How will my pregnancy be monitored?

Dear expectant parents. I am preparing a pregnancy tracking logbook. This will provide you with a general overview of pregnancy tracking. Below you can see the version of the logbook that is suitable for posting on the website. I strongly recommend that you read it.

*This booklet contains the minimum information required for pregnancy tracking. The purpose is to help expectant parents understand the basics of pregnancy tracking and obtain essential information. More detailed information can be obtained from your doctor during your check-ups. Additionally, the goal is to establish standardization in pregnancy tracking and implement a comprehensive tracking program step by step.

I wish you a healthy and happy pregnancy and delivery.

PREGNANCY CHECK-UPS

(UNLESS OTHERWISE INDICATED, THIS IS THE STANDARD SCHEDULE)

*Routine tests: Complete blood count, Urinalysis, TSH, AST, ALT, AKŞ, ferritin, TORCH panel, Hepatitis B, Hepatitis C, and HIV screenings, VDRL, Vitamin levels (folate, B12, D...)

 

** NIPT test: A screening test performed by searching for fetal DNA in the mother's blood, which detects Down syndrome with 99% accuracy. It is recommended if deemed necessary. Please consult your doctor. More information is available later in this document. Please read.

 

Under normal circumstances, your delivery may occur between 37 and 42 weeks. Delivery before 37 weeks is considered premature. If delivery does not occur by 40 weeks, it may be necessary to wait a little longer. During this period, you will need to have at least two check-ups per week.

Follow-up programs for high-risk pregnancies are completely different.

FIRST EXAMINATION – AVERAGE 7TH WEEK

 

It is performed between 7 and 8 weeks after a missed period (4-5 weeks).

 

The following questions must be answered:

 

- Is it an intrauterine pregnancy or an ectopic pregnancy?

- Is there a heartbeat? (after 6 weeks)

 

- Is it a single or multiple pregnancy?

- Is there a risk of miscarriage?

- Are there any gynecological problems other than pregnancy? (Ovarian cyst, fibroid, etc.)

 

If all answers to these questions are positive, no further examination is necessary. In cases of ectopic pregnancy, inability to detect a heartbeat, or risk of miscarriage, more frequent examinations may be required.

The week calculated based on the date of the last menstrual period may not match the week determined by ultrasound. If the pregnancy is healthy, this is due to early or late ovulation. The expected date of delivery and actual week are determined by recalculating.

 

Folic acid has been started in advance in planned pregnancies. If not started, it is started at this examination. Folic acid protects the baby against neural tube defects.

 

The mother's weight and blood pressure are evaluated.

- Routine blood and urine tests are performed.

If a smear has not been taken in the last year, a Pap smear test is performed.

SECOND EXAMINATION – 11-13 WEEKS

During this week, many issues regarding your baby will become clear under current conditions. Some anomalies can be detected during this week. Gender prediction is made with 80% accuracy. The dual screening test, which is a Down syndrome screening test, is performed. This test is performed using a combination of the following three parameters.

1- Measurement of nuchal translucency on ultrasound

2- HCG level in the blood

3- PAPP-A level in the blood

 

The combination of these values provides a risk ratio for Down syndrome.

During this week's examination, the baby's features are now clearly visible. The arms, legs, head, and body can be distinguished by the family on the ultrasound. The baby is 5-6 cm long.

- The mother's weight and blood pressure are evaluated.

- Multivitamins and any vitamins the mother is deficient in can be started as supplements.

- Creams to prevent stretch marks related to pregnancy can be started this week...

SCREENING TESTS DURING PREGNANCY

It is not possible to detect all structural abnormalities in the baby with routine ultrasound monitoring. Cerebral palsy, autism, intelligence level, vision and hearing ability, genetic diseases, and many syndromes cannot be detected by ultrasound.

For this reason, screening tests are performed on pregnant women without any risk factors, and definitive diagnostic tests are performed on pregnant women who are determined to be high-risk based on screening tests. Similarly, diagnostic tests are performed on pregnant women in the high-risk group (those who have previously given birth to a baby with anomalies, have a family history of genetic diseases, have first-degree relatives with diabetes, or have a genetic disease or are carriers of a genetic disease in the mother and/or father).

