Pre-pregnancy counselling should include ways to improve a couple’s chances of conception and advice on antenatal care to prevent disease and improve postnatal outcomes. If you are planning to have a baby you should see a gynaecologist ideally at least 3 months before you get pregnant. This is called a preconception visit and he will do the following:
• Ask for a history of past illnesses which may have a bearing on future pregnancy.
• Ask for a family history of illness which may have a bearing on future pregnancy.
• Carry out a general examination which will help detect basic problems.
• Ask for basic tests.
• Identify your Rubella status. If you have not had rubella [German measles] in your childhood and not been immunized for this you may need to take a Rubella vaccine and delay your pregnancy by 3-6 months.
• Take a folic acid supplement every day. This reduces the chance of certain birth defects. Do not wait until you are pregnant to do this.
• Make a doctor’s appointment for a check up/wellness visit.
• Make sure to get and begin taking prenatal vitamins.
• Check with your doctor about any over-the-counter and prescription medications you currently take.
• See your dentist for a cleaning or check up if you have not done so in the last six months. Untreated gum disease is linked to preterm birth.
• Develop a maternity and baby budget.
• If you smoke, quit.
• Avoid alcohol and caffeine intake.
• Stock your refrigerator with healthy foods and snacks.
Congratulations – Your first Antenatal visit.
Now that you are pregnant you must see the doctor as soon as you know that you are pregnant. He will follow up on your tests and ask for a first trimester ultrasound scan [USG]. This is NOT at all harmful and very informative. It will pick up the following:
• Precise date of delivery – important if you cross your expected date of delivery [EDD].
• Twin pregnancy.
• Molar pregnancy.
• Tubal pregnancy may be excluded if an intrauterine pregnancy is detected.
• Any other early problems.
Your doctor will also examine you and call you back with your reports. You will be given a file with an ante-natal card which has to be filled at every visit. If all is well you will be asked to visit every 3 weeks till about 34 weeks and thereafter every 2 weeks.
What tests are done?
You will be asked to do the following tests:
• CBC- Complete blood counts to detect anemia and other disorders such as low platelet counts etc.
• Urine-routine & microscopy to look for protein, blood, pus cells etc in the urine.
• Blood group
• TORCH- IGm
• VDRL- Test for Syphilis, a routine for all pregnant patients
• BSF- Fasting blood sugar to test for diabetes, G.T.T
• HbsAg- Test for Hepatitis B
• HIV-AIDS screening
At every antenatal visit:
• You will have your weight checked-to look for either excessive weight gain or poor weight gain in your pregnancy.
• Your BP will be checked.
• You will be asked about any complaints. Feel free to make a complete list of your complaints/queries and ask your doctor at the next visit.
• The height of the uterus will be seen to see whether it corresponds to the period of your pregnancy
• The position of your baby will be checked.
• Swelling of the feet will be checked.
• Your babies heart beat will be checked either with a machine [Doppler] or with a stethoscope.
• A prescription will be given as per your needs.
• You will be given dietary advice as required.
During the first 3 months you will be given Folic Acid supplements, and after the 12th-14th week iron and calcium supplements will be added.
Why are regular visits important?
It is only if you make regular visits that your doctor will be able to monitor important things such as the growth of your baby, your BP, answer your queries etc.
What other test will you require?
• USG at about 20 weeks to detect any abnormalities in your baby if any. This is the time that by and large all the organs of the baby can be visualized. You must realize however that ultrasound may not detect all anomalies.
• Repeat haemoglobin [Hb] at about 24 weeks to look for anaemia.
• A 50g oral glucose test at about 24 weeks to look for pregnancy diabetes [gestational diabetes]
• A repeat USG may be done at 32-34 weeks to evaluate growth of the baby.
• NST [non stress test] at about 35 weeks to see if your baby is getting enough oxygen.
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