hormone (TSH)

– Toxoplasma IgM and IgG

– Rubella IgM – IgG (measles tests)

– Cytomegalovirus (CMV) IgM and IgG

– HbsAg (if positive, the baby will receive an antibody injection after birth to prevent transmission)

– HCV test

– HIV (AIDS) test

– VDRL test for syphilis

– Biochemistry tests (cholesterol, kidney and liver function tests, etc.) are not routine tests during pregnancy. They should be performed if the mother is older or has certain systemic diseases.

Follow-up and treatment plans are created based on the results of the initial check-up and tests.

During each check-up, general complaints are listened to, systemic examination and ultrasound are used to monitor the progress of pregnancy. The mother’s weight gain, presence of edema (swelling), and blood pressure are monitored. The use of recommended vitamins, such as omega-3, iron, and magnesium during pregnancy, is evaluated based on the mother’s nutritional status and blood results and started or continued if necessary.

Subsequent tests may not be performed at every visit. However, depending on the condition of the mother, any deficiencies, and systemic diseases, the frequency of tests can be increased or adjusted.

In a normal pregnancy, the following tests are usually performed at specific intervals:

Between weeks 11-14:

At 11 weeks of pregnancy, the nuchal translucency (NT) thickness of the baby is measured during an ultrasound examination. The nasal bone is checked, as well as the development of the skull and extremities (arms and legs). On the same day, the dual marker test (blood test) is performed. This test is meaningful until the 14th week and is not conducted after that. It is a prenatal screening test that determines the risk of common chromosomal disorders.

Between weeks 16-18:

During this period, triple or quadruple tests are performed. These tests are also prenatal screening tests and are generally not performed if the dual marker test has already been done, except for the evaluation of neural tube defects, for which a second-level ultrasound may be added.

If the results of these tests indicate a high-risk condition, consultation with a perinatologist should be sought, and further invasive tests may be considered:

– Fetal DNA test from the mother’s blood

– Chorionic villus sampling (CVS)

– Amniocentesis (amniotic fluid sampling)

Between weeks 20-22:

Second-level ultrasound, also known as detailed ultrasound, is performed to check for any anomalies, abnormal development, or abnormal blood flow in the internal organs of the baby.

Between weeks 24-28:

– Complete blood count (CBC)

– Complete urine analysis

– 50-gram glucose tolerance test is conducted between weeks 24-28. If the result is higher than 140, a 100-gram OGTT test is performed. If a patient misses this timeframe and comes in at a later stage, fasting and postprandial blood sugar levels can be evaluated to assess their susceptibility to diabetes.

– If there is Rh (blood group) incompatibility, the IDC (indirect Coombs test) is performed at week 28. If the result is negative, it indicates that there is no significant impact of blood incompatibility between the mother and the baby. In this case, an Rh immune globulin injection is administered. If there is an impact (a positive indirect Coombs test), further tests are conducted to determine the extent of the impact on the baby.

Between weeks 35-37:

This period involves weekly monitoring. The baby’s growth, amniotic fluid volume, and fetal heart rate tracings are assessed, and the mother’s blood pressure and edema are carefully monitored.

– Complete blood count (CBC)

– Complete urine analysis

– Group B Streptococcus (b

acteria) screening

– Non-stress test (NST)