Synonyms in a broader sense
prenatal care, controls during pregnancy
Pregnancy care includes regular examinations and consultations of the pregnant woman throughout the entire pregnancy. The task of this continuous care is to detect signs of complications and disorders as early as possible, to detect high-risk births and pregnancies and to take appropriate measures. Both maternal and fetal health are the focus of the examinations.
Preventive examinations during pregnancy have been proven to reduce the mortality of mother and child as well as their diseases. The routine program of preventive examinations during pregnancy is set out in the maternity guidelines. The results of these examinations are entered and noted in the so-called maternity pass, thus simplifying communication between the doctors, midwives and the clinic. According to the guidelines, the check-ups must initially take place once a month. In the last two months of pregnancy, even twice a month.
The examination during early pregnancy
The first examination with a detailed consultation should take place before a pregnancy, especially for couples with known family illnesses, so that the pregnancy can be well planned and nothing stands in the way of a normal course. During such an examination, mother’s diseases such as diabetes mellitus and birth canal malformations can be detected and discussed at an early stage. But also lifestyles that endanger the future child, such as smoking, alcohol or drug consumption, should be uncovered in such an examination and a solution for avoiding these substances should be found together.
Thus, this advisory examination serves in particular the prevention of risks and their therapy even before the beginning of the pregnancy. The first examination after fertilization should be performed as soon as possible after the absence of menstruation. It includes
- The diagnosis of pregnancy,
- The collection of the pregnant women’s medical history,
- The provisions of the date of birth,
- Physical and gynecological examination,
- Ultrasound examination and
- A detailed consultation
Pregnancy is diagnosed by indicating the absence of menstruation (secondary amenorrhea).
Nowadays, the diagnosis of early pregnancy is supported by an ultrasound examination (sonography) and, if necessary, by an additional hormone test, which detects the hormone HCG, which is produced by the placenta in detectable quantities at a very early stage of pregnancy. In the past, when the above mentioned methods were not available for diagnosis, the diagnosis was based on pregnancy signs, which were divided into safe, probable and unsafe. Safe pregnancy signs include hearing fetal heartbeats and feeling fetal body parts and movements.
The probable pregnancy signs are physical manifestations of the mother. These are the absence of menstruation, the increasing coloration (pigmentation) of the nipple and vagina as well as changes in the breast and uterus. Especially the increase in size and the changed condition (consistency) of the uterus represent a very important examination possibility for diagnosis, which is still used today.
By palpating the uterus, the doctor can feel loosening, dilatation and pulsating vessels and confirm an existing pregnancy. Digestive disorders, in particular vomiting and nausea, frequent urination and changes in mental mood are among the uncertain signs of pregnancy. In order to ascertain the history of the pregnant woman, questions are asked about previous illnesses, especially about possible illnesses after fertilization.
You can find more information here: Infections during pregnancy It is particularly important to take in medication taken for treatment. Some pathogens and medications can enter the child’s body through the placenta and endanger the developing child. In order to record the physical changes caused by pregnancy, the doctor will ask about the current state of health of the pregnant woman.
Previous births and pregnancies are also asked in this conversation.The way of previous deliveries, the duration of pregnancy and the time after delivery are also important information for the doctor. This first intensive conversation is an important step in the care of the pregnancy and the cooperation between the pregnant woman and the treating doctor. In order to determine the date of delivery, questions must first be asked about the last menstrual periods that have taken place and the woman’s cycle.
The regularity, duration and interval between two bleedings play a major role. The date of the last menstrual period and its duration and strength are also important for calculating the date of birth. If the last bleeding was weaker or shorter than usual, there may have been a so-called implantation bleeding, which occurs shortly after fertilization and determines the time of implantation in the uterine wall.
This date would result in a too late birth date in the calculation, because the start of pregnancy is faked too late. If the date of fertilization is known, it will also be documented. The first possibility to determine the date of birth is the day of fertilization plus 267 days with a fluctuation of about 7 days.
Since the date of fertilization is rarely known, there is another calculation possibility based on the information about the monthly cycle. The so-called nails rule helps here. It uses the first day of the last menstrual period and the interval between two menstrual periods as a basis.
