How Should Pregnancy Monitoring Be Done?
First Examination
In a patient with a missed period or a positive pregnancy test, the first step is to determine whether the pregnancy is normal or ectopic. An ultrasound examination is performed to visualize the gestational sac, its number, and its location. If the gestational sac is visualized normally, the pregnant woman should be re-examined approximately 7-10 days later to detect the baby’s heartbeat. During this period, there are specific tests that should be requested for every pregnancy. These tests include blood type, complete blood count, fasting blood sugar, urine analysis, and immune screening for certain infections (Hepatitis B, Hepatitis C, toxoplasmosis, rubella, etc.). Blood pressure and weight measurements of the pregnant woman should be taken from the first examination.
11-14 Weeks Screening
After the initial examination, the pregnant woman should be re-examined between the 11th and 14th weeks of pregnancy. During this period, the nuchal translucency of the baby should be measured, and on the same day, blood should be drawn to measure PAPP-A and free beta-hCG levels (dual test), and Mom values should be calculated. As nuchal translucency increases, the likelihood of genetic or structural anomalies in the baby also increases. In addition to nuchal translucency, the baby’s nasal bone can be examined to contribute to anomaly screening. Ultimately, the total risk calculation of both measurements is performed to determine how risky the pregnancy is for certain genetic diseases, including Down syndrome. If a high-risk situation is detected, chorionic villus sampling (sampling from the baby’s placenta) or amniocentesis (sampling from the amniotic fluid of the baby) is performed to definitively determine if the baby has a genetic disorder. From this period onwards, iron and vitamin supplements should be initiated for the pregnant woman. Additionally, stretch mark prevention creams may be provided during this examination.
16-18 Weeks Screening
In cases where the dual test has been performed, an alpha-fetoprotein (AFP) test should be requested to determine if there is an opening in the baby’s nervous system (neural tube defect). This period is also when the triple test (blood beta-hCG, AFP, u-E3) is still performed for cases where the dual test cannot be done or has been missed. Additionally, the quadruple test can be performed by checking inhibin-A during this period. In cases of a history of preterm birth or for patients at risk, cervical length can be measured, and if necessary, cervical cerclage (stitching of the cervix) can be performed.
20-24 Weeks Examination
During this period, a detailed ultrasound examination is performed to examine all of the baby’s organs and to detect structural developmental abnormalities to a large extent. Fetal echocardiography may also be performed during this period, especially in cases where there is a history of heart problems in the mother or child, etc. Additionally, in this detailed examination, blood flow in the vessels supplying the baby and the uterus is evaluated. The presence of resistance in blood flow may indicate the development of preeclampsia in the later stages of pregnancy. If there is suspicion of a genetic disease during this period, cordocentesis (sampling from the baby’s umbilical cord) is performed to make a diagnosis.
24-26 Weeks Examination
During this period, a 1-hour 50g glucose challenge test should be performed to screen for gestational diabetes. If the 1-hour value in this test is higher than 135-140 mg/dL, a 3-hour 100g glucose tolerance test should be performed to make a definitive diagnosis. If gestational diabetes is diagnosed, dietary therapy is initially applied. If the desired blood sugar values cannot be achieved, insulin therapy may be initiated.
Examinations After 32 Weeks
At 32 weeks of pregnancy, fetal heart monitoring (NST) is requested to check the baby’s heart rate and the presence of any contractions in the uterus, thus attempting to identify the risk of preterm birth. Additionally, blood count and urine analysis are repeated during this week to investigate anemia and the presence of bacteria in the urinary tract. Generally, from this point on, examinations are continued every 2 weeks using NST and ultrasound to monitor the baby’s growth and development. Starting from the 36th week, the monitoring frequency should be weekly, and monitoring should continue until the 40th week. If birth has not occurred by the 40th week and there is no sign of danger (such as a decrease in amniotic fluid), monitoring can continue until the 41st week with NST and amniotic fluid tracking every 2 days.
Please note that the content on this page is for informational purposes only, and it is essential to consult your doctor for diagnosis and treatment.
Content Update Date: December 26, 2022