Signs of pregnancy.

In the life of almost every woman, sooner or later the question arises regarding the likelihood of pregnancy. For expectant mothers, the appearance of the first symptoms of this condition becomes the starting point of a new life, full joyful expectation the miracle of the birth of a baby.
The onset of pregnancy is inextricably linked with a number of physiological changes occurring in the body of the expectant mother, which forms the signs of pregnancy. These signs are considered to be probable, since they may also indicate certain diseases and conditions of the woman's body.

Establish the fact of pregnancy and continue to carry out medical supervision a pregnant woman can only be an obstetrician-gynecologist.

In obstetrics, it is customary to distinguish between objective and subjective, reliable and indirect signs of pregnancy.

A woman may suspect that she is pregnant if she identifies several signs related to indirect signs of pregnancy:

• delayed menstruation,
• the mammary glands increase in size, pain in the mammary glands may appear,
• many women in the morning may experience nausea, vomiting, dizziness,
• some women start to get fat,
• arises frequent change mood,
• develops hypersensitivity to minor odors,
• often there is a change in appetite and taste preferences,
• frequent urination may occur.

If a woman thinks that she is pregnant, she needs to visit an obstetrician-gynecologist to confirm the fact of pregnancy.

On examination, the doctor may find objective signs of pregnancy.

Objective signs of pregnancy are:

• increase in the size of the uterus and its softening,
• the acquisition of the mucous membrane of the cervix of a cyanotic hue,
• darkening of the halo of the nipples of the mammary glands.

The presence of a uterine http://www.clinzdrav.ru/obstetrics/veden_ber.html must be confirmed by a doctor. Unfortunately, pregnancy can also be ectopic. Its early diagnosis is all the more necessary, since the earlier measures are taken to terminate an ectopic pregnancy, the less likely it is that negative consequences for a woman will occur.

What does the doctor see during the examination? During a routine examination, an obstetrician-gynecologist can see the following objective signs of pregnancy:

• venous plethora of the external genital organs,
• discoloration of the vagina and cervix (the cervix becomes bluish),
• softening of the isthmus in a two-handed study.

The pregnant uterus is large, soft, may be asymmetrical due to bulging at the site of implantation gestational sac.
Necessarily palpable uterine appendages: fallopian tubes and ovaries on both sides.
There are cases that even with a properly developing uterine pregnancy, formations are found at the location of the uterine appendages. This is often a pregnancy corpus luteum or a corpus luteum cyst in one of the ovaries. This condition is functional and does not require special treatment. But formations can, alas, turn out to be pathological. To identify this, you should resort to additional research methods.

The simplest, most affordable and safest method for health is considered Ultrasound of the pelvic organs. Already starting from 2.5 - 3 weeks of pregnancy, you can get information about the presence of pregnancy and its localization.

Starting from 10-12 days from the intended conception, reliable information about a developing pregnancy (uterine and ectopic) is hCG blood test. For differential diagnosis, this study is used in dynamics, since the level of the hCG value during a developing pregnancy increases significantly as the pregnancy develops.

Reliable signs of pregnancy:

• Detection of the embryo during ultrasound of the pelvic organs. Perhaps from 4-6 weeks after fertilization.
• Fetal heartbeat. It is possible to determine from 10-20 weeks (depending on the ultrasound machine).
• Various movements of the fetus, which the woman feels through the abdominal membrane. Usually appear after 16 weeks.

At home, with a delay in menstruation for two days or more, you can use pregnancy test. It is very easy to use and reliable. The reliability of the answer will be higher if the study is carried out more than 2 times. Despite the external differences in the tests, they are based on a reaction to a specific hormone (chorionic gonadotropin - hCG), which begins to be produced in a woman's body during pregnancy. The hormone and decay products can be found in the urine.
For research, they usually take a morning portion of urine: after a night's sleep, the concentration of the hormone and its decay products increases.

Thus, in modern conditions confirmation of the fact of pregnancy is not difficult.
The main thing is that the pregnancy should be desired and planned.
And when a woman plans the birth of a child, the first signs of pregnancy will not go unnoticed for her.

How to determine the gestational age and the expected date of birth.

The determination of gestational age and due date is based on the assumption that a woman has a 28-day menstrual cycle with ovulation on days 14-15 of the cycle. The duration of pregnancy is on average 280 days (40 weeks) from the start of the last menstruation. There are 4 weeks or 28 days in the obstetric month. Therefore, the duration normal pregnancy is 10 obstetric months. However, 280 days is the conventional number of days of pregnancy. Determining the true duration of pregnancy is difficult due to the fact that it is difficult to establish the exact period of ovulation, the time of movement of spermatozoa and fertilization, it is difficult to take into account all the characteristics of a woman’s body and predict the time when a baby is “ready” for birth. Therefore, a baby is considered full-term if it is born between 266 and 294 days (38 to 42 weeks) of pregnancy.

To calculate the expected due date, use the Negele formula - 9 months and 7 days are added to the date of the first day of the last menstruation. A simplified method of these calculations - from the first day of the last menstruation, count 3 months ago and add 7 to the resulting number.

