The period from the moment pregnancy is diagnosed until birth is the period when the biggest psychological and physical changes in a woman's life occur. During this period, the gynecologist evaluates the health of the mother and the baby and makes recommendations for the continuation of the mother's health. So, there are two main elements of the pregnancy follow-up process; The first is to evaluate the growth and development of the fetus, and the second is to evaluate the effects of physical and psychological changes in the mother due to adaptation to pregnancy.

Pregnancy is divided into 3 periods (trimesters), each consisting of 3-month periods. Each period has a different importance. For example, screening for baby-related anomalies is performed in the first two periods. Pregnancy-related high blood pressure and diabetes occur in the last three months. Ultrasound examination of pregnant women can also turn into a ceremony. Mother-in-law, siblings and close friends will also attend this examination and will want to satisfy their curiosity about seeing the baby. For this reason, a woman may skip her annual pap smear check, but she rarely forgets her pregnancy check-up.

Preconceptional examination

In fact, the ideal thing is to have a pre-pregnancy examination of the woman when the couple decides to become pregnant. In this examination, a detailed history is taken and a systemic examination is performed. If it has not been done recently, a smear test is taken. Thyroid gland (Goiter) and breast examination are important in this period. Because thyroid gland (goiter) disorders cause serious problems during pregnancy. In addition, it becomes difficult to evaluate and perform mammography during pregnancy due to breast growth and edema. Women with a family history of premenopausal breast cancer should have a mammogram, even if they are under the age of 40. The woman's vaccination status is determined, if missing, rubella, hepatitis-B and tetanus vaccines are administered. Women living in risk areas should be screened for tuberculosis.

One of the most important stages of the pre-pregnancy examination is the assessment of the patient's risks. Some of these risks cannot be changed, and some can be changed with various measures. The patient's height, age, race, education level, genetic structure and socioeconomic level are risk factors that cannot be changed. On the other hand, high blood pressure (hypertension), diabetes, thyroid gland disorders (goiter disease), asthma, epilepsy (epilepsy), extreme underweight and obesity are modifiable risk factors. The existing diseases of these women before pregnancy should be treated or controlled. Vitamin A (accutane), anticoagulant coumadin (coumadin), and some epilepsy medications, which we call teratogens that cause anomalies in the fetus, should be discontinued before pregnancy. Women who are exposed to heavy metals (mercury, lead) or volatile toxic substances in the workplace should be warned, and the presence of domestic violence should be investigated. Remedial measures should be taken on these issues.

Effects of alcohol

The harmful effects of alcohol on the fetus have been conclusively proven. This harmful effect increases in proportion to the amount of alcohol used. For this reason, women planning pregnancy are recommended to stop drinking alcohol. It is also known that smoking has negative effects on pregnancy. Causes low birth weight in the baby, early birth and infant death are known side effects. Not only pregnant women but also other family members in the same household should be advised to quit smoking. Gingivitis in women is also important. Because these pose a risk of premature birth. Therefore, it should be treated before pregnancy. Women should be advised to use folic acid during the pre-pregnancy period. Because folic acid significantly reduces congenital brain and spinal cord anomalies in babies. This effect is especially important in women who have given birth to babies with brain and spinal cord anomalies in previous pregnancies. In these women, 1 mg per day during the first three months of pregnancy, starting 4 month before pregnancy. They should be advised to use folic acid. Women whose risk category is not high can use folic acid between 400 mcg and 1mg.

skeletal system

normal birth The existence of a skeletal system (orthopedic) problem that may prevent this should be investigated. If available, birth is planned to be performed by cesarean section. Some risks of pregnancy increase with age. For example, women over the age of 40 have an increased risk of miscarriage, giving birth to a low-birth-weight baby, premature birth, and infant death. This information should also be shared with women.

Ideally, one of the issues that should be discussed before pregnancy is genetic diseases. Unfortunately, in countries where consanguineous marriages are common, such as Türkiye, the risk of genetic diseases also increases. There are also genetic diseases (such as Mediterranean anemia) that have increased frequency in society due to the geography we live in. Finally, the postponement of the age of childbearing due to women's education and work planning causes an increase in the rate of genetic diseases such as Down syndrome (Mongolism) that develop due to advanced maternal age. Therefore, it is necessary to take a detailed history, including the couple's families.

First pregnancy examination

A woman should plan as soon as she finds out she is pregnant. Because approximately 1-2% of pregnancies occur outside the uterus. ectopic pregnancy It is in the form. With early examination and ultrasonography, it is understood whether the pregnancy is established in the uterus or not. This examination is very important as it is possible to treat ectopic pregnancies detected at an early stage with medication. Pregnancy can be detected by urine test, β-hCG blood test and ultrasonography. Once the pregnancy is determined, the number of weeks it is present must also be determined. In a woman whose menstrual bleeding is regular, it is checked whether the week of pregnancy is compatible with the last menstrual period. If the woman's menstrual bleeding is irregular or she does not know her last menstrual bleeding, determining the size of the baby by early ultrasonographic examination is very important for subsequent follow-ups.

The pregnant woman's height/weight ratio, blood pressure, goiter gland and pelvis examination should be performed. A Pap smear test should be taken if it has not been taken recently. The patient should be informed that spotting-like bleeding may occur after this test.

