Maintaining a Physiological Pregnancy

prenatal-management-of-the-normal-pregnancy

Antenatal fetal protection – Pregnancy is a physiological condition during which a woman’s body undergoes some changes. First of all, this is due to a change in the hormonal status of the body, the appearance of fetal and placental blood flow, an increase in the size of the uterus and the development of the fetus. Specific changes are characteristic of almost all organs and systems: cardiovascular (in the form of increased cardiac output, circulating plasma volume), respiratory (increased respiratory volume, minute ventilation of the lungs …), renal (increased glomerular filtration rate ..), hematologic (increased ESR , physiological anemia …) etc. All these changes are physiological and do not require any interventions. From the earliest possible period of pregnancy, it is necessary to contact an obstetrician-gynecologist to conduct a whole range of examinations, including not just general clinical studies (such as a complete blood count, blood groups, Rh, etc.), but specific to each period of pregnancy survey.

At the first visit of a pregnant woman, according to the international standards, it is necessary to conduct the following studies:

  • blood type, Rh factor;
  • clinical blood test;
  • HIV status;
  • syphilis screening (RPR),
  • hepatitis;
  • rubella antibodies;
  • swab from the cervical canal for gonorrhea, chlamydia, cytomegalovirus infection, toxoplasmosis;
  • tank urine culture (in the identification of bacteriuria even asymptomatic, antibiotic therapy is necessary);
  • smear from the cervical canal for oncocytology –Pap-smear; Further tactics depend on the results obtained.

Second visit:

Further, at 11-13 weeks screening for hereditary and congenital abnormalities of the fetus is carried out, which includes as an assessment of the thickness of the collar area of the fetus during ultrasound (Nuchal translucency) and biochemical markers: PAPP-A and β-HCG free.

Third visit:

At 15-16 weeks of gestation, the second trimester is screened for hereditary and congenital fetal abnormalities based on biochemical markers (β-HCG free + AFP + Estriol free);
At 21-24 weeks, a pregnant woman is sent to radiology to conduct an extended ultrasound examination in order to exclude hereditary and congenital abnormalities of the fetus.

Fourth visit:

At 24-28 weeks, all pregnant women are tested for glucose tolerance.

It is known that pregnancy is a diabetic factor, hormones produced by the placenta have a contra-insular effect and predispose to the development of gestational diabetes.

The timely detection of GSD in pregnant women prevents the occurrence of fetal complications and also prevents the onset of type 2 diabetes in women in the future.

Fifth visit:

If a pregnant woman has Rhesus negative blood affiliation without isoimmunization (no antibody titer), then in the 28 week period it is necessary to prevent Rh-conflict by administering antiresus gamma globulin D.

Sixth visit:

At 35-37 weeks it is necessary to conduct an examination for colonization of the genital tract by Streptococcus group B, upon detection of which, antibiotic therapy should be promptly received during pregnancy and childbirth to prevent the risk of septic complications in the newborn.

At each visit, an obstetrician-gynecologist focuses on the complaints of a pregnant woman and, if indicated, can expand the list of mandatory research (laboratory tests, doplerometry, biophysical profile of the fetus, etc.).