When determining the due date, it should be borne in mind that ovulation does not always occur in the middle of the cycle. In addition, the duration of pregnancy increases by approximately 1 day for each day of the menstrual cycle exceeding 28 days. For example, with a 35-day cycle, ovulation occurs on day 21, and then the due date will be shifted a week later.

Sometimes, when determining the duration of pregnancy and childbirth, the time of the first movement of the fetus is taken into account. To the date of the first movement, 5 obstetric months are added for primiparous and 5.5 obstetric months for multiparous and the estimated due date is obtained. It should be remembered that this sign has only an auxiliary value. Some mothers may feel the baby move at 16 - 18 weeks of pregnancy.

The data of an objective study help the doctor to determine the term of childbirth: measuring the length and size of the fetus, the circumference of the abdomen of the pregnant woman, the height of the fundus of the uterus, the degree of its excitability and other signs.

More than 10% of all pregnancies last more than 42 weeks, of which 14% last more than 43 weeks. A pregnancy lasting more than 42 weeks is called post-term. This condition is more often observed in primigravidas, whose age is more or less than the average childbearing age, and in women who have had 5 pregnancies or more. The reasons for a delayed pregnancy can be different. Often this is just a hereditary feature, sometimes it is a pathology associated with a violation of hormonal balance, metabolism in the mother's body, obesity, delayed biological maturation of the neuromuscular apparatus of the uterus, intrauterine fetal growth retardation.

The absence of labor activity at the expected date of birth for the baby is often unfavorable. Normally, after 40 weeks of pregnancy, fetal growth slows down, and at 42 weeks it practically stops. Therefore, the so-called syndrome of impaired maturation is observed in 30% of post-term children. To stimulate labor expectant mother it is recommended to move more, with inefficiency, at present, special gels are most often used, which are found in the cervix to stimulate labor.

In turn, childbirth until the end normal period intrauterine development (before 37 weeks of gestation) are considered premature. Among the total number of births - the frequency of premature births is 5 - 10%. As a result premature birth premature babies are born. Prematurity is the condition of a fetus born before the expected date, weighing less than 2,500 g, less than 45 cm tall, characterized by the immaturity of organs and systems, insufficient resistance to the effects of factors environment. Currently, in modern maternity hospitals, it is possible to nurse babies born after the 28th week of gestation and weighing more than 500 g.

How to prepare for the initial visit to the obstetrician-gynecologist during pregnancy.

Many women who plan pregnancy in advance or even those who did not plan to have a baby in the near future may suspect, by their well-being, the coming change in their life - the expectation and birth of a baby.
It’s good if this is a planned pregnancy and future parents prepared for it by going through in advance medical examination and following all the recommendations of the doctor.

In any case, if pregnancy is suspected, it is recommended as early as possible (up to 12 weeks of pregnancy) to register for pregnancy monitoring at an obstetrics and gynecology clinic.
In our country, there is an incentive for expectant mothers who applied for registration with an obstetrician-gynecologist for pregnancy up to 12 weeks: they are paid a cash allowance in the amount of one minimum size wages (SMIC).

What is required for the initial visit to an obstetrician-gynecologist?

First of all, you will need:

1. Passport.
2. Medical documentation: results of previous tests, medical reports from other specialists, extracts from the medical history after hospitalization in a hospital (if any), etc. (Note that these may be photocopies of the originals).
   Later, when you are given an exchange card - the main medical document of a pregnant woman - you will also need to carry it with you.
3. You may need a notepad and pen for personal note-taking of recommendations.
   Before the consultation, make a list of questions that you would like to ask the doctor, and during the conversation, you can write down the recommendations received in a notebook.

For a gynecological examination in the "Health Clinic" disposable towels and diapers, disposable gynecological instruments are used.

What you need to pay attention to.

1. You should know the date of your last menstrual period, the nature (copious, light flow) and the length of your menstrual cycle.
2. It is better not to plan visits to the obstetrician-gynecologist for those days when, in the absence of pregnancy, menstruation should have begun. Experts consider these days to be critical for the development of the fetus, and examinations and examinations during a dangerous period can cause abortion. Therefore, if you mark the dates of the expected menstruation on the calendar, you can avoid unnecessary risk.
3. Feel free to ask your doctor about intimate features and the specifics of sexual life, do not hide information related to your health. A qualified gynecologist will never judge you, but on the contrary, will try to help and explain the situation.
   You do not need to set yourself up in advance for the occurrence of unpleasant, painful sensations during the examination.
4. A day before the visit to the doctor, it is recommended to exclude sexual intercourse, otherwise the results of the analysis may be unreliable due to the possible presence of seminal fluid.
5. Before visiting the doctor, empty the bladder and, if possible, the intestines so that during the examination they do not interfere with the assessment of the condition of the internal genital organs. Take a shower, change your underwear.
   At the same time, you can not douche, since such a procedure can change the microbial flora of the vagina, and the test results will also be unreliable.
   In addition, the doctor will not be able to assess the nature of the vaginal discharge.
   If waiting in line to the gynecologist is delayed, empty your bladder again.

The main thing is a positive attitude, trust in the doctor and the desire to endure and give birth to a healthy child.

A very important component for pregnancy monitoring is the choice of a qualified obstetrician-gynecologist and a clinic that meets modern requirements.

How many mandatory visits to the antenatal clinic are established in Ukraine, and what a pregnant woman expects during each doctor's consultation in this article.