The most commonly used screening tests during pregnancy are those used to screen for chromosomal abnormalities. The first trimester screening test, or more commonly known as the dual screening test, is a test used to screen for chromosomal abnormalities such as Down syndrome and trisomy 18 (an extra copy of chromosome 18) in the fetus in the mother's womb.

Approximately 60% of babies with Down syndrome have detectable ultrasound findings. In the remaining cases, ultrasound findings may be completely normal. Therefore, it is important to perform the first dual screening test to detect this group.

The dual screening test consists of measuring nuchal translucency (NT) via ultrasound (neck thickness, neck translucency) and analyzing two hormone levels (HCG and PAPP-A) in the mother's blood. For this test, nuchal translucency is measured between weeks 11 and 14 of pregnancy using ultrasound while the fetus (the baby in the mother's womb) is in a supine position. Blood samples are taken from the pregnant mother to measure HCG and PAPP-A hormone levels. With the dual screening test and experienced measurement, approximately 90% of babies with Down syndrome can be detected.

 

In the second trimester screening tests for Down syndrome (triple and quadruple screening tests) performed between the 16th and 20th weeks of pregnancy, this rate is lower. (60-65% for the triple test and 72-75% for the quadruple test.)

 

If the expectant mother applies between the 11th and 14th weeks of pregnancy, the dual screening test should be performed first. If the expectant mother applies late and misses the dual screening test, one of the triple or quadruple screening tests should be performed regardless of age. It is not recommended to perform screening tests consecutively. Depending on the results of the screening tests, an evaluation by a perinatologist may be recommended for pregnant women who are positive (at risk).

 

Even if the test results are positive (low risk), there is still a small chance that the baby will be born with Down syndrome or another chromosomal disorder. Prenatal screening tests (dual or quadruple screening tests) do not guarantee that you will have a healthy baby. The presence of Down syndrome or another chromosomal abnormality in the baby can only be definitively determined through advanced tests (CVS - 11-14 weeks, amniocentesis - 16-22 weeks).

 

Since 2011, it has been possible to screen for chromosomal abnormalities using tests (NIPT) based on the separation and quantification of fetal DNA detectable in the mother's blood from the 10th week of pregnancy. These tests have an accuracy rate of over 99% for Down syndrome. You can consult your doctor for more detailed information on this subject. Prenatal screening test results do not provide a definitive diagnosis, but rather reflect the likelihood of a condition. If there is an increased risk, further tests are required for a definitive diagnosis.

 

THIRD EXAMINATION - 16TH WEEK

- The growth of the baby and the position of the placenta are evaluated.

- The sex of the baby is determined with 100% accuracy.

- If the mother-to-be has not had a dual test, a triple or quadruple screening test is performed.

- Iron supplementation is started this week.

- The mother's weight and blood pressure are evaluated.

FOURTH EXAMINATION - 20-22 WEEKS -

The mother's weight and blood pressure are evaluated.

 

A detailed obstetric ultrasound scan is performed during this week to examine the baby in detail. The baby's organs are examined from head to toe.

 

Fetal anomaly screening is an ultrasound procedure in which every part of the body is examined in detail and should be performed by experienced personnel. The images obtained during this ultrasound are used to evaluate body parts, and color images (DOPPLER) are used to measure the blood flow of the baby and mother to look for clues about possible placental insufficiency and fetal growth retardation in the baby. Particular attention is paid to the brain, face, spine, heart, abdominal wall, stomach, intestines, kidneys, arms, legs, and fingers. If any abnormalities are detected, the family is provided with detailed information about the significance of these findings, the risks they may pose, and their potential impact on the baby's health. If necessary, further tests are planned, the diagnosis is confirmed, and the family is informed about the options available to them.

 

Anomalies that appear normal at 17-23 weeks of pregnancy may become apparent on ultrasound in later weeks. Therefore, it is important not to neglect regular monthly checkups. On the other hand, there may be ultrasound findings that appear to be problems between the 18th and 22nd weeks of pregnancy but disappear in the later weeks of pregnancy. These are also ultrasound findings that can be encountered during the normal course of fetal development.

The family should be aware that this ultrasound is not for the diagnosis of Down syndrome and that Down syndrome can only be diagnosed with 100% accuracy by amniocentesis...

