Watching a pregnant woman at a doctor

What is the need for regular monitoring by a pregnant doctor?

The purpose of antenatal care of a woman is to ensure that:

  • The mother will maintain her health after pregnancy;

  • Any physical or mental problems that arise during pregnancy will be identified and eliminated;

  • Any complications of pregnancy will be timely diagnosed and treated;

  • Give birth to a healthy child;

  • A pregnant woman will have the opportunity to discuss with her doctor her concerns about pregnancy and childbirth;

  • The pregnant woman will receive information about the indications and possible side effects of the proposed treatment;

  • The couple will be prepared for the birth of the child, including obtaining information about the nutrition and development of the child, as well as further planning of the family.

Where can I be observed during pregnancy?

Antenatal supervision is performed by an obstetrician / gynecologist in the physician's rooms of the inpatient clinic (maternity hospital or gynecological observation) and in the women's consultation. The woman should have the opportunity to choose the place of care and the doctor, if there is no need for treatment or supervision performed only in the hospital.

Whichever type of observation the pregnant woman chooses, in identifying any complication or disease, she should be consulted by a specialist in this pathology.

How often should a pregnant woman visit a doctor?

If the pregnancy runs without complications, then visits to the doctor should be at least 1 time per month before the 28 weeks, 1 time in 2 weeks from 28 to 36 weeks and 1 time in 7 days in the last weeks of pregnancy. If a woman has any concomitant diseases, complications during pregnancy, the frequency of visits to the doctor usually increases.

During visits to the doctor, the pregnant woman should receive information about the negative effect on the fetus of nicotine, alcohol, drugs, unknown or known medications. The doctor tells the woman about the favorable mode of the day, the need for timely rest, adequate sleep, and rational nutrition at various stages of pregnancy.

According to labor legislation , a pregnant woman is given the opportunity to transfer to easy labor, change of place of work when she comes into contact with harmful physical and chemical agents. The pregnant woman has the right to release from night shifts, business trips, on antenatal and postnatal leave.

At the first visit to the pregnant doctor, the individual card must be filled in and filled in, where all the research and observations of the woman during the entire pregnancy are recorded.

What are the main questions the doctor determines?

  1. Surname, name, patronymic and home address.
  2. Age, place of birth, where children's and young years passed.
  3. Postponed diseases and surgical operations: in childhood, in adulthood.
  4. Heredity: were there any twins in the family, mental illnesses, the birth of children with developmental defects.
  5. Conditions of work and life.
  6. Menstrual function: the time of appearance and establishment of menstruation, the duration of the cycle, the amount of blood lost, soreness. And the mandatory date will be the date of the last menstruation . This question should be answered most accurately, because it will determine the duration of pregnancy, prenatal leave and forthcoming birth.
  7. Sexual life: at what age did it begin, what methods of preventing unwanted pregnancies were used earlier.
  8. Details of each of the preceding pregnancies, regardless of whether it resulted in an abortion or childbirth.

Then the midwife makes a measurement of height, weight, blood pressure on both hands.

Blood pressure (BP)

Increased pressure worries the doctor that the patient may develop a toxicosis of the second half of pregnancy (preeclampsia and eclampsia ).

For this reason, blood pressure is measured in a woman every time she visits a woman's consultation.

With a normal current pregnancy, blood pressure remains at a constant level until the last trimester, when it can normally rise by less than 10mm. Gt; Pillar. Therefore, an increase in systolic pressure> 140 and diastolic pressure> 90 or more compared to the baseline, is regarded by the doctor as a late toxicosis.

In order to avoid errors in the registration of blood pressure, it is measured on both hands, in different positions of the woman.

Weighing a pregnant woman

It is common to weigh a pregnant woman every time she visits a woman's consultation, because even a slight increase in body weight between visits is compared with the growth of the fetus. Estimating the amount of weight gain, the doctor takes into account a number of factors affecting him (age, initial weight before pregnancy, weight loss due to first-line toxicosis, growth, eating habits, nature of work).

It is generally accepted that starting at about 32 weeks of pregnancy, the weight of a woman should increase by 50 g per day, 350-400 g per week or 1 kg 600 g (but not more than 2 kg) per month, and for the entire pregnancy - not More than 10-12 kg.

Excessive weight gain of a pregnant woman is regarded as an opportunity to develop latent edema and late toxicosis of pregnant women.