How many times should you visit a doctor during pregnancy?

Regular visits to an obstetrician-gynecologist at a antenatal clinic during pregnancy are not a whim of your personal doctor, but a requirement World Organization Health. Moreover, in different countries, the number of mandatory antenatal visits varies.

For example: in Georgia, the expectant mother meets with a gynecologist only 4 times throughout her pregnancy, in Lithuania 5 times, in Moldova - 6, Armenia - 8, Kazakhstan 4-14 and in Russia 13-16 times - depending on the condition of the pregnant woman.

I must say that in the last decade, almost all orders of the Ministry of Health of Ukraine on obstetric and gynecological care are based on the latest recommendations of the World Health Organization. That is, at the level legislative framework the obstetric and gynecological service of Ukraine is not one step behind the world practice.

Another question is that in some medical institutions there are material and technical capabilities and the enthusiasm of the team to work "in a European way", while others are lagging behind.

In Ukraine, 8 - 9 obligatory visits of a pregnant woman to the doctor are accepted, (8 - in the period up to 40 weeks of pregnancy and 1 more at the 41st week, if the birth has not occurred).

You will visit a doctor:

• 1 time per month up to 32 weeks of pregnancy;
• 2 times a month after 32 weeks and until the birth.

We emphasize once again that this is the minimum required number of meetings with a doctor, provided that the pregnancy is proceeding normally. In case of pregnancy complications, the number of meetings with the doctor is determined individually and depends on the physical and emotional state of the expectant mother.

Registration during pregnancy. First visit to the doctor during pregnancy

The very first, exciting visit, which confirms the onset of pregnancy, should take place for up to 12 weeks. As a rule, it occurs when a woman observes a prolonged absence of menstruation.

What does the doctor do during the first visit to a pregnant woman:

• Prepares all necessary medical documentation and creates your personal exchange card.
• Asks you to fill out a questionnaire with basic information about yourself.
• Conducts a detailed survey about your state of health, including clarifies the presence of hereditary, chronic, gynecological diseases. Information about the health of the future father is also collected.
• Asks a series of questions that identify risk factors for occurrence.
• Determines the prerequisites for the development of preeclampsia.
• Identifies the need for genetic counseling.

Also, your doctor may be interested in the working conditions in which you are. If earlier it was considered harmful: work at the machine tool and activities related to toxic substances, now among the dangerous professions are business women and salespeople who spend all day on their feet, and operators who constantly communicate via mobile communications and many others.

• A general examination of the pregnant woman is carried out.
• The work of the heart and lungs is checked.
• The thyroid gland is palpated. It is important for us to notice a malfunction in the thyroid gland as early as possible. The fact is that with the growth of the fetus, the load on the thyroid gland will double, it is important to know in advance whether it will cope with such a difficult task.
• Palpation is recommended mammary glands, it is important not to miss the presence of swelling and formations.
• The condition of the lymph nodes is checked.
• Measurements of blood pressure, pulse and body temperature are recorded.
• Height, weight and body mass index compliance rates are recorded.
• The size of the fingers and ankles are measured in order to determine the occurrence of edema in the future.

Also, the specialist sends directions to the expectant mother.

The doctor conducts a mandatory examination in the gynecological chair using special mirrors. This examination allows you to determine the state of the microflora of the vagina, the state of the neck of the poppy.

• A smear is taken for a cytological examination;
• Investigated (if there is evidence).

A general examination in the chair also allows you to clarify the presumptive, which is confirmed by subsequent ultrasound. As a rule, you will undergo the first ultrasound diagnostics at the earliest stage of pregnancy, just to confirm the movement of the fertilized egg into the uterine cavity and the attachment of the fetal egg.

In admission for up to 12 weeks, one of the most important studies of the first half of pregnancy is included. It is held between 11 weeks + 1 day and 13 weeks + 6 days. It is not worth neglecting such serious research, the fact is that markers of congenital and chromosomal pathologies are detected at this time. If necessary, the doctor prescribes a double biochemical test of hCG and PAPP A.

We can say that the very first reception is the most detailed in terms of testing and conducting research. But it is he who allows us to draw complete picture the state of health of a pregnant woman and to suggest how her pregnancy and childbirth will proceed.

What to talk about with the doctor during the first visit:

• Be sure to discuss folic acid intake. The fact is that the lack of this substance provokes underdevelopment nervous system fetus, so daily intake up to 12 weeks should be 400 mg. Sometimes, to determine a more accurate rate of the drug, experts prescribe a blood test for homocysteine. The higher this figure, the more folic acid you need to take.
• Discuss the issue. Talk about the best. Now many books and online publications are full of a variety of healthy menus for pregnant women, which involve preparing 4-5 fresh meals daily. Probably the network and such happy expectant mothers who can handle it, but if you work a lot and do not have the opportunity to spend so much time in the kitchen, discuss the best nutritional option with your doctor.

Consider Buying From Mom's Store Special Healthy Naturals for pregnant and lactating women, which are well suited for trips and walks, snacks and the main meal at work and at home.

Note. Return of food and cosmetics possible only with undamaged packaging.

Discuss the intake of minerals and vitamins for pregnant women. Do not listen to your friends, but check with your doctor what is right for you.

