Observation in the antenatal clinic, diagnosis of fetal anomalies. Pregnancy management plan

Monitoring a woman during pregnancy (observation scheme) is also regulated by orders

• Ν 50 from 10.02.2003 "On the improvement of obstetric and gynecological care in outpatient clinics"
• Ν 430 dated 04.22.1981 "On the approval of instructive and methodological guidelines for organizing the work of the antenatal clinic"
• Ν 457 of 28.12.2000 "On the improvement of prenatal diagnostics in the prevention of congenital and hereditary diseases in children"

According to order Ν 50 of February 10, 2003 "On improving obstetric and gynecological care in outpatient clinics"

In the physiological course of pregnancy, the frequency of observation by an obstetrician-gynecologist can be established up to 6-8 times (up to 12 weeks, 16 weeks, 20 weeks, 28 weeks, 32-33 weeks, 36-37 weeks), provided regular (every 2 weeks) observation by a specially trained midwife after 28 weeks of pregnancy.

When somatic or obstetric pathology is detected, the frequency of visits to an obstetrician-gynecologist increases.

A change in the number of visits by pregnant women to an obstetrician-gynecologist can be introduced by a regulatory document of the local health authority, subject to the availability of conditions and trained specialists.

Private clinics, on the basis of this order, develop pregnancy management programs, which differ in the number of visits to the doctor and the volume of laboratory tests.

Prestigious private clinics, in compliance with this order, conduct, among other things, classes with pregnant women in the "School of Motherhood", the so-called psycho-preventive preparation for childbirth.

Considering that antenatal clinics issue birth certificates that provide for free provision of pregnant women and nursing mothers with vitamins and nutrition (milk, juices), private clinics can compensate for this moment in their pregnancy management programs.

For clarity, we present all this in the table.

At the first visit to the obstetrician-gynecologist for the purpose of registration for pregnancy, a conversation is conducted (a survey of a woman to collect anamnesis), an examination, the duration of pregnancy and the expected birth are specified.

All pregnant women, according to order Ν 430 of 04/22/1981, "On the approval of instructive and methodological guidelines for organizing the work of antenatal clinics" are determined by prenatal risk factors for an unfavorable pregnancy outcome:

1. Socio-biological factors,
2. Obstetric and gynecological history,
3. Extrogenital diseases
4. Complications of pregnancy (previous).

These data may change during pregnancy.

In order to minimize prenatal risk factors, the obstetrician-gynecologist can issue certificates to pregnant women (form 084 / y) about the need to transfer to easy and harmless work. Such a transfer, in accordance with a medical opinion, is carried out at any stage of pregnancy.

According to order Ν 430 dated 04.22.1981 "On the approval of instructive and methodological guidelines for the organization of work antenatal clinic"

To resolve the issue of employment of pregnant women, the "Hygienic Recommendations for Rational Employment of Pregnant Women" approved by the USSR Ministry of Health on August 29, 1979 (NN 2049-79, II-9 / 96-6) should be used.

After the first examination by an obstetrician-gynecologist the pregnant woman is sent for examination to a therapist who examines her twice during a physiologically proceeding pregnancy (after the first examination by an obstetrician-gynecologist and at 30 weeks gestation).

At the first visit to a pregnant doctor, therapist assesses the somatic status of a woman and enters the examination data into the "Individual card of a pregnant and postpartum woman". If necessary, an extract from the "Outpatient Medical Card" is requested.

In the presence of extragenital diseases, the therapist, together with the obstetrician-gynecologist, decides on the possibility of prolonging the pregnancy.

Dynamic monitoring of pregnant women with extragenital diseases is carried out by an obstetrician-gynecologist together with a therapist and other specialists.

During controls, special attention is paid to assessing weight gain according to the mass-growth coefficient, depending on the nature of the physique.

For a timely assessment of deviations during pregnancy and fetal development, a gravidogram is used, in which the main indicators of mandatory clinical and laboratory examination of a pregnant woman are recorded.