NOTE: Ultrasound findings indicate that approximately 70% of fetuses with Down syndrome and 90-95% of fetuses with Trisomy 13-18 are suspected, and amniocentesis is performed for confirmation if necessary. The absence of the markers mentioned in the ultrasound does not completely rule out chromosomal abnormalities in the baby. Approximately 70% of all congenital heart anomalies can be detected by evaluating the four chambers of the heart and their outlets during a detailed ultrasound. Approximately 70% of birth defects that can be observed at birth can be detected by detailed ultrasound.

 

NOTE: This week, until the 30th week, is the ideal time to resolve all questions and issues related to normal (vaginal) delivery. The problems of the first half of pregnancy are over, and the screenings are complete. The complications of the last stage of pregnancy have not yet begun. I recommend that you discuss these issues with your doctor and take the time to resolve any problems. You should overcome your fears and concerns by talking to your doctor. Everything will be easier if you use a common language.

 

FIFTH EXAMINATION (24-28 WEEKS)

- During this week, a 75-gram OGT, commonly known as a glucose tolerance test, is performed.

- Pregnant women with abnormal glucose test results are referred to a diet and lifestyle changes based on the degree of abnormality.

- In cases of extremely high results, insulin is required to regulate blood sugar levels.

- In addition, a complete blood count and complete urine tests are evaluated.

- The mother's weight and blood pressure are evaluated.

- Uterine artery Doppler is repeated if necessary.

SIXTH EXAMINATION - 32 WEEKS -

- The baby's growth, amniotic fluid, length, and weight are evaluated.

- The umbilical cord and, if necessary, brain blood flow are examined.

- Findings indicating the baby's well-being, known as the fetal biophysical profile, are evaluated.

- A blood count and urine test are performed.

- The mother's weight and blood pressure are evaluated.

- If the mother is working, a report is issued for maternity leave. (She may take 8 weeks of maternity leave before delivery or transfer up to 5 weeks to after delivery.)

SEVENTH EXAMINATION -34-35 WEEKS -

- The baby's growth, amniotic fluid, length, and weight are evaluated.

- The cord and, if necessary, cerebral blood flow are examined.

- Findings indicating the well-being of the baby, known as the fetal biophysical profile, are evaluated.

- The mother's weight and blood pressure are evaluated.

EIGHTH, NINTH, TENTH, AND ELEVENTH EXAMINATIONS -- 37-38-39-40 WEEKS --

- The baby's growth, amniotic fluid, length, and weight are assessed.

- The umbilical cord and, if necessary, brain blood flow are examined.

- The baby's position and posture are assessed.

- Findings indicating the baby's well-being, known as the fetal biophysical profile, are evaluated.

- An NST is performed to evaluate the baby's heart rate and uterine contractions.

- The mother's weight and blood pressure are assessed.

- Labor may occur during these weeks. The family is informed about emergency situations.

AFTER 40 WEEKS

If a normal (vaginal) delivery is expected, examinations become more frequent. Preferably, examinations are performed at least twice a week. This is because certain risks (meconium aspiration, loss of the baby in the womb) increase. The biophysical profile is evaluated and the examination intervals are adjusted accordingly.

There is no universally agreed waiting period worldwide. Various schools of thought recommend waiting between 40 and 43 weeks. Therefore, each doctor has their own waiting period. I wait 10 days after 40 weeks (41 weeks and 3 days). If there is still no birth, I recommend hospitalization. We use methods and medications to induce labor and ensure that the birth takes place.

PREVIOUS C-SECTIONS

1- A planned C-section can be performed between 39 and 40 weeks.

2- A C-section can be performed after waiting for the mother's contractions to begin.

3- Vaginal birth after cesarean (VBAC). VBAC is performed if the necessary criteria are met and the family is aware of the risks.

-- PLEASE CONSULT YOUR DOCTOR FOR DETAILS.

FINAL WORD

The purpose of all these examinations is to identify possible problems. The probability of problems during pregnancy is approximately 5%. We strive to identify that 5%. When we do, we provide the necessary guidance. If there is a situation that threatens the health or life of the mother and/or baby, we intervene. If not—which is highly likely—we let nature take its course and wait for the birth. Remember: Childbirth is a process of letting go and being patient.