• Talk about how to mitigate the manifestations, if it manifested itself.
• Be sure to talk about your bad habits, if any. Together with the doctor, work out a strategy for avoiding them.
• Talk about your load at work, clarify what you can do and what is absolutely impossible. What to do in case of feeling of constant fatigue, drowsiness, fatigue and absent-mindedness.
• Ask if you can continue. In most cases, the doctor will give a positive answer, only serious violations, such as placenta previa, etc., can be a refusal of intimate pleasures.
• Discuss your physical activity, you may have to give up the usual activities, but a competent specialist can recommend a set of exercises that will help keep the muscles in good shape without harming the fetus. More in the article.
• Ask about what is happening with the fetus, how it grows and develops when you feel movement.
• It is very important that the doctor describes everything to you dangerous symptoms termination of pregnancy. This will help you not to worry about trifles and readily accept any changes in the body. However, any deviations from the norm should be clear to you. You must know who to call and where to go in case of a threat.
• Talk about the participation of the future father in the process of pregnancy, describe his habits, life principles, fears. So the doctor will be able to choose the most correct tactics of behavior with your partner.

You may have many more questions, be sure to write them down in a notebook so as not to miss anything important.

Second doctor visit during pregnancy

The second visit must take place no later than 2 weeks after the first visit. During this meeting, you will discuss in detail with the doctor the results of all previous examinations, specify what needs to be corrected or corrected.

In particular:

• In the presence of anemia, iron levels in the blood will be less than 110 g / l, the doctor will prescribe the necessary drugs, and also indicate foods rich in iron.
• In the absence of antibodies in the mother's blood, with a Rh conflict, an initial conversation will be held on the topic of introducing anti-Rh immunoglobulins at 28-32 weeks of pregnancy.
• If a protein or infection is found in the genitourinary system, effective antibiotic therapy will be prescribed, and the diet will be adjusted.

What organs and systems are examined:

• A urine test or rapid protein detection test is done.
• Measured blood pressure, heart rate and rhythm, body temperature.

During this visit, you will receive a referral for a second mandatory ultrasound screening, which should be done at 18-20 weeks. It will show the presence or absence of possible physical abnormalities in the development of the fetus.

Information about the screening results described by the sonologist during the ultrasound examination must be reported to your doctor over the phone, and the printout with the diagnosis must be handed over at the next visit. If the specialist detects low placenta previa, you may be prescribed an additional ultrasound at week 32, but if the sonologist fixes the central one, the pregnant woman can be sent to the obstetric hospital for preservation.

All data received as a result of your visit is entered into the exchange card.

What to talk about with the doctor during the second visit.

Do not forget that you have the right to ask the doctor any questions and describe any of your conditions. If for your own peace of mind you need to understand the changes in your own body in detail, do not hesitate to find out the cause-and-effect relationships. Ask about everything!

Third visit to the doctor during pregnancy

This visit should be scheduled for 19-21 weeks of pregnancy, when you have the results in your hands.

During the third visit, the doctor will conduct the following examinations:

• Measure the height of the fundus of the uterus;
• If this question bothers you, you can measure your own weight to determine the dynamics of its set.

All these indicators are entered into the exchange card. It also includes data on changes in weight. The doctor enters the indicators of the growth of the uterus into a special graph - a gravidogram.

What to talk about with the doctor during the third visit:

• Discuss the issue. If the pregnancy is the first, most likely you already feel his flutters, and perhaps they will appear only after the 22nd week. With a second pregnancy, movements could appear at 16 weeks. Ask the doctor to teach you to record the movements of the child so that you can always understand whether everything is in order with him and not worry in those situations when the baby wants to fall asleep for a couple of hours, leaving you "without communication" for a couple of hours.
• Ask questions about improving nutrition and how to reduce manifestations.

Surely you have already learned to recognize certain symptoms, you understand what and why is happening in your body. Fix everything new and get a competent answer from professionals at the meeting.

Fourth doctor visit during pregnancy

It is recommended to carry out at 25-26 weeks of pregnancy. By this time, you already feel the movements of the child well and you can discuss his behavior with the doctor. The doctor also discusses with you all previous examinations and explains which related specialists you need to visit before taking maternity leave.

During the fourth visit, the doctor will perform the following examinations:

• He will measure the height of the uterine fundus and enter the data into a special graph - a gravidogram;
• Check your blood pressure, pulse and body temperature.
• Examine the lower extremities for varicose veins veins;
• Clarifies the weight gain in dynamics, if you ask him about it;

At this time, directions for conducting are issued.

What to talk about with the doctor during the fourth visit:

• Be sure to talk about your feelings, if there are controversial questions that may seem ridiculous and funny to you, ask them anyway. Once again, talk about threatening symptoms, discuss what manifestations you may expect in the near future.
• Consult with a doctor on the topic and a specialist who can take delivery. Write down the phone numbers of all important doctors.
• If you have rezu-conflict, talk about the process of administering immunoglobulins in case your blood tests do not show antibodies.
• Discuss how to relieve insomnia and choose the most comfortable sleeping positions. Most likely it's time to buy or change for convenience, as the tummy is growing rapidly. Might be worth changing or due to breast enlargement and the rest of the body.