Laboratory research:

  1. A blood test for the detection of syphilis (RW), HIV infection, infectious hepatitis is taken at the first visit to the doctor and is repeated twice during the entire pregnancy.
  2. Clinical and biochemical blood tests are taken immediately. Then the level of erythrocytes and hemoglobin is constantly determined (for the detection of anemia of pregnant women ).
  3. The level of sugar in the blood and urine is determined.
  4. The blood group and Rh factor are determined, if a negative rhesus is detected, the pregnant woman's blood is examined for the duration of the entire pregnancy for the presence of antiresusive antibodies.
  5. Examination of smears from the external opening of the urethra and cervix to exclude infection of the genital tract is carried out immediately by contacting a doctor and then immediately before childbirth.
  6. From the nasopharynx take smears on the carriage of pathogenic staphilococcus twice during pregnancy.
  7. Clinical analysis of urine is examined at each visit to a pregnant doctor.
  8. Investigation of feces on eggs of worms is done once.

After receiving the results of the laboratory examination, the pregnant woman is sent for examination to the following specialists:

  1. Therapist (additionally assigned ECG).
  2. The ophthalmologist (the status of an eyeground, an acuity of vision is investigated).
  3. To the stomatologist (in the presence of carious foci, their sanation is required). Although the teeth are better to put in order before the onset of pregnancy.
  4. To the neuropathologist.
  5. To the otolaryngologist (ENT-doctor).

Obstetrical examination allows the doctor to determine the duration of pregnancy, the estimated weight of the fetus, the position of the fetus in the uterus, identify polyhydramnios and multiple pregnancies.

Measurements are made with a centimeter tape (the largest abdominal circumference at the navel level and the height of the standing of the uterus bottom) and an obstetric compass tasometer to determine the size and shape of the pelvis.

More accurate data on the height and weight of the fetus can be obtained by ultrasound.

Until 28 weeks of pregnancy, the position occupied by the fetus in the uterus does not play a big role. After the 28th week, these data become very important in terms of expected delivery, so the position of the fetus is established at each visit to the doctor, and the data must be entered into the card of the pregnant woman. For the purpose of describing the position of the fetus, the doctor uses the following terms:

Fetal position : this is the ratio of the fetal axis to the longitudinal axis of the uterus. Physiological (normal, in which births are possible through the natural birth canal) the position is considered the longitudinal arrangement of the fetus. But sometimes, for some reason the child can be located in the uterus transversely or obliquely , in this case the birth through the natural birth canal becomes impossible and resort to the operation of cesarean section.

Fetal position : the ratio of the fetal back to the left (first position) or right (second position) to the sides of the uterus. The position may be anterior or posterior, with respect to the frontal back to the posterior or anterior wall of the uterus.

The fetal part is the part of the fetus that first passes into the cervix in the first stage of labor, or into the vagina in the second period. Physiological is the head presentation . In this case, most often the present part is the occiput, but there may be facial or frontal presentation.

Pelvic presentation ( leg and gluteal) in modern obstetrics is considered a deviation from the norm, and births are often performed by cesarean section.

The fetus is termed the relation of the limbs to the trunk and head. Usually, the facial affection is of the flexion type (the characteristic posture of the embryo with the arms and legs bent by the arms), but in some cases, the extension of the head, the extension of the legs along the body, etc.,

During the first half of pregnancy, and sometimes in the future, the fetus, having a relatively small size, can change its position in the uterus. This is called the unstable position of the fetus. As he grows and develops, he occupies a certain position, which is of great importance for the doctor's decision to conduct labor.

Listening to the heartbeat of the fetus is made by an obstetric stethoscope at every visit by a female doctor. Palpitation of the fetus has three main characteristics: frequency, rhythm and clarity. The frequency of strokes in normal ranges from 120 to 160 beats per minute and should be rhythmic and clear.

Measurement of pelvis size

Tactics and the prognosis of childbirth are also determined by the size of the woman's pelvis. As already mentioned above, the doctor makes a measurement of the pelvis with a special obstetric tasomer, while the woman is lying on the couch. Distinguish the following dimensions of the pelvis:

  1. The distance between the most separated points of the upper tips of the ileum pelvic bones, in norm it is 26 cm.
  2. The distance between the most distant points of the scallops of the iliac bones, normally about 28 cm.
  3. The distance between the large trochanteres of the femur, in norm this size is not less than 30 cm.
  4. The distance between the appendix of the 5 lumbar vertebra and the upper edge of the pubic bone. In the normal pelvis it is 20 cm or more.

The size of the pelvis is measured, as a rule, when the woman first contacts the doctor, and their data are necessarily recorded in the individual card of the pregnant woman. Sometimes a re-measurement is carried out with the arrival of a woman in the maternity ward for childbirth.