This is called a shortened cycle if the interval is less than 28 days and a lengthened cycle if the interval is more than 28 days. It should be noted that this calculation is not exact. Thus, two thirds of all children are born within 3 weeks around the date of birth determined with the help of this calculation and only a share of 3.9% of the children is actually born on the calculated day.
The date of birth determined with the help of this calculation represents accordingly only a guideline value and in no case an absolute value. Especially in early pregnancy, the measurement of the child with the help of ultrasound images allows a fairly accurate statement about the age of the child and its due date. The length from the crown to the rump of the child is measured as well as the diameter of the amniotic sac and the child’s head.
The measurements obtained are then compared with a standard curve. The results of the examinations are documented in the maternity record and, if necessary, the previously calculated due date is adjusted to these results. However, these examinations are only meaningful up to the 12th week of pregnancy, as the development of the children is very different at later points in time.
The physical examination at the beginning of the pregnancy includes in particular the determination of the mother’s body weight in order to be able to determine the progress of weight gain in the further course of the pregnancy. A urinalysis and blood pressure measurement are also part of the physical examination, for example to detect pregnancy poisoning at an early stage. In addition, the maternal blood group is determined, the iron content of the blood is determined and the blood of the pregnant woman is examined for infectious agents and antibodies.
An HIV test is only carried out with the consent of the pregnant woman and the maternity record only documents the performance of the examination but not the result. All other results are entered in the maternity record. In the course of an addiction test (first trimester screening) two hormones are determined in the blood of the pregnant woman.
These are free HCG, which is produced by the placenta, and the pregnancy-specific hormone PAPP-A. The determination of the concentrations can be used to detect a chromosome-related disease in the child, taking into account ultrasound results. These are manifested in an altered number of chromosomes in all the child’s body cells.
Probably the best known disease with a chromosome-related cause is Down syndrome. Likewise, the so-called triple test determines the presence of a child’s chromosomal disorder, especially Down’s syndrome. This test determines three hormone concentrations and is performed around the 16th week of pregnancy.
However, the results are not always accurate and must be clarified by further examinations. The gynecological examination includes palpation of the uterus and the ovaries. In addition, cells are taken from the cervix by a smear test.
According to the maternity guidelines, three ultrasound check-ups are carried out during pregnancy.This should be done in the 10th, 20th and 30th week of pregnancy. The first ultrasound examination, in addition to the above-mentioned determination of the date of birth and the age of the child, serves to control the pregnancy and the early detection of childhood diseases. This examination will show whether the fertilized egg has properly implanted in the uterus and whether there is a multiple pregnancy.
In addition, the transparency of the nape of the neck is measured and a check is made to see whether water has accumulated in the area of the child’s neck and is forming a so-called dorsonuchal edema there. These findings can indicate the presence of Down syndrome as well as heart or kidney disease in the child. Placental insufficiencyRight the first examination of the pregnant woman should be followed by a detailed consultation with recommendations and behavioral advice about the time of pregnancy.
These are briefly outlined in the following, but are by no means a substitute for such a consultation. The mother’s diet must provide enough nutrients so that mother and child have sufficient energy. With the usual food in Germany must be eaten nevertheless not for two persons but the usual food quantity is completely sufficient.
A balanced diet is important. In addition, the increased need for proteins should be considered, these are mainly contained in eggs, meat and fish. Also important is the increased need for minerals and trace elements, which concerns iodine, iron and folic acid and can be supplied by appropriate tablets.
The increased intake of milk and dairy products covers the necessary need for calcium and magnesium. The consumption of alcohol, smoking and other drugs should be stopped completely, as this leads to disturbances in the child’s development up to malformations as well as complications of birth. Passive smoking should also be consistently avoided.
Even medication can impair child development and should therefore only be taken for important reasons and only after medical advice. If the pregnancy proceeds according to the rules, light sports such as swimming or hiking can have a positive effect. However, competitive sports as well as all sports with strong vibrations or increased risk of falling, such as skiing or athletics, should be avoided.
Heavy physical work should also be avoided in the household or at work. Short trips, especially to countries with no climatic stress due to fluctuations in temperature or altitude, are also possible during pregnancy. In the middle of the pregnancy this is associated with the lowest risk.