  Fifth doctor visit during pregnancy

It is carried out at the 30th week of pregnancy. Allows you to assess the condition of the mother and child, taking into account all previous analyzes. Iron indicators are checked, if they are below 110 g / l, iron preparations are prescribed. At this time, it is already possible to discuss the issue of future childbirth, the presence of a partner and the collection required documents for him.

During the fifth visit, the doctor will perform the following examinations:

• Measure the height of the fundus of the uterus;
• Check your blood pressure, pulse and body temperature.
• Clarifies the weight gain in dynamics, according to your desire;
• Listen to the fetal heartbeat.

What to talk about with the doctor during the fifth visit:

• Discuss the issue of sex life. Find out which ones are the most suitable for you.
• Tell us about all the symptoms that you feel during this period.

After 30 weeks, you will officially be on maternity leave. Do not forget to take all the necessary documentation from the doctor in order to transfer it to the employer or to the Social Security.

Sixth doctor visit during pregnancy

It is carried out at 34-35 weeks of pregnancy. At this time, the specialist can already check the position of the fetus in the uterus and recommend special exercises to turn it over if the baby is.

During the sixth visit, the doctor will perform the following examinations:

• Measure the height of the fundus of the uterus;
• Check your blood pressure, pulse and body temperature.
• Examine the lower extremities for the occurrence of varicose veins;
• Examine and palpate the mammary glands;
• Listen to the fetal heartbeat.

At this time, the pregnant woman receives a referral for a general urinalysis or a rapid test for protein detection.

What to talk about with the doctor during the sixth visit:

• Talk about the harbingers of childbirth, specify which of them can talk about the real onset of labor.
• Describe your feelings, the doctor will reassure you about incomprehensible symptoms.
• This time you can discuss the upcoming birth in detail, ask questions about the indications for a possible operation. Talk about this topic, even if there is no indication for a caesarean.

Seventh doctor visit during pregnancy

It is carried out at the 38th week of pregnancy. Childbirth can occur any day, the pregnancy is considered fully full-term.

During the seventh visit, the doctor will perform the following examinations:

• Measure the height of the fundus of the uterus;
• Check your blood pressure, pulse and body temperature.
• Examine the lower extremities for the occurrence of varicose veins;
• Examine and palpate the mammary glands;
• Listen to the fetal heartbeat.

What to talk about with the doctor during the seventh visit:

• Discuss what requirements the maternity hospital puts forward for collection.
• Ask questions about preterm delivery, what you will do if delivery occurs before 40 weeks.
• Describe your feelings to the specialist, you are probably very tired and can hardly cope with household chores.
• Talk about and postpartum contraception.

Usually, at this time, the doctor who will conduct the birth appoints the first acquaintance (if you have not been observed by him before or have given birth). During this appointment, he may perform a gynecological examination to assess the condition of the cervix and suggest a preliminary date for the onset of labor.

Eighth visit to the doctor during pregnancy

It is carried out at the 40th week of pregnancy. This is exactly the visit that indicates that the body is completely ready for childbirth. You meet with your doctor to discuss the upcoming changes one more time.

During the eighth visit, the doctor will perform the following examinations:

• Measure the height of the fundus of the uterus;
• Check your blood pressure, pulse and body temperature.
• Examine the lower extremities for the occurrence of varicose veins;
• Examine and palpate the mammary glands;
• Listen to the fetal heartbeat.

As a rule, before giving birth, the expectant mother is prescribed a general urine test or a rapid test for the presence of protein.

What to talk about with the doctor during the eighth visit:

• Discuss how you will hand over postpartum documentation.
• Decide when you will make an appointment to undergo a gynecological examination and decide on the restoration of sexual activity. This usually happens 1.5-2 months after birth.

Ninth doctor visit during pregnancy

Applies only to those expectant mothers whose gestational age has exceeded 280 days or 40 full weeks of full-term pregnancy. Of course, childbirth can begin at any time, but the specialist must make sure that everything is in order with the baby.

During the ninth visit, the doctor will perform the following examinations:

• Measure the height of the fundus of the uterus;
• Check your blood pressure, pulse and body temperature.
• Examine the lower extremities for the occurrence of varicose veins;
• Listen to the fetal heartbeat
• The pregnant woman is again prescribed a general urinalysis or a rapid test for the presence of protein.

Experts will start talking about a delayed pregnancy after the period exceeds 294 days after the last menstruation (42 weeks). Perhaps, after this visit, a decision will be made on artificial stimulation of the birth process.

We can say that now, compared to how it was a few years ago, the attitude towards the expectant mother, in terms of mandatory research, is quite loyal. The same goes for weight gain. A specialist can only correct them, and not frighten a woman with too much.

Recall that there are 9 mandatory visits to the doctor, any other meetings are solely your desire, or a necessity caused by serious medical indicators, such as real, fetal developmental delay, etc.

Additional tests and studies that are not included in the above should be clearly argued by your supervising physician. Every pregnant woman needs to understand why and for what reason she is assigned new examinations. If you have not received an intelligible answer from a specialist, we can talk about unnecessary overdiagnosis, which you have the right to refuse.

