Pregnancy Checklist: What Care Should A Pregnant Woman Take

Pregnancy Checklist: What Care Should A Pregnant Woman Take

Pregnancy Checklist

Ideally, a couple who thinks they have a baby should seek medical attention or another health care professional to assess whether it is advisable to become pregnant. Usually, pregnancy is very safe, but some disorders can arise and in some couples the risk of having a child with an inherited disease is higher.

As soon as the couple decides to have a child, the woman should start taking a multivitamin complex containing Folate (folic acid) once a day. The minimum recommended amount for women of childbearing age is 400 micrograms, although some experts recommend slightly larger quantities (between 600 and 800 micrograms). Often such doses are available as over-the-counter products, such as multivitamin tablets. Folate reduces the risk of congenital spinal cord or neurological defects ( neural tube defect) of the fetus. It is appropriate that women who have had a child with this defect begin to take much higher doses than are normally recommended: 4,000 micrograms as soon as they start planning another pregnancy. Doses of 1,000 micrograms and up are available only on presentation of a prescription.

Did you know...?
Women planning a pregnancy should start taking folic acid immediately (for the prevention of some birth defects) rather than waiting to get pregnant.

If the couple decides to try to have a child, they should discuss with the doctor how to make everything go as healthy as possible. The woman should ask for information about the factors that may compromise her health or that of the developing fetus.

Factors or situations to avoid can be:
Use of tobacco or alcohol exposure to secondhand smoke, which can harm an unborn baby come into contact with cat litter or feces, unless the animal is strictly confined to the house and not exposed to other cats (such contact can transmit toxoplasmosis , a protozoa infection that damages the brain of the fetus) have contact with people with rubella or other infections that cause birth defects
to have contact with people who have chickenpox or St. Anthony's fire , unless the woman has already contracted the chickenpox or has undergone tests to prove immunization Chickenpox and St. Anthony's fire are caused by herpetic viruses that during childbirth can spread and affect the fetus causing serious diseases. The virus can also cause pneumonia, sometimes severe, in women.

Knowing and dealing with these factors before pregnancy can help reduce the risk of problems during pregnancy (see High-risk pregnancy). In addition, diet and social, emotional or medical concerns can be discussed with the doctor.

When a woman turns to a doctor or other healthcare professional before pregnancy, she may be given the necessary vaccinations, such as rubella vaccination. If you have not already started folic acid therapy, doctors may prescribe prenatal multivitamin tablets containing the recommended daily amount (RDA) of folic acid or a larger amount if the woman had had a previous child with a neural tube defect. If necessary, genetic screening can be performed to determine whether the woman and her partner are at risk of having a child with an inherited genetic disorder.

First visit
Once the pregnancy is confirmed, the woman must undergo a physical examination, preferably between 6 and 8 weeks. During this period it is possible to calculate the duration of the pregnancy and provide an estimate as accurate as possible of the date of delivery.
Doctors inquire about the woman's previous ailments, the medications she takes and the details of previous pregnancies, including any problems such as diabetes , miscarriages and birth defects .

The first physical examination performed

during pregnancy is extremely accurate and includes:
Measurement of weight, stature and blood pressure
Examination of the ankles for possible swelling
Pelvic exam: during this exam the doctor takes note of the size and position of the uterus.
Blood test: a blood sample is taken for analysis, which includes complete blood count, tests for infectious diseases (such as syphilis, hepatitis and human immunodeficiency virus [HIV]) and tests for immunity to rubella and chickenpox. The blood type and the state of the Rh factor (positive or negative) are determined.
Urinalysis: a urine sample is collected for culture and analysis.
Papanicolaou test (Pap test) or a variant: tissue samples are taken from the cervix to check for the presence of cancer cells.

Sexually Transmitted Disease Tests : Another tissue sample is taken from the cervix immediately after the Pap smear to evaluate sexually transmitted diseases, such as gonorrhea and chlamydia infection.
Other tests are performed, based on the woman's condition. Thyroid hormone levels may be measured in some women (such as in women with a thyroid disease, diabetes, infertility or miscarriage).
In the presence of the Rh-negative blood group, antibodies to the Rh factor are sought (see Rh incompatibility). The woman's immune system produces these antibodies when her Rh negative blood comes into contact with Rh positive blood, such as in the case of a previous pregnancy in which the fetus had Rh positive blood. Antibodies (called Rh antibodies) can destroy all the blood cells of a fetus with Rh positive blood, causing serious problems (up to death) for the fetus. If these antibodies are detected early in pregnancy, the doctor may take measures to protect the fetus. Immunoglobulin Rh (D) is administered to all women with Rh-negative blood, injected intramuscularly at 28 weeks of gestation. The injection is repeated whenever there is a possible contact between the maternal blood and that of the fetus, for example in case of vaginal bleeding and after childbirth. Rh (D) immunoglobulin reduces the risk of destruction of the blood cells of the fetus.