It is necessary to register with the selected antenatal clinic as early as possible, but in any case, no later than 12 weeks of pregnancy - this will allow timely identification of possible problems in the development of the fetus, as well as reduce the risks to the health of women and children. At the first visit, the doctor should:

· Create a medical record, which will include the results of all tests and examinations, examination data of the pregnant woman, her complaints, as well as appointments and recommendations;

Study the woman's medical record, as well as ask her about all health problems, possible pathologies, past illnesses, blood transfusions, operations;

· Conduct a full examination, prescribe the necessary tests.

Based on the data obtained as a result of the examination, the doctor develops, which depends on the state of health of the woman and the degree of her falling into the risk group.

Visit your doctor during pregnancy

As a rule, the schedule for visiting the antenatal clinic, in the absence of a threat to the health of the pregnant woman and the fetus, is set as follows:

· First trimester - 1 examination per month;

· Second trimester - 1 examination every 14 days;

· Third trimester - 1 examination every 7 days.

More frequent visits to the doctor are necessary in the event of any pathology, and may also be required to clarify the test results.

Approved, which is followed in the absence of perinatal pathology, consists of 10 visits to the antenatal clinic:

1. Up to 12 weeks - a gynecological examination, referral for laboratory tests, the first ultrasound scan, filling in an individual card. Ultrasound examination allows you to confirm pregnancy, detect a threat of miscarriage, ectopic pregnancy, determine possible problems of the uterus or placenta.

2. At 14-16 weeks - receiving and studying the test results, issuing a referral for a second ultrasound.

3. At 18-20 weeks - ultrasound, which allows to determine the size, age, position of the fetus, to identify developmental pathologies, in some cases to determine the sex.

4. At 22 weeks - studying the results of ultrasound.

5. At 26 weeks - inspection.

6. At 30 weeks - blood and urine tests, if necessary, registration of sick leave.

7-10. Examination at 33, 36, 38, 40 weeks.

At each visit, the doctor measures blood pressure, and starting from 22 weeks - the height of the bottom of the uterus and waist circumference, and also gives a referral for a general urine test to determine the protein level. The third ultrasound scan is appointed from 32 to 36 weeks, and serves for the final study of the level of development of the fetus, its location and size, as well as to clarify the planned date of birth.

In addition, it includes two screening tests that allow you to determine the level of risk of developing congenital malformations in the fetus, in particular, Down and Edwards syndromes. To do this, during an ultrasound scan, it is necessary to measure the thickness of the neck zone of the fetus, and when examining the blood, to find out the level of certain hormones. The first test is scheduled for up to 14 weeks, and the second at 16-20 weeks.

If the test results suggest the likelihood of a congenital pathology, the doctor will recommend additional invasive studies to more accurately determine chromosomal abnormalities. It is important to understand that the final conclusion about the presence of malformations in the fetus after screening studies alone is not made.

The schedule for visiting a consultation, whether it is a district clinic or a paid medical institution, given above, is indicative, and the specialist makes a decision on the number of visits based on the study of the health status of the pregnant woman and the assessment of fetal development.

To confirm the "interesting position", you can conduct a home pregnancy test (it will show two strips from the first days of the delay) or undergo a "manual" examination of the uterus with a gynecologist (it will increase, the cervix will be visualized, etc.), perform an ultrasound scan (by 3 -6 days from the delay) or donate blood to the level of hCG (on the 8-14th day from the moment of conception, the level of hCG during pregnancy will be more than 25 mU / ml).

With the help of ultrasound examination it is possible to "see" the ovum and the embryo inside it, usually not earlier than 5-7 weeks after conception. The first contractions of the fetal heart can be heard from 5-6 weeks of pregnancy using a transvaginal sensor, a conventional ultrasound will recognize the heartbeat a little later (somewhere in 6-7 weeks).

It is necessary to visit the gynecologist of the antenatal clinic before the 12th week (in fact, at 7-11 weeks and preferably not later) in order to confirm the developing uterine pregnancy and be registered.