To be on the safe side, you should have a check-up by your doctor before you start your journey. In general, rapid temperature changes and excessively high temperatures should be avoided. This also applies during showering or bathing.
Saunas longer than 10 minutes should also be avoided. If the pregnancy is normal and no functional disorder of the cervix has been found, no restrictions on sexual intercourse are necessary. However, it is recommended that sexual intercourse be withheld until the beginning of the 3rd month of pregnancy and in the last month before the birth, as this can lead to premature rupture of the bladder or to contractions.
The physical examinations hardly differ from those already mentioned. They also include the determination of weight and blood pressure and the examination of urine and blood. The gynaecological examinations such as the assessment of the uterus are carried out as usual on the gynaecological chair until about the 16th week of pregnancy.
Afterwards it is performed on the couch. The vaginal examination is still important here, too, in which cells are removed for evaluation and the cervix is assessed. Around the 24th week of pregnancy, pregnant women are recommended to undergo a so-called oral glucose tolerance test, which reveals a possible diabetes mellitus.
Such a disease can also occur and be detected only in the period of pregnancy due to the altered hormone concentration and is then called gestational diabetes (gastric diabetes). The child is also examined during the preventive medical checkups. Here, the fetal heart work can be made visible with the help of ultrasound from about the 5th week of pregnancy.
The fetal movements can also be seen here. The first-born mother can feel these even from the 20th week of pregnancy. Mothers who have already given birth to several babies notice these movements several weeks earlier.It is important that the pregnant woman knows that child movements which are diminishing or changed must be clarified absolutely by the physician.
The child’s movements can also be recorded objectively. Kineto-cardiotocography (K-CTG) is used for this purpose. With the help of the ultrasound device, statements about the development of the child and its condition are made in the 20th week of pregnancy.
In the process, various disorders can be ruled out or abnormalities can be detected early on. The amniotic fluid as well as the placenta are also assessed and provide important information about the care of the child. The examinations and consultations towards the end of the pregnancy serve to prepare for the upcoming birth.
Thus, the pregnant woman should decide during this time for a maternity clinic and present herself there. This makes the later birth process much easier, since the conditions and the personnel can be familiarized with at an early stage and possibilities of delivery can be discussed. Important insights gained with the help of the third ultrasound examination are important points for the birth, such as the position of the placenta and that of the child.
It is important for the pregnant woman to know that the onset of regular contractions and the loss of amniotic fluid around the calculated date of delivery should definitely lead her to visit the maternity clinic immediately. In addition, a birth preparation course can be recommended during a consultation, which contains information about the birth and the care of the newborn child. Participation in the pregnancy gymnastics course also results in a reduced need for painkillers and a more rapid birth process during the birth due to the breathing, positioning and relaxation exercises learned there.
Especially around the time of birth and especially if the time of birth is exceeded, a close monitoring of the fetal heartbeat and uterine activity with the help of cardiotocography (CTG) is necessary to give the doctor a picture of the child’s condition. If the birth date is exceeded, appropriate examinations are performed every 2 days to be sufficiently informed about the maternal and fetal condition. In addition to the above mentioned methods, there are other options available.
These are especially offered to pregnant women over 35 years of age. What these methods have in common is that different fetal cells are taken to examine their chromosomes. Furthermore, this method involves certain risks due to the procedure, including the risk of miscarriage.
For this reason, a detailed consultation with the attending physician takes place before such an intervention. The following examinations should be mentioned here as important methods:Amniocentesis (amniocentesis), in which amniotic fluid is taken through the maternal abdominal wall, usually takes place between the 15th and 18th week of pregnancy. The amniotic fluid contains fetal cells that can be examined for various clinical pictures.
Another possibility is the chorionic villus sampling. Here a tissue sample is taken from a part of the placenta and also analyzed. The sample can be taken either through the vagina or through the abdominal wall.
When taking fetal blood samples, a small amount of fetal blood is taken from the umbilical cord under ultrasound vision, which is then examined for possible diseases. The low-risk variant for determining a chromosomal disorder is now the prenatal test, in which only blood is taken from the mother. In addition, various optical devices allow a look at the amniotic fluid at the end of the pregnancy, which is called amnioscopy, or a direct view of the child, which is called fetoscopy.
