PREGNANCY

FOLLOW-UP
EMINE ZEYNEP YILMAZ, MD, ASSISTANT PROFESSOR

MEDIPOL UNIVERSITY HEALTH CARE

PRACTICE & RESEARCH CENTER ESENLER HOSPITAL
MAIN GOALS

• To reduce maternal and perinatal mortality and morbidity rates

• To improve the physical and mental health of women and children

• To ensure that the pregnant woman and her fetus are in the best possible health.

• To detect early and treat properly complications

Routine antenatal care
• Every four weeks till 28th week
• Every two weeks till 36th week
• Weekly then

• The frequency of visits should be

individualized.
• Whose visits should be more frequent?
Frequency of antenatal appointments

Nulliparous with an Parous with an

uncomplicated uncomplicated
pregnancy, a schedule pregnancy, a schedule
of 10 appointments. of 7 appointments.
 The first visit for
prenatal care typically
occurs in the first
trimester.

LMP?
First Visit Ultrasound
measurement up to
13w6d is most accurate
method to establish
If not:

ART?
 Personal history

Family history

Medical and surgical history

History Menstrual history

Obstetrical history

History of present pregnancy

 • Physiological changes • Smoking
during pregnancy • Medications
• Weight gain • Infection
• Fresh air and sunshine
Health • Irradiation
• Rest and sleep
Teaching • Occupational and
• Diet environmental
during the • Daily activities hazards
First • Exercises and relaxation • Travel
Trimester • Hygiene • Follow up
• Teeth • Minor
• Bladder and bowel discomforts
• Sexual counseling • Signs of Potential
Complications
 Rh (D) Type. -
Bloodtype antibody CBC
testing?

Routine VDRL
Urine
screening and
urine culture
HBsAg –
vaccination?

Laboratory Chlamydia,
Tests HIV
gonorrhea
GBS screening

GDM
screening
 Influenza

Tetanus toxoid

HepB,
pneumococcal (prior splenectomy or functional asplenia)
Immunization Meningococci?

HPV?

VZV ? MMR?
 First trimester. :NT, PAPP-A and hCG

Triple screen: hCG, AFP, uE3

Screening
Tests for Quad screen: hCG, AFP, uE3, Inhibin

Aneuoploidy cFDNA**

Woman should be counseled regarding the difference

between screening and invasive diagnostic testing.
Invasive Tests

• Chorionic villus sampling (10-13 weeks) -5-40 mg

placental tissue (chorionic villi), transabdominal or
transcervical . Pregnancy loss rates 0.22%

• Amniocentesis: 15-20 weeks. 0.1-0.3% pregnancy-

loss
Screening
or Invasive
Tests?
Second Trimester
Ultrasound

• Ideal circumstances, 100% detection of

anencephaly and 95% of spina bifida anomalies.
• Also cleft lip, diaphragmatic hernia, gastroschisis,
exomphalos, serious cardiac abnormalities, bilateral
renal agenesis, lethal skeletal dysplasia
2 Trimester Ultrasound
nd
So… What to do
• First trimester.
detailed history, lab test, information about pregnancy
• 11-14 weeks
first trimester screening
• 16-18 weeks
triple or quad screening
• 20-22 weeks
second trimester ultrasound
• 24-28 weeks
• GDM screening
So… What to do
• After 30 weeks
visits during 2 weeks

• After 36 weeks
weekly visits and NST