Did you know...?
Among the things to avoid during pregnancy are tobacco, secondhand smoke, drugs, alcohol, cat litter and feces, contact with people with chicken pox or shingles.
During the flu season, pregnant women should be vaccinated.
Tests for sickle cell anemia are performed in women of African descent if they have not previously been performed. The skin tests for tuberculosis are recommended for all women.

Follow-up exams

After the first visit, a pregnant woman should go to the doctor at the following intervals:
every 4 weeks up to the 28th week of gestation
then every 2 weeks up to the 36th week
then once a week until delivery
During each examination, the weight and blood pressure of the woman is recorded and the size of the uterus is detected, to evaluate the development of the fetus. The ankles are examined for swelling.
The doctor also evaluates the heartbeat of the fetus, usually detectable around 10 or 11 weeks with a manual ecodoppler device. Once the heart rate is detected, doctors check it at each visit.
At each visit, the sugar content in the urine is also examined, which may be an indication of diabetes. If your urine contains sugar, a blood test for diabetes is performed as soon as possible. Even in the absence of urine sugar, doctors usually run an exam for the type of diabetes that develops during pregnancy ( gestational diabetes ). This test is performed between 24 and 28 weeks and allows you to measure the level of sugar (glucose) in the blood one hour after the patient has ingested a liquid containing a certain amount of glucose; it is called glucose tolerance test. If the woman has risk factors for gestational diabetes, the test is performed in early pregnancy, preferably before 12 weeks.

Risk factors for gestational diabetes include:
severe overweight (over 120 kg)
gestational diabetes or very large child (over 4.5 kg) in a previous pregnancy
previous unexplained spontaneous abortion
first degree relatives (mothers or sisters) with diabetes
history of presence of sugar in the urine for a prolonged period
polycystic ovary syndrome with insulin resistance
If the results of the initial examination are normal, women at risk must repeat it at a distance of 24-28 weeks.
During each visit, the presence of protein in the urine (proteinuria), which can be an indication of preeclampsia (increase in blood pressure that develops during pregnancy) , is sought .
For women at high risk of conceiving a child with a genetic disorder, prenatal diagnostic tests can be performed.

Ultrasound
Many doctors believe that ultrasound , the safest diagnostic imaging technique, should be performed at least once during pregnancy to ascertain the normal development of the fetus and to check the expected date of delivery. It is usually performed between 16 and 20 weeks of pregnancy.
During this investigation, a device that produces sound waves (transducer) is placed on the woman's abdomen. Sound waves are translated into images displayed on a monitor. Sometimes, particularly in early pregnancy, the doctor uses a device that can be inserted into the vagina. Ultrasound produces high-quality images, including images that show the movements of the fetus. These images provide the doctor with useful information and can reassure the patient.

Ultrasound during pregnancy: 
Ultrasound is also useful for the following purposes:
show the heartbeat of the fetus, already at 5 weeks of pregnancy, and therefore confirm that it is alive
identify the sex of the fetus as early as 14 weeks of pregnancy
check if the woman has more than one fetus on her lap
identify anomalies, such as abnormal placenta ( placenta previa ) or abnormal position of the fetus
establish the date of development of the pregnancy and check its normal evolution
identify congenital defects (sometimes)
search for evidence of Down syndrome (and some other pathologies) by measuring the space full of liquid near the back of the neck of the fetus (called nuchal translucency)
guide the placement of instruments during certain procedures, such as prenatal diagnostic tests.
In late pregnancy, ultrasound can be used to identify premature rupture of the fluid-filled membranes that contain the fetus. It can provide information that allows doctors to decide whether to perform cesarean section.

Ultrasound:
Other imaging tests
X-rays are not regularly performed in the early stages of pregnancy, but can be done safely, when necessary. In this case, the fetus is shielded by placing a sheet containing lead on the woman's lower abdomen to cover the uterus.
Immunization
Specialists recommend to all pregnant women to undergo vaccinations of 'virus flu during flu season.
If necessary, hepatitis B vaccine can be administered to pregnant women.
Experts recommend a booster dose for tetanus, diphtheria and pertussis after 20 weeks of gestation (preferably between 27 and 36) or after childbirth, even if vaccinations are recent.
The vaccine for measles, mumps and rubella and chickenpox vaccine should not be administered during pregnancy.