Now great importance is given to the psychological health of the expectant mother. Naturally, the fear for the health and life of her own child, caused by referrals for additional tests, makes a pregnant woman worry and experience unnecessary stress. A woman unconsciously assumes: "something is wrong with her baby, he will be born sick or weak."

Such fears are exacerbated while waiting for the results of the study, which are often much more detrimental to the fetus than the prerequisites for examinations.

doctors during pregnancy. How can they help?

On the this moment there was no direct relationship between the number of prenatal appointments and successful/failed pregnancy outcomes. This suggests that it is not so much the number of visits that is important, but the quality of communication between the pregnant woman and the doctor observing her, their mutual understanding and the ability to work “in a team”. Do not be surprised - just work, and exactly “one team”.

If you look globally, you and your doctor have exactly the same goals, only motivation can differ. You need a healthy, timely born baby - this is a guarantee of well-being and joy in the family. The doctor is interested in the same, because on the one hand, these are the indicators of his work in front of the administration, on the other hand, this is his professional reputation.

We will not discount the human factor either - of course, the doctor is sincerely glad for the successful outcome of your pregnancy. And, finally, a certain material component - happy parents of a healthy child are more likely to be grateful to the doctor not only in words.

Carrying and giving birth to a healthy baby is really a serious job. Therefore, you need:

• More than usual, take care of yourself (follow the regimen, and, use, regularly examine yourself, follow the doctor's recommendations, etc.);
• Eat right (which means thinking through your diet in advance, planning more frequent food purchases, buying fresh, safe and healthy foods, cooking for 1 meal, counting nutritional value and calories, etc.);
• Find time for regular walks and sports activities, to visit the "School of Future Parents", to communicate with your baby and even for cultural and entertainment events - after all, your "pregnant" life should not be insipidly boring!
• Most women have to combine work and pregnancy, which means they need to learn how to prioritize, become a time manager in order to be in time everywhere; do not allow other employees or management to “overwhelm” you with work;
• Regularly visit a doctor, be examined in a timely manner and receive treatment if necessary.

An active pregnant woman can buy bright ones in the Mom's Store, and for moms.

Pregnancy record. Is it possible to visit the doctor less often or more often than the established norms?

Many experts with modern views believe that the time and number of visits to the consultation should be determined by the pregnant woman herself. If she feels the need to communicate with the doctor, questions have accumulated, unusual symptoms have appeared, there is a psychological need to hear the baby's heartbeat or words of support from the doctor - welcome to an unscheduled visit.

And vice versa - if a woman feels great, and the doctor has no reason to worry about her state of health - visits may be more rare, and some issues can be resolved over the phone (for example, discussing the results of routine tests). Of course, the complicated course of pregnancy or the presence of chronic diseases in the expectant mother may be the reason for more frequent meetings with the doctor.

Pregnancy record. Is it possible to register outside the place of residence?

Being pregnant, you have the right to independently decide which specialist to entrust yourself and your baby. You have every right to register for pregnancy both at the place of your real residence (registration does not matter), and at another medical institution upon your written application.

True, you need to understand that the medical institution you have chosen should have the appropriate capabilities, and the obstetrician-gynecologist should have enough free time. If the load on a doctor at the expense of patients “at the place of residence” is 100%, no one can force him to work even more and with more large quantity of people.

Unless you yourself will be able to convince the doctor you like to take up the observation of your pregnancy in addition to his main job.

Pregnancy record. Can I change doctors after registration?

It is wonderful when warm, trusting relationship. The doctor can be a professional the highest class, but if for some reason he is unpleasant to you, you are embarrassed by him (you are afraid, you don’t understand, etc.) - feel free to insist on changing the doctor.

The higher the level of trust, the less likely it is to miss alarming "bells" in the state of a pregnant woman and her baby. The calmer and more confident she feels, the less complications fall on her pregnancy. A direct link between emotional state women during the period of expectation of the baby and the severity of pregnancy complications. Therefore, it is very important for every expectant mother to find “her own” doctor, behind whose back she will feel “like behind a stone wall” - in safety and peace of mind.

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Women's consultation

When a woman finds out about her pregnancy, she needs to register with a antenatal clinic for follow-up.

Women's consultation is an outpatient treatment and prophylactic institution. It is served by doctors, midwives and nurses. In the antenatal clinic, specialized appointments are conducted: there is a family planning room, there is a gynecologist-endocrinologist who treats women with menstrual irregularities, and there is also a miscarriage room. The antenatal clinic has an ultrasound room and a laboratory. Most antenatal clinics have day hospitals where pregnant women with obstetric pathology are monitored and treated.

It is desirable that a woman is registered before 12 weeks of pregnancy for a more complete examination. When registering for a pregnant woman, two cards are usually entered. The first card is an individual card of a pregnant woman and a puerperal. The second card is an exchange card for a pregnant woman. These cards contain complete information about the course of pregnancy. An individual card is filled out by a doctor and is constantly in his office. The exchange card is usually filled in by a midwife or nurse and issued to the pregnant woman.

When registering, the doctor interviews the woman, clarifies the heredity and health of her husband. Assesses the general condition of a woman, measures height, weight, and blood pressure on both hands. Measure the external dimensions of the pelvis, conduct a gynecological examination. The doctor writes directions for laboratory tests. With a pregnant woman, a conversation is necessarily held about the daily routine and nutrition.

