Tests that expectant mothers must have

Providing information about routine examinations performed during pregnancy, Obstetrician and Gynecologist Op. Dr. Volkan Aksakallı listed the tests and check-ups that all expectant mothers should have as follows;

"Gynecological (pelvic) examination is generally performed during the first antenatal visit, and potential genital masses, infections, congenital genital anomalies, cancer, and pre-cancerous lesions that could negatively affect the pregnancy are identified. System examinations, in general, involve the gynecologist questioning the patient about symptoms related to the digestive system, heart and circulatory system, respiratory system, locomotor system (muscles and joints), nervous system, and mental state, as well as performing a general physical examination during the first antenatal visit. 

Blood pressure measurement is repeated at every pregnancy check-up. Blood pressure value is the most important criterion in the early diagnosis of a condition called preeclampsia (pregnancy poisoning). Weight measurement is also important, as excessive weight gain in a short time can be a harbinger of pregnancy poisoning. 

Excessive weight gain spread over a long period (weeks) may be due to unnecessary consumption of carbohydrate- and fat-rich foods, or it may be a harbinger of diabetes (gestational diabetes). It is also appropriate for the expectant mother to weigh herself on an empty stomach and report it to her doctor."

Stating that the evaluation of the growth of the abdomen is also important, Aksakallı said, "This evaluation is increasingly being abandoned today because most doctors perform ultrasounds at every antenatal assessment. By mapping the baby inside the abdomen, the doctor determines the position of the baby's head, back, and legs using special examination methods called Leopold maneuvers. 

IMPORTANT IN DETERMINING PREGNANCY 

Towards the end of pregnancy, how the baby enters the pelvis is also determined by these methods. In addition, ultrasound provides much more precise information than the information obtained through measuring the abdomen with a tape measure and Leopold maneuvers. Pregnancy tests are tests based on the detection of HCG, a hormone specific to pregnancy, in urine or blood. They can determine pregnancy in the blood before a missed period, and in the urine, depending on the sensitivity of the test, between one and ten days after a missed period. 

Blood types can be determined from a finger-prick blood sample for both the expectant mother and father. If the expectant mother's blood type is Rh (-) and the father's is Rh (+), this is referred to as Rh incompatibility. A complete blood count (hemogram) determines many parameters in addition to leukocyte (white blood cell) count, erythrocyte (red blood cell) count, mean hemoglobin content and size of erythrocytes, platelet count, hemoglobin, and hematocrit value. 

A complete urinalysis (TİT) aims to detect infections in the urine, evaluate the general nutritional status of an expectant mother who has excessive nausea and vomiting in the early pregnancy period, detect the presence of protein in the urine in the later stages of pregnancy (the presence of protein in the urine can be an indication of preeclampsia), and assess whether the expectant mother is drinking enough water. Urine culture is important because pregnancy facilitates the development of urinary tract infections. The presence of leukocytes, erythrocytes, and/or bacteria in the urine sediment indicates an infection and requires antibiotic treatment if the expectant mother has symptoms," he said.

Infection screening tests, such as Toxoplasmosis, Rubella (German measles), and Syphilis screening tests, are preferably performed during the period when pregnancy is planned. For this purpose, Toxoplasmosis IgG and IgM (antibodies), Rubella IgG and IgM, and a test usually called VDRL for syphilis are performed on the blood taken from the expectant mother. Screening tests for Hepatitis B and HIV (AIDS) are usually performed towards the end of pregnancy. 

QUADRUPLE TEST

HBsAg and AntiHBs examinations are performed for Hepatitis B screening. Ultrasound (vaginal, abdominal) is of great importance in the early weeks of pregnancy. It is extremely important to confirm the accuracy of the Last Menstrual Period (LMP); to determine the gestational age in expectant mothers who do not know their LMP; to detect conditions such as ectopic pregnancy and molar pregnancy at an early stage; to detect mass lesions such as fibroids or ovarian cysts that are likely to have a negative effect on the pregnancy; and to reveal a possible multiple pregnancy. 

The triple test (second-trimester Down syndrome screening test) is an examination performed between the 16th and 18th weeks of pregnancy. The risk of Down syndrome and neural tube defects is determined by performing three separate hormone tests on the blood taken from the expectant mother.

Today, a superior version called the quadruple test is used more often. Regarding the double test for nuchal translucency in pregnancy, the triple test is still the most common test used in Turkey to determine the risk of Trisomy 21 (Down syndrome). However, the risk of Down syndrome can be determined by measuring the nuchal fold thickness between the 11th and 14th weeks of pregnancy, along with measuring beta HCG and PAPP-A in the blood taken from the expectant mother and using the values obtained from these. 

Beta HCG and PAPP-A

The level of beta HCG in the blood decreases as pregnancy progresses. In babies with trisomy, this decrease is much slower. Measurements between the 11th and 14th weeks of pregnancy confirm that this decrease is slower in babies with Trisomy 21. PPG (Postprandial Glucose) and OGTT (Oral Glucose Tolerance Test) are important because pregnancy is a condition that increases the risk of developing diabetes.

Therefore, expectant mothers are subjected to a glucose tolerance test between the 24th and 28th weeks of pregnancy. For this purpose, a load of 50 grams (PPG) or 100 grams of glucose (OGTT) is administered depending on the expectant mother's risk factors. For TSH (thyroid hormone) measurement, normal TSH values during pregnancy are considered differently from normal adult values, and hormone supplementation is provided to the expectant mother when necessary. 

For expectant mothers already known to have thyroid hormone disease, other thyroid hormone measurements and measurements of certain substances such as anti-thyroglobulin may be added. Doppler ultrasonography, which is recommended as a screening test between the 20th and 24th weeks, is also becoming an examination performed with increasing frequency in our country," he said.

News Source: İHA