Pregnancy Care - week by week

Post in Publikationen
by Amelie Hofmann-Werther

Pregnancy Care week by week

You are pregnant or you assume to be pregnant?A visit with your OB/GYN doctor gives you confirmation. These joyful, exciting news will change your daily life remarkably. In an individualy tailored consultation, your doctor will explain what you need to know about pregnancy related changes in your body, and what to pay attention to in order to stay healthy and maintain physical, mental and spiritual wellbeeing throuhout your corse of pregnancy. What sort of physical activity and sports may be perfomed in pregnancy, how to nutrate healthy for mom and growing baby, what to know about travelling, sun exposure and medication intake whilst pregnancy and how to balance career, work load and stress release in the upcoming month.

As part of pregnancy care taking you will see your doctor for regulary check up’s. Your babies growth will be monitored as much as your wellbeing. Sometimes morning sickness, orthostatic dysregulation, digestion or sleeping problems will need a little more attention and treatment.Additionally, blood tests and ultrasound examinations will be performed. Together with your doctor, a pregnancy care calendar will be set up telling you which routine examinations and what sort of special investigations can be performed at what gestational age.Why they are beneficial, what they may tell you about your baby and help you decide, which are of interest in your individual situation.

2.2 High Resolution Ultrasound Examinations in Pregnancy

An ultrasound scan in pregnancy is a painless procedure that uses high frequency sound

waves to produce two-dimensional black and white images. Also 3D/4D pictures of your baby can be performed

The very first Dating Ultrasound examination after a positive urine pregnancy test usually confirms early detection of pregnancy, it determines the number of babies you are carrying, i.e. singleton or multiple pregnancy and it checks your baby is growing in the correct place i.e. not an ectopic pregnancy, which develops outside the uterus.

Starting from about week 7 gestational age, fetal heart beat can be vizualized. This scan confirms how many weeks pregnant you are by measuring the emryos crown rump length (CRL) to obtain an accurate due date.In the following antenatal visits routine ultrasound examinations focus on fetal growth in accordance to gestational age, fetal growth symmetry, fetal movements and activity. It also locates your placenta and assess the volume of fluid around your baby. Estimated fetal weight is measured. Ultrasound scanning has been used in pregnancy for nearly three decades. There has been no proven association between ultrasound exposure in pregnancy and possible harmful effects to your baby.

2.3 Special Ultrasound Examinations and Prenatal Diagnostics

2.3.1 First Trimester Screening (Nuchal Translucency Measuring, Down-Syndrome-Screening)

This first „exteded“ ultrasound examination in pregnancy is beeing performed in week 11+ 0 till 13+ 6 gestational age. Within this period, ultrasound conditions are optimal to get the required informations for this prenatal combined test. The First Trimester Screening is also often referred to as Down-Syndrome- Screening, although this investigation intends to rule out more genetic determined syndromes than just Down syndrome. The examination is a risk assessment calculating a couples individual risk for carrying out a baby that might be affected by a specific chromosomal abnormality such as Trisomy 21(Down syndrome),Trisomy 18 (Edwards syndrome) or Trisomy 13 (Patau syndrome). It combines a Nuchal Translucency Measuring (tiny clear space in the tissue at the back of the baby's neck) by high frequency ultrasound with certain biochemistry markers in maternal blood. Therefore A special blood test to measure levels of two pregnancy-specific substances in the mother's blood. With this two steps approach including the mother age risk, and individual risk assessment fort he parents to become can be performed. A few additional so-called ultrasound „soft markers“ can be vizualized also in ultrasound and can help interpreting the results. For the First Trimester Screening assessment, there is no fetal blood sample or amniotic fluid sample required. The First Trimester Screen is a routine screening that is not an invasive procedure and poses no known risks to the mother or baby. Abnormal test results warrant additional testing for making a diagnosis, such as invasive diagnostic tests, as CVS or amniocentesis.or Non Invasive Prenatal Test (NIPT)

2.3.2 Non Invasive Prenatal Test (NIPT)

Alternativly to a First Trimester Sceening o as an additional follow up testing after an abnormal First Trimester Screening test result a Non Invasive Prenatal Test (NIPT) can be performed. The NIPT intends to rule out chromosomal abnormalities in the fetus using molecular genetic analys6is. NIPT is performed on a maternal blood sample which contains DNA from the fetus. During pregnancy, cell-free DNA fragments from both the mother and fetus can be found in maternal circulation. It is possible to analyze fetal cell-free DNA to detect fetal trisomies. Although NIPT can be performed in all pregnancies without specific indication, it might be most appropriate in pregnancies with an increased risk upon a high maternal age (> 40 yrs) or abnormal result of the first trimester screening In these cases NIPT may be an alternative to invasive testings such as amniocentesis or chorion biopsy (CVS).

2.3.3 Routine Mid-Trimester- Scan and Anomaly Scan

A routine mid trimester scan is usually performed between 19 and 22 weeks of gestation. The main objective of a routine mid trimester fetal ultrasound scan ist to provide optimized antenatal care for best possible outcomes for mother and fetus. Goals are to perform fetal measurements (fetal biometry) and evaluate fetal age, size and estimated fetal weight using measurements in a standardized manner based on ultrasound guidelines. Fetal wellbeing (relaxed intrauterine fetal position with regular fetal movements) fetal heart activity, basic fetal organ anatomy in an anatomical organ survey are examined. Also amniotic fluid assessment, placental appearence and location and umbilical cord are vizualized. Gender of the baby can usually be vizualized too

In case of suspected or detected abnormalities, patients can be referred for more detailed fetal ultrasound diagnostics in specialised medical institutions. Although many malformations can be identified with ultrasound, some may be missed or may develop later in pregnancy. Therfore benefits and limitations of this assessment need to be discussed with each couple