Pregnancy Follow-up
Just as a healthy pregnancy begins with the mother-to-be’s preparations before conception, it should continue with regular check-ups with a doctor. All obstetrics and gynecology associations recommend seeing a doctor at regular intervals throughout pregnancy. Although every pregnancy begins with wonderful hopes, the journey or its outcome can sadly sometimes go wrong. Regular check-ups are based on the principle of detecting possible risks in advance, taking the precautions that can be taken and minimizing potential complications.
In a planned pregnancy, the process begins once the pregnancy is confirmed with a blood or urine test after a missed period and you attend your first check-up with an obstetrician. The first step is to assess the mother’s and father’s risk factors for the pregnancy and to inform the couple about what lies ahead. Then, when the pregnancy sac and heartbeat are seen on the first ultrasound, at around 6 weeks of pregnancy on average, the pregnancy is definitively confirmed and pregnancy follow-up begins.
After the check-up at which the first heartbeat is seen, monthly routine pregnancy check-ups will be sufficient if no risk factor has been identified. From then on, screening tests that we recommend at specific weeks of pregnancy will be used to look for any risk conditions related to the pregnancy. First, we recommend early screening tests. These tests calculate your baby’s risk of severe disabilities and syndromes that are incompatible with life, and if an increased risk is found, further diagnostic tests are needed (such as amniocentesis, in which a sample is taken from the amniotic fluid surrounding the baby). These tests, known as the double, triple, quadruple and combined tests, can be performed in specific weeks of pregnancy. A risk value is calculated by combining the baby’s ultrasound measurements with blood tests taken from the mother, and the result is interpreted accordingly. We first recommend the “Double Screening Test” at 11–14 weeks of pregnancy. After the double screening test, a “Triple Screening Test” or “Quadruple Screening Test” can be performed at 16–18 weeks. When the double and quadruple screening tests are performed together, this is called the “Combined Test”. None of these tests provides enough information for us to make a definitive judgement about your baby. In other words, they do not determine for certain whether your baby is healthy or ill. They help us identify high-risk pregnancies and the babies who need further investigation. Of these tests, the “Double Screening Test” has the highest specificity for detecting a condition; that is, its likelihood of detecting an existing condition is higher than that of the triple and quadruple tests. For this reason, if your double screening test result is “low risk”, the other screening tests will not be necessary. However, the specificity of the combined test is higher than that of the double test, so if you would like an additional test, choosing the combined test is the better option.
Another screening we recommend between 18 and 22 weeks of pregnancy is the “Level II Obstetric Ultrasound” (detailed anomaly scan). This scan evaluates your baby’s organ development in detail and shows whether there are any organ defects. This test, too, cannot give a definitive answer about your baby’s overall health. A normal Level II obstetric ultrasound allows us to predict with 70–80% probability that your baby will be completely healthy.
At 24–28 weeks of pregnancy, we also recommend the “75 g Oral Glucose Tolerance Test (75 g OGTT)”, the diagnostic test for gestational diabetes (glucose challenge test). We see that there is currently a great deal of confusion about the 75 g OGTT. In this test, the mother-to-be drinks a solution containing 75 g of sugar on an empty stomach, and her blood sugar is measured three times in total: before drinking the solution, and 1 hour and 2 hours afterwards. Gestational diabetes is a condition that can develop during pregnancy and cause serious problems for both mother and baby, yet these problems can be prevented with very simple measures before they arise. That is why this test is so important in pregnancy follow-up. Many obstetrics and gynecology associations around the world, the Turkish Society of Obstetrics and Gynecology (TJOD) and the Ministry of Health of the Republic of Türkiye recommend this test. The glucose tolerance test will be the last screening test we recommend during your pregnancy.
If there is Rh factor incompatibility between you and your partner based on your blood groups, the mother needs an anti-D injection (Anti-D Ig) at 28 weeks of pregnancy, following a blood test (indirect Coombs test). Depending on your baby’s blood group, this injection may be repeated after birth. It may also be given as a precaution after vaginal bleeding in early pregnancy, if your doctor considers it appropriate. The aim here is not to protect the current pregnancy, but to minimize the risk caused by Rh incompatibility in a future pregnancy.
After this, routine pregnancy check-ups will take place monthly until 32 weeks, every two weeks from 32 to 36 weeks, and weekly from 36 weeks until birth. At these check-ups, many parameters will be assessed, such as your baby’s overall growth, the amount of amniotic fluid, your baby’s position in the womb and the estimated fetal weight at that time. From 32 weeks onwards, a “Non-Stress Test (NST)”, in which your baby’s heart sounds are monitored and contractions of the uterus are tracked, will be performed at every check-up to assess your baby’s overall well-being. This test is one of the most objective ways of assessing your baby’s well-being.
Of course, throughout your pregnancy, we will not simply monitor you mechanically with specific tests and procedures. Your weight gain above all, as well as your diet, exercise plan and general emotional state, are without doubt very important to us for your overall well-being. We will give these matters all the care we can and, when necessary, seek the help of our colleagues who are experts in the relevant fields.
In short, pregnancy will be a long and demanding journey, both for you and for us as healthcare professionals. Rest assured that on this long and sometimes bumpy journey, we will support you carefully with all our knowledge and experience and be your traveling companion until you complete the journey in good health.