First pregnancy checkup tests

At the first pregnancy examination; Blood group determination, complete blood count, rubella, toxoplasma, hepatitis-B, hepatitis-C, HIV (AIDS), syphilis (syphilis), complete urine and urine culture tests should be requested. If there is colored and odorous discharge, this discharge should be cultured. Lower genital tract infections that are not treated early increase the risks of early rupture of membranes and premature birth during pregnancy.

During the first pregnancy examination, the couple's questions about pregnancy are answered in detail. The frequency of pregnancy examinations is planned. It is recommended to call your doctor immediately in cases such as fever, difficulty urinating, bleeding, severe pain in the groin, or dropping a piece.

Normal pregnancy period, Calculated based on last menstrual period It's 40 weeks. Pregnant women who do not have any risk are examined every 28 weeks until the 4th week, every 28 weeks between 36-2 weeks, and once a week after 36 weeks. After 40 weeks (pregnant women who are past due date) should be examined twice a week. This examination scheme can be changed according to the patient's risk factors.

Tests to be requested in subsequent examinations after the first examination:

A complete urine test should be requested every month. Urine culture is requested every 3 months.

Complete blood count should be repeated every 3 months.

Mongolian baby screening (Down syndrome screening)

11-14. It is performed between weeks of pregnancy. It has an 85-90% accuracy rate. By measuring the edema (nuchal pili thickness) in the baby's neck area, the risk is calculated together with the values ​​of two substances in the blood (PAP-A and fβ-hcg). If the calculated risk is above a certain level, amniocentesis is recommended for the expectant mother.

Neural tube defect (cerebrospinal system anomaly) screening

It is performed by AFP measurement between 16-20 weeks. If the value found is above a certain level, the baby is examined with detailed ultrasonography. If any anomaly is detected, it is shared with the family and a decision is made together regarding the method to be applied.

Gestational diabetes screening

24-28. During the pregnancy weeks, the pregnant woman's blood sugar is first checked and then 50 grams is given. It is done by giving sugar water and measuring blood sugar 1 hour later. If the value found is above 140 mg/dl, the second step, a 2-g sugar loading test, is performed. If 100 or more values ​​are found to be high in this test, gestational diabetes is diagnosed.

Blood incompatibility (Rh incompatibility) test

In pregnant women whose maternal blood is Rh(-), at the first examination and at the 26-28th week. It is required during pregnancy weeks. If the first test is positive, these pregnant women should be followed very closely.

Smelly and colored discharge

A white, transparent discharge is normal during pregnancy. However, discharges that are yellow-green in color and have a foul fishy smell require treatment. If diagnosis cannot be made by examination, culture and antibiogram should be performed. These infections can cause premature rupture of membranes and premature labor. 35-37 weeks of pregnancy. It is recommended that a bacterial culture called group B-streptococcus be taken from the vagina and perianal areas of all pregnant women during the XNUMXnd week. Patients with positive cultures should be treated with antibiotics such as penicillin or ampicillin during delivery. The risk of gestational membrane infection (amnionitis), uterine lining infection (endometritis), kidney infection (pyelonephritis) and wound infection increases in untreated pregnant women.

Examination with ultrasonography

The World Health Organization (WHO) reports that a total of three ultrasonographic examinations will be sufficient for pregnant women. However, we perform ultrasonographic evaluation at every pregnancy examination. This does not cause any harm to pregnant women. On the contrary, it enables early diagnosis of some problems.

Emergencies that require a pregnant woman to call her doctor

• vaginal bleeding
• Colorless fluid coming from the vagina
• Increasingly severe pain in the lower abdomen
• Pain in the form of more than 6 contractions in an hour
• Fever and chills, chills
• Burning and frequent urination
• Complaint of vomiting lasting more than 24 hours and not being able to take anything by mouth
• Constant headache, visual impairment, swelling all over the body, especially in the hands and face
• Significant decrease in the baby's movements.

Nutrition and weight gain

Pregnant women should have a balanced diet and avoid excessively salty, fatty foods, raw meat and raw meat products. Average of 1 gram per day. They should consume plenty of milk and yoghurt due to their need for calcium. It is recommended to eat some kind of meat every day. Multivitamin supplements are not absolutely necessary for pregnant women who eat a balanced diet and consume plenty of vegetables and fruits. However, it should be started before pregnancy and folic acid supplementation should be given in the first three months and iron supplementation should be given starting from the 3rd month.

During pregnancy, normal weight women weigh 12 kg, underweight women weigh 14-15 kg, and obese women weigh 8-9 kg. It is recommended to take it. Dieting or starvation is not recommended during pregnancy. This may negatively affect the development of the fetus. Nutritional problems may be observed in women who had stomach surgery related to obesity before pregnancy. These women should eat little and often and take multivitamin supplements.

The amount of tea and coffee consumed during pregnancy should be reduced. Drinking more than 3 cups of coffee a day increases the risk of miscarriage. Seafood should be consumed at most twice a week. Products with low mercury content, such as salmon, tuna and shrimp, should be preferred. Excessive consumption of seafood containing high levels of mercury may have a teratogenic effect on the fetus and lead to developmental disorders.

Nausea and vomiting occur in the first 4 months of pregnancy. It is more severe in the mornings. It is recommended to eat small and frequent meals, avoid fatty foods, and prefer dry and solid foods. Vitamin B6 should also be given along with these precautions. In persistent cases, anti-nausea medications are used.