Collecting information on the history data

The doctor will conduct a survey and write down all the necessary information in an individual card: personal data of the pregnant woman, about the sexual development of the woman and the nature of menstruation (at what age did menstruation first go, are there menstrual pains, duration and abundance of discharge, etc.) and about the menstrual cycle (duration and the constancy of the cycle, the date of the beginning (!!!) of the last menstruation, etc.), about the beginning of sexual activity and the number of sexual partners, about the nature of the discharge at the time of treatment and previous gynecological diseases, about the state of health of the child's father, etc.

The individual card remains with the doctor, and the exchange card is given to the pregnant woman.

An exchange card (a small book) is usually issued either when registering (at 7-11 weeks), or at 22-23 weeks of pregnancy, but each antenatal clinic has its own rules.

An outpatient or individual card of a pregnant woman (large card) is filled out with an indication of a more detailed picture of pregnancy, all the results of analyzes and studies are pasted into it. She remains in the clinic, and after the end of the monitoring of the pregnant woman, the card is stored in the archive.

In the exchange card (in another way, in the dispensary book or maternal passport), the pregnant woman must contain all the results of the mandatory tests, otherwise the maternity hospital has the right to refuse admission, since it is not known whether the woman in labor is contagious or what the risk of complications during childbirth is, not every maternity hospital is ready to take on such responsibility.

The exchange card is filled in by the antenatal clinic doctor at every appointment with a pregnant woman, so you should always carry it with you.

Also, the pregnant woman will sign an agreement on the processing of personal information and independently fill out a questionnaire in which it is necessary to indicate information about the lifestyle (presence / absence of bad habits), health status and hereditary diseases. The questionnaire is filled out with the consent of the pregnant woman, and not forcibly.

General examination and gynecological examination

He will perform a gynecological examination on a chair with the help of mirrors, take smears for tests, listen to the heart and lungs, feel the mammary glands for the absence of seals, remove the size of the pelvis, give directions for tests.

A bimanual gynecological examination (fingers of one hand are feeling the vagina from the inside, and the other - gentle pressure on the abdominal wall) makes the gynecologist understand about the state of the vagina and uterus, helps to recognize inflammatory diseases, pathologies of the uterus and appendages. Painful sensations and bloody discharge indicate the presence of gynecological diseases.

At each appointment, the doctor measures blood pressure, pulse, body temperature, and weight of the pregnant woman.

Issuance of an extract from an outpatient card and referrals for tests

The exchange card must contain all the necessary information about the pregnant woman, one of which is an extract from the outpatient card. The district therapist of the city polyclinic provides an extract, and analyzes are prescribed by both the gynecologist and the therapist of the antenatal clinic.

The list of mandatory tests for the first trimester

General urine analysis. Evaluates the work of the kidneys of a pregnant woman. Sick kidneys will not allow the expectant mother to carry the pregnancy and give birth normally, therefore, the doctor constantly monitors their condition and, if the indications deviate from the norm, prescribes adequate treatment.

For analysis, it is necessary to collect morning urine immediately after sleep, after having performed hygiene of the external genital organs and hands.

If a pregnant woman has a negative rhesus, a blood test to determine the titer of anti-rhesus antibodies is taken regularly (again at 18-20 weeks, and then once a month) in order to track a possible increase in antibodies and prevent the appearance of negative consequences (hemolytic anemia or jaundice, etc. .).

You also need to know the blood group in case of transfusion with significant blood loss during childbirth.

Blood for analysis is taken from a vein.

General blood analysis. A general or clinical blood test is able to determine the absence or presence of anemia in a pregnant woman, which threatens oxygen starvation of the fetus and its developmental delay, therefore it is important to determine this disease at an early stage and prescribe treatment in order to save the baby from vices and even save his life.

Also, this analysis will indicate the degree of blood clotting of the pregnant woman, which will help to avoid large blood loss during childbirth.

Blood is usually taken from a finger, preferably on an empty stomach.

Blood chemistry. It allows you to assess mainly the work of the liver of a pregnant woman, but according to the results of a biochemical blood test, diseases of the pancreas, kidneys and even the heart can be diagnosed. Hepatitis, pancreatitis and other inflammatory diseases indicate poor functioning of human organs, intoxication of the woman's body and the fetus as a whole. It is even possible that a miscarriage occurs in the acute course of the disease, but mainly in the presence of such an ailment in the mother, the embryo suffers from oxygen starvation, lags behind in development.

