Pregnancy Follow-up

The aim of pregnancy follow-up (prenatal care) is to evaluate the pregnancy process and the fetus during the whole pregnancy after the pregnancy is detected and to take the necessary precautions in a timely manner.

Gestational Age Calculation

The start of the normal gestation period is the last menstrual period (LMP). The estimated date of birth is calculated according to the Naegele rule, adding 7 days to the first day of the SAT, going back 3 months and adding one year to determine the estimated date of birth. Fetal heartbeats can be monitored from the 6th week with a high-quality ultrasound. In the first pregnancy, fetal movements are felt after the average 19th week of pregnancy. Fetal movements may be noticed in earlier weeks in later pregnancies.

Around 20 weeks, the upper part of the uterus is detected at the level of the navel. Fetal age can be determined by ultrasonography performed in the first trimester in those who do not know the LMP and in pregnant women whose fetal measurements in ultrasound are not compatible with LMP.

Examinations to be Done in Pregnant Women Applying for Pregnancy Examination for the First Time

In the first visit, blood group and Rh factor, blood count, hepatitis markers, HIV, complete urinalysis, urine culture, vaginal smear, thyroid function test, screening of TORCH group infectious diseases, routine biochemistry examination.

Dual screening test at 11-13 weeks of gestation

Triple screening test at 16-18 weeks of gestation

Amniocentesis for pregnant women who are at risk at 15-18 weeks of gestation

Detail ultrasonography for fetal anomaly screening at 18-22 weeks of gestation.

Glucose screening test and routine biochemistry, complete blood count at 24-28 weeks of gestation.

Group B streptococcus at 36 weeks of gestation.

Nutrition and Weight Gain

Pregnant women need 300-500 calories more per day than non-pregnant women. In a balanced diet, the vitamins and minerals that the pregnant woman should take are generally sufficient. Pregnant women need more iron both for their increased blood volume and for the needs of the fetus. It is abundant in iron, eggs, red meat, liver, green leafy vegetables, whole wheat, dried beans and dried fruits. If pregnant women use iron pills, their absorption increases when they are taken on an empty stomach and with orange juice. Pregnant women should avoid raw meat because of the risk of Toxoplasma.

An average of 12-16 kg weight gain is considered normal throughout the entire pregnancy. At the beginning of pregnancy, a maximum of 3 kg should be gained in the first 3 months. In the last 3 months, no more than half a kilogram should be taken per week. Pregnant women should not lose weight, even overweight pregnant women should not gain less than seven kilograms during pregnancy. Since the increase in blood plasma volume of pregnant women who gain weight below 7 kilograms will be less, growth retardation can be detected in their babies.

In order to prevent nausea and vomiting, which are common in the first trimester of pregnancy, pregnant women should eat at frequent intervals and leave the stomach empty, stay away from oily and spicy foods, take protein (milk, yogurt, meat) at night, and consume foods such as crackers and bread before getting out of bed in the morning.

Exercise

If there is no medical or pregnancy-related complication during pregnancy, pregnant women can continue moderate physical activities. These activities increase cardiovascular and muscle performance. Pregnant women should be given exercises that do not include weight lifting and do not tire their abdominal muscles. Pregnant women who exercise should not be dehydrated and should wear very comfortable clothes during exercise. Pregnant women should avoid standing for long periods of time. Pregnant women should not do aerobic exercise as it reduces the amount of oxygen.

Since the center of gravity of pregnant women changes, they should not do movements that cause loss of balance.

Exercising is inconvenient for pregnant women who have pains during pregnancy, who are at risk of premature birth, who have cervical insufficiency, who have bleeding during pregnancy, and who have growth retardation in their baby.

Habitual substance use such as cigarettes and alcohol

Since the carbon monoxide and nicotine in cigarette smoke have harmful effects on the fetus, risks such as miscarriage risk, early separation of the placenta, premature opening of the water sac, and sudden infant death are more common in pregnant women who smoke.

Drinking alcohol during pregnancy is very harmful. The threshold at which the harmful effects of alcohol on the fetus occur is unknown. Alcohol (ethanol) easily crosses the placenta and fetal blood-brain barrier, and its teratogenic effect on the fetus is most observed in the first trimester. Alcohol consumed during pregnancy mostly causes fetal facial anomaly and brain dysfunction.

Illegal substances such as marijuana and cocaine should not be used during pregnancy. It should be explained that there are risks such as premature birth, fetal death, developmental delay, and behavioral disorder in all drugs-addicted pregnant women, and drugs-addicted pregnant women should be treated for drugs addiction.

Vaccines

In fact, all women should be vaccinated against measles, rubella, mumps, diphtheria, tetanus, poliomyelitis and chickenpox before becoming pregnant. It is recommended that women who have received the rubella vaccine should not become pregnant for four weeks.

In pregnancy, only live virus vaccines pose a risk to the fetus. Tetanus and diphtheria vaccines can be given to pregnant women in combination. In the second and third trimesters of pregnancy, pregnant women with asthma, heart and lung disease, diabetes or a weak immune system should be vaccinated against influenza during epidemic seasons. Depneumococcal vaccine should be given to pregnant women whose spleen has been removed somehow.

Pregnant women who are exposed to hepatitis A or B, tetanus, measles, chickenpox or rabies virus can be given immunoglobulin specific to that disease as a preventive measure. Varicella zoster immunoglobulin (VZIG) should be given as a prophylactic to newborn babies of pregnant women with chickenpox five days before or two days after birth. 

Sexual intercourse

Women at risk of bleeding and premature birth should avoid sexual intercourse.

Other pregnancy-related conditions

Complaints such as back pain, groin pain and hemorrhoids (hemorrhoids) are common in pregnant women. These complaints can be greatly reduced by measures such as standing upright, not wearing very high heels, and not being constipated.