Pregnancy management

Pregnancy is not only a joyful expectation, but also care, an effort that needs to be made so that everything proceeds as it should, and the fetus develops correctly. It is also important to control the process. Pregnancy management – measures that allow you to monitor the development of the baby, and prepare a woman for childbirth and motherhood. In the article, we will tell you about the correct tactics of pregnancy management, what tests you need to take and by what criteria to choose a doctor.

Do I need a pregnancy management program

A woman is registered in the first trimester. Depending on her preferences, she can choose to conduct pregnancy in an antenatal clinic, or contact a paid clinic that has an appropriate license. Why is this necessary and what is the purpose of such close attention to the expectant mother?

The main task of dispensary observation is the prevention of complications of pregnancy, miscarriages, prevention of complications of childbirth, pathology of newborns. A competent doctor will refer a woman for examinations in order to exclude health problems, give recommendations on nutrition and lifestyle. Prepares for childbirth, motherhood, newborn care, lactation – not only physically, but also mentally. This is especially important when the woman is primiparous. During this period, an obstetrician-gynecologist for a woman is support, reliable support and protection.

When a woman is diagnosed with a pregnancy pathology, the doctor selects therapy, taking into account her history and concomitant pathology. If necessary, he sends her to a day or round-the-clock hospital, to a spa treatment.

In cases where, during the medical genetic consultation, an anomaly in the development of the fetus (chromosomal, congenital malformations) is confirmed, the medical consultation will help to make a timely decision on further tactics.

In addition, medical support in the prenatal period implies the preparation of medical documentation – an exchange card, a sick leave for pregnancy and childbirth (to be provided at the place of work), a birth certificate.

What is included in “pregnancy management”

Pregnancy monitoring is carried out according to a certain algorithm prescribed in Order No. 572. It says that the obstetrician-gynecologist during the first visit conducts a vaginal examination with taking smears from the cervix for genital infections, the same procedure awaits a woman on the 28th and 36th th weeks. Also, at the first visit, the doctor assesses the size of the pelvis.

Further, at each appointment, the doctor measures blood pressure, body weight, pulse, abdominal circumference. From the 8th week, he determines the position of the fundus of the uterus, from the 20th – he listens to the heartbeat of the fetus and assesses the position.

The document specifies the frequency of examination by an obstetrician-gynecologist: during the first 2 trimesters – a monthly examination, from the 28th to the 36th week – once every two weeks, then – weekly.

It is necessary to consult a dentist 2 times, a therapist – 2 times, an ophthalmologist and an ENT doctor – at least 1 time. Other specialists – according to indications.

Analyzes

A healthy pregnant woman must pass:

1. Blood tests – general, biochemical, at least three times;
2. Urine analysis – at every appointment with an obstetrician-gynecologist;
3. Blood for HIV, syphilis. viral hepatitis – 3 times;
4. Blood for clotting – once;
5. Analyzes for chlamydia, mycoplasma, ureaplasma, rubella, herpes, cytomegalovirus, toxoplasmosis – once;
6. A swab from the nose and throat for Staphylococcus aureus – once;
7. Analysis within the framework of prenatal diagnostics – once at 11-14 weeks, includes the determination of plasma protein A and free beta-subunit of chorionic gonadotropin.

According to the indications, the list of analyzes is expanding.

Instrumental research

Includes 3-fold prenatal ultrasound screening: at 11-14 weeks, at 20-24 weeks, at 30-34 weeks. At a high risk of chromosomal abnormalities or congenital malformations in the fetus, the patient is referred for additional ultrasound examination. Then for  medical and genetic counseling to confirm / refute the diagnosis and conduct invasive examination methods: amniocentesis, cordocentesis, placentocentesis, chorion biopsy.

Also, a woman makes an electrocardiogram (ECG) with decoding.

Choosing a doctor and clinic

If desired, a woman can be observed in a private clinic. According to the patients, clinics have their own peculiarities of pregnancy management:

• conduct the same examinations as in a regular antenatal clinic;
• control over the quality of the services provided and their timeliness in accordance with Order No. 572;
• service is more convenient as there are no queues;
• tests can be taken almost all day, and not just in the morning;
• the doctor provides information on choosing a maternity hospital;
• you can contact your doctor at any time.

To get quality services and not waste your money, we advise you to pay attention to the following aspects:

1. Check if the clinic has a license for pregnancy management and how long it is valid. This can be done on the Roszdravnadzor website ;
2. Pay attention to well-known clinics that are well known;
3. Find out if the clinic has the right to write out sick leave, draw up an exchange card;
4. Also, study the certificates and qualifications of specialists and gynecologists for the management of pregnancy.

Please note that you can choose several monitoring programs – they are different for each clinic. For example, a batch program includes a standard and an extended form. The standard one is suitable for women with singleton pregnancies without pathology. Extended is chosen by women with concomitant diseases, and multiple pregnancies when there is a need for additional research.

Usually, there is a program without a package when each visit and each analysis is paid for separately. Such a program should be chosen if you will undergo the main procedures in a regular antenatal clinic, and only some tests will be taken in the clinic.

Rights of expectant mothers in antenatal clinics

According to Federal Law No. 323 “On the Fundamentals of Health Protection of Citizens in the Russian Federation”, a pregnant woman with a compulsory health insurance policy has the right to conduct pregnancy during the entire period free of charge. This includes consultations, tests, examinations, filling out an exchange card and issuing a sick leave. In addition, she can be observed in any antenatal clinic, regardless of the place of registration and place of residence.

She also has the right to receive comprehensive information about her state of health. That is, medical personnel, in the event of a threat or other situations, must inform the patient about this in an accessible form, without hiding anything. A pregnant woman should know about research results, diagnosis, prognosis, treatment methods, risks. Upon confirmation of fetal malformations and chromosomal abnormalities, she can decide on further tactics: endure and give birth or terminate the pregnancy. The pressure from the medical personnel is unacceptable.

If the expectant mother decides not to interrupt, further pregnancy management is carried out according to the protocol.

All procedures are carried out with the informed voluntary consent of the pregnant woman.

Conclusion

Monitoring during pregnancy is an issue that should be taken seriously. The literacy and experience of the doctor is the main thing that you should pay attention to. Find a doctor you can trust, and then you can be sure that everything will be fine with you and your baby.