HIV test (first). Testing at an early stage of pregnancy allows, in case of confirmation of the disease, to promptly start treatment and subsequently give birth healthy child... Blood is taken from a vein on an empty stomach.

Test for hepatitis B and C viruses. This analysis is assigned to determine whether the expectant mother is a carrier of the hepatitis virus, since the symptoms of a chronic form of the disease may not manifest in a woman in any way, but the virus will be transmitted to the child, who already in the womb begins to destroy the cells of his liver.

In general, the hepatitis virus is insidious, and it can be introduced into the DNA structure, where it will develop, while slightly affecting liver function. In this case, the woman will transmit the hepatitis virus to her child and immediately in a chronic form.

Serological examination for syphilis (first). Syphilis during pregnancy leads to infection of the placenta, its blood vessels become thin or even devoid of lumen, due to which the fetus does not receive the necessary nutrients and oxygen, and dies while still in the womb. Infection on later dates causes premature birth, but most often the child is born dead or dies after a while.

Detection of syphilis in the first 4 months of pregnancy avoids the infection of the child, which is why it is so important to diagnose this disease in the early stages of pregnancy.

A smear for cytological examination from 3 places: vagina, cervical canal, urethra. A smear is taken to exclude an infection in the genitourinary system, the presence of which is dangerous for the fetus, regardless of the type of pathogen and the degree of spread.

Scheduled ultrasound (at 11-14 weeks). At this time, the first scheduled ultrasound of the fetus is performed. This is a mandatory procedure that is aimed at diagnosing abnormalities in the development of the fetus.

You can also carry out the so-called screening or "double test" (donating blood for hormones "plus" to conduct a conventional ultrasound), which allows you to determine the malformations of the neural tube of the fetus and other organs, calculate the likelihood of Down syndrome and Edwards syndrome.

Examination by doctors of narrow specialization

No later than 7-10 days from the date of registration, the pregnant woman must go through several main doctors: therapist, dentist, otolaryngologist (ENT), ophthalmologist (ophthalmologist), and, possibly, a surgeon, cardiologist and endocrinologist.

During pregnancy, the hormonal background changes, the protective functions of the body decrease, therefore, during this period of women's lives, an exacerbation of chronic diseases and the emergence of new ones lie in wait.

The dentist will examine the teeth and gums for caries, periodontitis, etc. These diseases can cause late toxicosis.

The ENT will examine the throat for plaque and hidden diseases, take a smear for bacteria.

The optometrist will check the eyesight, look at the fundus and, in case of deviations from the norm, will give recommendations on the method of delivery (he may prescribe a cesarean if pushing is harmful to the eyes)

The surgeon looks at the veins, the presence or absence of edema, the cardiologist conducts an ECG and in case of heart problems, additional examinations are prescribed, and the endocrinologist probes the thyroid gland for an increase in size, asks about the presence of diabetics in the family and, if necessary, prescribes additional tests.

You will need a fresh (made at least six months ago) fluorography of the husband / roommate / household. It must be taken to a tubologist (phthisiatrician), who will make a note in the exchange card about the presence / absence of the possibility of contracting tuberculosis from household members.

A pregnant woman is not allowed to undergo fluorography!

Women after 35 years old (or if the child's father has reached 40 years old) are additionally referred to genetics, because with age, the risk of having a child with genetic developmental defects increases.

The therapist will make a conclusion about the state of health of the pregnant woman. It is passed last.

Additional studies (according to indications):

- a blood sugar test or a two-hour oral glucose tolerance test (OGTT) (if you suspect diabetes mellitus, gestational diabetes or if you have a birth predisposition to this disease);

- colposcopy (for diseases of the epithelial lining of the vagina or the mucous membrane of the cervix, for example, with erosion, ectopia, colpitis);

- a smear on flora (in case of obvious signs during a gynecological examination or when contacting a doctor with complaints of nonspecific, for example, cheesy discharge with an unpleasant odor or itching, burning, redness in the genital area).

For the first and, possibly, for subsequent appointments, take your passport, insurance policy (if any), examination gynecological kit (or diaper), money with you.

