Obstetrical examination during pregnancy - Causes, symptoms and treatment. MF.
In most cases, a woman learns of her pregnancy by making a home pregnancy test against the background of a delay in menstruation. If the test was positive, then you should contact an obstetrician-gynecologist and register for pregnancy as soon as possible. If you are not sure that you are pregnant, but the results of the test are dubious and menstruation does not occur, this is also a reason for visiting a doctor.
Why is it necessary to register for pregnancy as early as possible? In order to prevent various pathologies that are possible in the early stages. It should not be forgotten that the most serious complication of pregnancy is miscarriage, it occurs in the early stages. Therefore, the sooner the future mother begins to be examined, the better for her and for the baby. Therefore, it is necessary to stand for pregnancy for up to 12 weeks.
During your first visit to an obstetrician-gynecologist, be prepared for a detailed doctor's interview. It is necessary to remember the date of the last menstruation, namely its first day. Since it is for this date that the gestational age and the date of the forthcoming birth are determined. If you have an irregular menstrual cycle, to calculate the timing, it is advisable to know the expected day of conception.
Be sure to tell your doctor about any previous illnesses. This applies not only to gynecological diseases, but also chronic diseases of a systemic nature. The most important role in collecting anamnesis is given to diseases of the endocrine system, heart defects, kidney diseases and infections of the genital area. Based on the state of health of a pregnant woman, a gynecologist may prescribe an additional examination from other specialists.
Also at the first reception is a gynecological examination on the armchair. Measures blood pressure of a pregnant woman, height, weight. Using a centimeter tape, measure the abdominal circumference, the height of the standing of the uterine fundus above the pubic articulation. In addition, it is necessary to measure the size of the pelvis with a special tool - tazomer.
Pelvic dimensions are of great importance during childbirth. Based on these sizes, it is possible to predict the occurrence of any obstacles and complications during the passage of the child through the birth canal at the most crucial moment.
Measurement of blood pressure, weight and abdominal circumference must be carried out at every visit to the doctor throughout the pregnancy. Beginning around the 20th week of pregnancy, at each admission the doctor listens to the fetal heartbeat using a special tube - an obstetric stethoscope, which is applied to the naked pregnant belly.
For the general examination of all pregnant women( without exception!), The following tests and examinations are mandatory:
- The general analysis of urine is the most "popular" analysis in pregnancy. It is taken before every visit to a gynecologist( usually 2 times a month).This analysis reflects the state of the genitourinary system of a pregnant woman;
- The total blood test is given at a pregnancy at least 4 times. Normally, with pregnancy, a slight decrease in hemoglobin, hematocrit and erythrocyte levels is possible;
- Biochemical blood test is given at least 3 times during pregnancy;
- Coagulogram( analysis of blood coagulation and hemostasis) is given 3 times in each trimester of pregnancy;
- Blood test for HIV, hepatitis and syphilis is dealt 3 times;
- Determination of blood type and Rh factor, determined once immediately after registration;
- Blood test for TORCH infection( rubella, cytomegalovirus, herpes simplex virus and toxoplasmosis).Despite the high cost of research, this analysis must be submitted necessarily, since it is the TORCH infections that can lead to intrauterine infection of the fetus, and, as a consequence, to its death;
- A smear on the flora of the vagina and a smear for cytology( scraping from the cervix) is given once, usually at the first visit to the gynecologist;
- Ultrasound examination of pelvic organs( ultrasound).If pregnancy is normal, then ultrasound should not be done more than 3 times for pregnancy.
The first ultrasound is performed for a period of 10-12 weeks. Some pregnant women prefer to do it early, but if there are no serious indications( spotting, pains in the lower abdomen), it is inadvisable to do ultrasound on earlier terms. On the first ultrasound, you will be told, in general terms, how pregnancy proceeds, determine the timing of pregnancy and childbirth.
The second ultrasound is done for a period of 20-24 weeks. At this time, you can determine the sex of the child, see the development of internal organs, identify the developmental defects of the fetus( if any).
The third and last ultrasound is performed at 32-34 weeks. Define the presentation of the fetus, placenta, etc., that is, they primarily evaluate the characteristics that are related to childbirth.
- consultations of related specialists: oculist, therapist, ENT doctor, dentist.
Additional studies in pregnancy are prescribed by a gynecologist according to the indications depending on the age of the pregnant woman, the presence or absence of concomitant diseases, complications of pregnancy. Also in the supplementary examination need pregnant women who have a history of miscarriages and long-suffering infertility.
Most often for additional examination, the following types of studies are prescribed:
- Urine analysis for Nechiporenko, according to Zimnitsky, if there are any deviations in the general urine analysis;
- PCR-smear from the vagina for examination for sexually transmitted infections( chlamydia, ureaplasmosis, mycoplasmosis, HPV, HSV, CMV, trichomoniasis).Appointed by inspection and smear and suspected intrauterine infection;
- Study of the level of antipruritic antibodies in a woman's blood. Assign in the presence of Rh-negative blood in a pregnant woman, to exclude the risk of occurrence of Rh-conflict several times throughout pregnancy;
- Glycemic profile with determination of blood sugar level. Surrenders if the patient has diabetes mellitus or if he is suspected( with glucose in his urine or with an elevated blood glucose level);
- Blood test for thyroid hormones( TTG, T3 and T4) in the presence of thyroid disorders;
- Blood test for sex hormones( FSH, LH, testosterone, DGA-S, 17-OH progesterone).Assign in the presence of miscarriages in the anamnesis;
- Prenatal biochemical screening for blood analysis - to detect chromosomal and nonchromosomal abnormalities in the fetus is carried out at the 11-14th week of pregnancy. Recommended for pregnant women over 35 years. In some women's clinics appoint all pregnant women regardless of age;
- Chorion biopsy, amniocentesis, cordocentesis, placentocentesis - methods of prenatal diagnosis of fetal pathologies. Using a thin needle, the fetal material( umbilical cord, placenta, amniotic fluid) is taken for examination. Since these procedures are quite invasive and imply invasion of the uterus - they are performed according to strict indications( if there are chromosomal diseases in the family, during radiation exposure, when taking antitumor drugs, with suspicion of chromosomal anomaly according to ultrasound, biochemical screening).Some gynecologists recommend that all these women, older than 35, go through these studies.
Obstetrician-gynecologist, Ph. D.Christina Frambos