• A mandatory set of examinations for a pregnant woman includes:
• blood test for AIDS and syphilis - 2 times during pregnancy;
• clinical blood test - 3 times;
• biochemical blood test - 3 times;
• general urinalysis for each visit of a pregnant woman;
• smears on the flora from the vagina - 2 times;
• examination for latent infection - 1 time;
• smears from the pharynx and nose for pathogenic staphylococcus aureus;
• a study of blood coagulation at a period of 33-35 weeks of pregnancy;
• Ultrasound - 3 times.

Expert advice needed:

• therapist - 2 times;
• oculist - 2-3 times;
• dentist - at least 1 time;
• ENT - at least 1 time.

If necessary, some examinations may be carried out more frequently.

The doctor at each appearance of the pregnant woman finds out the presence of complaints, assesses her general condition, monitors weight gain for one week, measures blood pressure and abdominal circumference, determines the tone of the uterus, from 21-22 weeks listens to the fetal heartbeat, after 35 weeks of pregnancy determines the location of the fetus , and also makes recommendations and appoints the next turnout.

Women's consultation provides an opportunity to assess the health of a woman as much as possible. Even if you feel well, you still need to register. You can never know exactly what problems may arise, and the observation of a doctor will allow you to notice warning signs as early as possible.

continuation

During the entire period of pregnancy, the child depends on the mother. The necessary research makes it possible to monitor the health of both the woman and the child. First of all, inspection should be included in the necessary examinations. The doctor measures the height and weight of the pregnant woman, examines the breasts in order to find out how developed the nipples are. To prepare the chest for breastfeeding your doctor can give you some tips for developing and strengthening your nipples. The study includes the measurement of blood pressure. An increase in blood pressure can be a sign of hypertension. The doctor performs palpation of the abdomen to determine the length of the uterus and find out how normal the fetus is developing. In the later stages, the doctor listens to the fetal heartbeat. A gynecological examination is carried out during which palpation and smears are taken for flora and cytology.

The doctor must measure the woman's pelvis. These measurements are carried out using a tasometer. Three measurements are taken when the pregnant woman is lying on her back and one when she is lying on her side. All this is done in order to be able to judge the size of the small pelvis, which determines the possibility of childbirth, the course of childbirth and their outcome. The shape and capacity of the small pelvis can be judged by the shape and size of the lumbosacral rhombus. The doctor finds such a conditional rhombus on the lower back of the pregnant woman and makes necessary calculations. They also measure the wrist joint of the left hand. This method is called the Solovyov index. It makes it possible to judge the massiveness of the bones of the skeleton, and hence the pelvis.

Research includes laboratory tests. A urine test is taken, the average portion is examined for the content of sugar and protein in it. With this method of research, it is possible to detect a latent urinary tract infection and, if necessary, begin treatment. It matters such tests as biochemical and clinical blood tests. These tests make it possible to detect diabetes mellitus and anemia in a pregnant woman. Knowing about the presence of anemia is very important, if the concentration of hemoglobin in the blood is very low, the doctor will prescribe treatment. Also, blood is taken to determine the infection with syphilis. Syphilis can cause very serious harm to a child, and if syphilis is recognized on early dates pregnancy, infection can be prevented. Blood is also taken to detect diseases such as AIDS and hepatitis. Blood is taken in order to determine the blood type and Rh factor.

Recently, tests have been carried out for the presence in the mother's body of immunity to diseases such as rubella, toxoplasmosis and for the presence of herpes and cytomegalovirus viruses in the body. These diseases can adversely affect the course of pregnancy and adversely affect the child. Examinations are carried out for sexual infections, such as chlamydia, gonorrhea, trichomoniasis. These diseases can occur in a latent form and, if left untreated, can provoke a miscarriage or premature birth.

Some tests can eliminate the risk of chromosomal abnormalities in a child (Down's disease). Such tests are carried out at certain stages of pregnancy.

In addition to all of the above, it is impossible not to note such a research method as ultrasound. Ultrasound examination makes it possible to more closely monitor the health of the child. Also, with the help of this examination, you can find out how the placenta is located, whether the amount is normal amniotic fluid etc.

There is such a research method as fetal electrocardiography. This method allows you to monitor the child's cardiac activity and identify signs of oxygen starvation. The study is carried out on an outpatient basis, special electrodes are attached to the front wall of the mother's abdomen.

All these studies make it possible to make sure that the pregnancy is going well, and if problems arise, prescribe the right treatment.

At this stage, the gynecologist interrogates and records data in the pregnant woman's exchange card about: existing pregnancies, methods of delivery, miscarriages, abortions, the general health of the patient, previous diseases, operations, the presence of acute and chronic diseases in the pregnant woman and her relatives, bad habits, place of work, type of work, living conditions and social status of the family. All this information will help to give specific recommendations and build individual plan pregnancy in order to maximize the health of mother and child.

