Pregnancy is a miraculous phenomenon and it is period that the expectant mother must be aware. Various analyses and tests must be conducted in different periods from the beginning to the end. In fact, it is convenient that some tests are conducted and therefore, receive consultancy before pregnancy when the couple has decided to have a baby and the most important part is to make a firm decision to be parents. And some tests must be taken in certain weeks of the pregnancy. Thus, these tests must be carefully followed in the pregnancy and the times to take the tests should not be missed. Some of the tests taken during the pregnancy are routine tests for every pregnant woman and some of the tests are conducted only in certain circumstances.
Apart from this, it is necessary to have ultrasound and a medical examination every month in the first 32 weeks, once in 15 days between 32. and 36. weeks, at least once in a week after 36. week.
The analyses :
These tests are the analyses that are conducted in the first application to the doctor. The most accurate thing would be for couples to apply to the doctor when they have first decided to have a baby before the pregnancy and to have these tests during this appointment. Because some measurements can be taken before the pregnancy according to some abnormalities that can be identified in these tests. However, most of the couples apply to the doctor after the pregnancy starts (when the menstruation is delayed). The woman's genital organs are evaluated with gynecological examination and ultrasonography in this first appointment. If it hasn't been conducted in the recent year, PAP Smear test should be conducted. A general systemic examination can also be conducted and if there are systemic disorders (diabetes, hypertension etc.), it can be consulted to the relative branch specialist. The analyses conducted in the first examination:
- Complete blood cell count (Hemogram)
- Blood type of the mother and the father: In order to take measures if blood incompatibility is detected.
- Indirect Coombs test if there is blood incompatibility
- Complete urinalysis (Urinary culture if necessary)
- TSH: If the mother has goiter and thyroid hormonal disorder, it may affect the baby and treatment by endocrinologist is necessary if a disorder is detected.
- Toxoplasma IgM and IgG: It is a screening test for a parasitic infection coming from the stools of cats and dogs, raw meat, vegetables which are not washed well.
- Rubella IgM - IgG: Tests showing whether the rubella vaccine is successful and there is an acute infection
- HBsAg for Hepatitis B: Hepatitis B Ig serum is applied to the baby after the birth in order to prevent the Hepatitis found in the mother to infect the baby.
- HCV test
- HIV (AIDS) test
- VDRL test for syphilis is not necessary to take routinely but it can be conducted.
- HbA1C test showing the pre-prandial blood sugar or average sugar level in the last 3 months in risky patients in terms of diabetes
- Biochemistry (cholesterol, kidneys and liver etc.) tests
Between the weeks 11.-14.:
The nuchal translucency, CRL (crown-rump length), nasal bone (NB) are measured in the ultrasound examination and double test (blood analysis) is conducted after the 11. gestational week. Why it is called double screening test is that 2 parameters are examined. Since it is a possibility test, if the risk is over the limit value, more comprehensive tests such as amniocentesis must be conducted. This test can be conducted between the weeks 11.-14., it cannot be conducted after the week 14.
And with the Prenatal Pregnancy Test being used for approximately 10 -12 months, the chromosome abnormalities can be detected. This test is safe since it can be conducted only with the mother's blood starting from the 9. gestational week. The parts from DNA within the cells of the baby taken from the mother's blood are examined and therefore, it becomes possible to examine the chromosomes in terms of count and structure. The results coming out of this diagnosis test can give accurate results by 98-99%. The only problem and why it is not so common at the moment is the financial matter.
Between the weeks 16.-20.:
Tripler test and quad test are conducted between these weeks.
If the double, triple or quad tests are resulted as risky, a further examination can be done by conducting amniocentesis (Entering into the mother's womb with a needle by the help of ultrasound and taking water from the liquid that the baby is living in). The reason why amniocentesis is not conducted to everyone is that it is risky and it might cause losing the baby.
Between the weeks 24.-28.:
75 gr glucose tolerance test is conducted between the weeks 24.-28. The tendency of the patient to diabetes can be evaluated also by looking at the pre-prandial and post-prandial blood glucose for the patients who missed these weeks and came in the following weeks. If there is blood incompatibility between the mother and the father, IDC (indirect coombs test) is conducted in the 28. week and it is negative, it shows that there is no contagion between the mother and the baby. If there is a contagion (if the indirect coombs test is positive), it is examined in what degrees the contagion in the baby can be in the following examinations.
The forgoing are the routine analyses conducted on almost every pregnant woman. It might be necessary to make other analyses apart from the abovementioned analyses in some certain circumstances and diseases coming out during the pregnancy.
Between the weeks 34.-36.:
Blood cell count and complete urinary analysis must be repeated.
After the 32. gestational week, especially in the last weeks of the pregnancy, biophysical profile evaluation must be made when there is a problem in the mother's uterus or for usual follow-up. These are five parameters; four of them are the ones conducted in the ultrasound and the fifth is NST (Non-stress test, Fetal monitoring). Therefore, the stress factors of the baby in the uterus close to the labor are evaluated. Doppler ultrasound can also be used. In this multi-discipline follow-up, the mother can also watch the movements of the baby. Regular follow-up, general routines and personal follow-up are very important for you to have a healthy pregnancy.
Wishing you a stress-free but a careful pregnancy.
Please note that problems of mother and baby are experienced in pregnancies with no follow-ups.
Dr. A. Refik KELEŞ, M.D.C.M
Obstetrician and Gynecologist / İRENBE