Medical Care During Pregnancy
Ideally, a couple who is thinking of having a baby should see a doctor or other health care practitioner to discuss steps that they can take to help make the pregnancy as healthy as possible. The woman should ask the doctor about factors that could impair her health or the health of the developing fetus. Knowing about and dealing with such factors before pregnancy may help reduce the risk of problems during pregnancy (see Section 22, Chapter 258). These factors include the use of tobacco or alcohol and exposure to possibly harmful substances. For example, a pregnant woman should avoid exposure to secondhand smoke because it may harm the fetus. A pregnant woman should avoid contact with cats or cat feces unless the cats are strictly confined to the home and are not exposed to other cats. Such contact can transmit toxoplasmosis, an infection by a protozoan that can damage the fetus's brain. Rubella (German measles) can cause birth defects. In addition, the woman can discuss her diet and her social, emotional, and medical concerns with the doctor.
When a woman sees a doctor or other health care practitioner before she is pregnant, she can be given any needed vaccines, such as the rubella vaccine. She can also start taking prenatal multivitamins containing folic acid. If needed, genetic screening can be performed to determine whether the woman and her partner are at increased risk of having a baby with a hereditary genetic disorder (see Section 22, Chapter 256).
After pregnancy is confirmed, the woman should have a physical examination, preferably between 6 and 8 weeks of pregnancy. At this time, the length of the pregnancy can be estimated and the date of delivery can be predicted as accurately as possible.
The first physical examination during pregnancy is very thorough. Weight, height, and blood pressure are measured. The doctor performs a pelvic examination, noting the size and position of the uterus.
A sample of blood is taken and analyzed. Analysis includes a complete blood cell count, tests for infectious diseases (such as syphilis and hepatitis), and tests for evidence of immunity to rubella. Blood type, including Rh factor status (positive or negative), is determined. A test for the human immunodeficiency virus (HIV) is recommended. Other routine tests include an extensive analysis of a sample of the woman's urine and a Papanicolaou (Pap) test for cancer of the cervix. A sample from the cervix may be obtained to test for sexually transmitted diseases, such as gonorrhea and chlamydial infection.
Other tests may be performed, depending on the woman's situation. If the woman has Rh-negative blood, it is tested for antibodies to the Rh factor (see Section 22, Chapter 258). Having Rh antibodies can cause severe problems (even death) for a fetus who has Rh-positive blood. If antibodies in a pregnant woman's blood are detected early, the doctor can take measures to protect the fetus.
Women of African descent are tested for sickle cell trait or disease if they have not been tested previously. Skin tests for tuberculosis are advisable for all women. X-rays are not routinely taken early in pregnancy, but they can be taken safely when necessary. If an x-ray is required, the fetus is shielded by placing a lead-filled garment over the woman's lower abdomen to cover the uterus.
After the first examination, a pregnant woman should see her doctor every 4 weeks until 32 weeks of pregnancy, then every 2 weeks until 36 weeks, then once a week until delivery. At each examination, the woman's weight and blood pressure are usually recorded, and the size of the uterus is noted to determine whether the fetus is growing normally. The ankles are examined for swelling.
At each visit, urine is tested for sugar. Sugar in the urine may indicate diabetes. Women who have sugar in the urine should be screened for diabetes at 24 to 28 weeks of pregnancy, as should women who have had large babies or unexplained stillbirths, who are overweight, who are older than 25, who have a close relative with diabetes, or who have polycystic ovary syndrome. At each visit, the urine is also tested for protein. Protein in the urine may indicate preeclampsia (a type of high blood pressure that develops during pregnancy (see Section 22, Chapter 258)).
For women who have a high risk of conceiving a baby with a genetic disorder, prenatal diagnostic testing is performed (see Section 22, Chapter 256).
Many doctors believe that ultrasonography, the safest imaging procedure, should be performed at least once during a pregnancy to make sure the fetus is normally formed and to verify the expected date of delivery. For the procedure, a device that produces sound waves (transducer) is placed on the woman's abdomen. The sound waves are processed to form an image that is displayed on a monitor. Sometimes doctors use an ultrasound device that can be inserted in the vagina. Ultrasonography produces high-quality images, including live-action images that show the fetus in motion. These images provide the doctor with useful information and can reassure a pregnant woman.
Before ultrasonography of the abdomen is performed, especially early in pregnancy, a woman must drink a lot of water. A full bladder pushes the uterus out of the pelvis so that a clearer image of the fetus can be obtained. When a vaginal ultrasound device is used, the bladder does not have to be full, and a doctor can detect pregnancy even earlier.
Ultrasonography can show the fetus's beating heart at 6 weeks of pregnancy and thus can confirm that the fetus is alive. Doctors may periodically use an ultrasound device to listen to the fetus's heartbeat. Or they may use a stethoscope designed to listen to a fetus's heartbeat (fetoscope). The fetoscope can detect the heartbeat as early as 18 to 20 weeks of pregnancy.
Ultrasonography can identify the sex of the fetus at 14 weeks of pregnancy. Ultrasonography is also used to see whether a woman is carrying more than one fetus and to identify abnormalities, such as a mislocated placenta (placenta previa) or an abnormal position of the fetus. Ultrasonography is used for guidance during certain procedures, such as prenatal diagnostic testing.
Toward the end of pregnancy, ultrasonography may be used to identify premature rupture of the fluid-filled membranes containing the fetus. Ultrasonography can provide information that helps doctors decide whether to perform a cesarean section.
Experts recommend that all pregnant women be vaccinated against the influenza virus during the influenza (flu) season.
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