Measurement of physiological data when registering with a gynecologist in the first weeks of pregnancy

At this stage, the gynecologist measures:

• weight and height of the pregnant woman (to control weight gain during pregnancy). It is believed that a normal increase in 9 months is about 12 kg. But this number is rather relative. Each organism is individual. Weight gain in the first weeks of pregnancy is approximately 2 kg. But if a woman has toxicosis, then weight loss is also possible.
• the size of the pelvis of a pregnant woman (to assess the possibility of self-delivery). Usually, the dimensions of the pelvis are measured using a special tool, similar to large tweezers - a pelvis. Indicators of the size of the pelvis indicate the Latin names: Distantia spinarum, Distantia cristarum, Distantia trochanterica and Conjugata externa. Accordingly, normal indicators of the size of the pelvis are: 25-26 cm / 28-29 cm / 31-32 cm / 20-21 cm. The difference between the first three indicators is also taken into account, it should be 3 cm.
• the height of the standing of the bottom of the uterus of a pregnant woman (to assess the normal increase in the uterus). This parameter is measured in the supine position and, usually, in the first weeks of pregnancy it is 8-9 cm. An increased indicator may indicate multiple pregnancy, incorrect gestational age and polyhydramnios. A reduced rate may indicate a delay in fetal development or an incorrect gestational age.
• girth of the abdomen (to assess the positive dynamics of fetal growth). Also, the size of the abdominal circumference is used at later stages of pregnancy to determine the approximate weight of the fetus.
• blood pressure (to rule out hypertension). Most often, pregnant women in the first weeks of pregnancy have low blood pressure and a rapid pulse. If, with such indicators, the patient feels normal, then this is not considered a pathology. But high blood pressure is very dangerous. Hypertension can lead to a condition such as preeclampsia, which can cause placental abruption, bleeding, and even intrauterine fetal death.

Gynecological examination during registration with a gynecologist in the first weeks of pregnancy

When registering with a gynecologist in the first weeks of pregnancy, a gynecological examination on a chair is mandatory. During this procedure, the gynecologist examines the walls of the vagina, the cervix and takes a smear on the flora. A smear can determine the presence of certain infections (trichomoniasis, thrush, gonorrhea) and, if present, prescribe treatment in a timely manner. There is such a myth that a gynecological examination on a chair during the first weeks of pregnancy cannot be performed. Actually this is not true. The doctor does not perform a rough examination, but realizing that you are in a position, he will do everything delicately.

Issuance of referrals for tests and additional examinations when registering with a gynecologist in the first weeks of pregnancy

When registering, the doctor will give you many referrals for various tests, namely:

• general blood test - to assess the level of hemoglobin and exclude anemia, as well as to identify hidden inflammatory processes in the body of a pregnant woman;
• general urinalysis - a mandatory analysis to assess the general condition of the kidneys and exclude acute and chronic diseases of the urinary system (cystitis, pyelonephritis, glomerulonephritis), as well as control the level of acetone in case of toxicosis;
• analysis for RW - a mandatory analysis to exclude the presence of syphilis, in the presence of syphilis, there is a high probability of miscarriage or the birth of a dead child;
• blood test for HIV - a mandatory test to identify the risk of infection of the fetus with this disease;
• a blood test for hepatitis B is a mandatory test to identify an increased risk of infection of the fetus;
• a blood test for hepatitis C is not a mandatory test, but recommended, to identify the possibility of intrauterine infection of the fetus;
• analysis for thyroid hormones and antibodies to them - not a mandatory analysis, but a recommended, normal TSH indicator is very important for the full formation of the child's organs and systems;
• blood sugar test - to rule out diabetes;
• analysis for the blood type and Rh factor of the mother - a mandatory analysis to exclude the possibility of a Rh conflict and a conflict between the mother and the child by blood groups;
• analysis for blood biochemistry - a mandatory analysis for diagnosing the functioning of the liver and kidneys and excluding their pathologies;
• coagulogram - not a mandatory analysis, but recommended, with poor hemostasis, there is a high probability of miscarriage;
• a blood test for antibodies to TORCH infections (toxoplasmosis, rubella, cytomegalovirus, herpes - a mandatory analysis, all these diseases directly affect the normal development of the fetus;
• bacteriological culture of urine is not a mandatory analysis, but recommended, to detect bacteriuria and its timely treatment.

Also, a gynecologist may prescribe such additional examinations as:

• ultrasound examination - to establish a uterine or ectopic pregnancy, clarify the gestational age, identify aggravating factors such as tone and others.
• cardiogram - examination of the work of the mother's heart.

At the first appointment, the gynecologist will give directions for a scheduled examination of such narrow specialists as:

• ENT - to exclude chronic ENT infections;
• ophthalmologist - to assess the vision of a pregnant woman, with a large visual impairment, there may be a question of delivery by caesarean section;
• endocrinologist - to evaluate the result of tests for thyroid hormones and blood sugar and exclude diseases of the thyroid gland and pancreas;
• a dentist - to assess the state of dental health and eliminate diseases, since calcium and phosphorus are washed out during pregnancy;
• therapist - to identify and treat comorbidities.

Recommendations when registering with a gynecologist in the first weeks of pregnancy

At the first visit to the antenatal clinic, the gynecologist will prescribe special vitamins for pregnant women and other (if necessary) drugs, answer all your questions, make the next appointment and send you to visit the school of expectant mothers, where you will learn a lot interesting information about proper balanced nutrition and lifestyle during pregnancy. Also, a gynecologist, if necessary, can issue a sick leave and write a certificate about facilitating the work regime.