As soon as the doctor issues an exchange card, do not forget to take it with you to each appointment.

II trimester (from 13 to 27 weeks)

From the second trimester, at each visit to the gynecologist who monitors your pregnancy, in addition to the standard parameters, the doctor will measure the height of the uterine fundus (the distance from the pubic bone to the place where the uterus ends - that is, the places where the dense part of the abdomen becomes soft) and volume belly.

List of required studies and analyzes

Scheduled ultrasound scan (for 16-20 weeks). The second planned ultrasound scan is mandatory, as it allows you to understand exactly how the baby develops in the womb at this stage of pregnancy.

Comprehensive examination, ultrasound "plus" blood for hormones (given at the request of the pregnant woman), called "triple test" or "second screening", is carried out to clarify the risk of developing possible fetal defects.

General urine analysis. For rent at every scheduled visit to the obstetrician-gynecologist. It evaluates kidney function throughout pregnancy.

Serological examination for syphilis (second). Usually, each trimester of a pregnant woman is given a referral to donate blood for syphilis.

Additional analyzes:

- measure the level of hCG in the blood of a pregnant woman, if necessary, at 15-18 weeks (blood is donated over time, i.e. several times with an interval of 1 week) (if there is a suspicion of fetal lag in development or a frozen pregnancy);

- a blood sugar test (if you suspect gestational diabetes);

- a blood clotting test or a coagulogram.

III trimester (from 28 to 42 weeks)

From the 28th week and at each subsequent appointment, the lower extremities are examined for varicose veins, for the timely appointment of its prevention or treatment, and listening to the fetal heartbeat.

Usually, a repeated examination by a cardiologist, dentist, etc. is prescribed. At 32-34, cardiotocography is performed - a study of the fetal heart and its movements.

From the 37th week of pregnancy, a woman should visit her obstetrician-gynecologist once a week.

Mandatory analyzes and research

Scheduled ultrasound at 30-36 weeks (third screening). Determines the position of the fetus, the state of the placenta and umbilical cord. If necessary, an additional ultrasound scan is prescribed shortly before childbirth, namely at 36-40 weeks.

Biochemical blood test at 29-30 weeks. In the later stages of pregnancy, it is necessary to donate blood again for analysis, which will allow the doctor to have an idea of \u200b\u200bthe work of most internal organs, and in which case, correct their condition before the onset of childbirth.

Complete blood count at 30 and 36 weeks. A repeated clinical blood test is performed in order to monitor the woman's health.

General urine analysis. Kidney disease carries the risk of complications after childbirth, therefore, at the first suspicion of a possible disease, you should consult a doctor. To exclude or control the course of the disease, pregnant women constantly donate urine for analysis.

Smear for cytological examination at 30 and 36 weeks. During pregnancy, there is a colossal hormonal change and, on the basis of this, a change in the epithelial cells of the internal genital organs of a woman may occur, and the presence of an infection contributes to the infection of the child during the passage of the birth canal.

Serological examination for syphilis at 28-30 weeks (third). A woman may not even be aware of the presence of this ailment, therefore, before entering the hospital, it is necessary to undergo a second blood test for syphilis.

HIV test at 30 weeks (or before childbirth). In the absence of this analysis, it is forbidden to give birth to a woman in the common delivery room; she will be transferred to the observation department to the rest of the infected.

Additional studies and analyzes:

- conduct a blood test for the presence of Rh antibodies and its titer (at 28 weeks), if there is a Rh-conflict; an injection of human anti-rhesus immunoglobulin D is made to prevent the destruction of embryonic cells;

- dopplerography (examination of the vessels of the uterus, placenta and fetus, which can determine whether the fetus is receiving required amount oxygen and nutrients);

- an analysis for blood coagulation or coagulogram (the birth process is accompanied by bleeding, and if the coagulation is poor, then it will be difficult to stop the blood).

In total, for the prenatal period of uncomplicated pregnancy, a woman should visit her obstetrician-gynecologist 10-12 times: up to 30 weeks - once a month, and after 30 weeks - once every two weeks.

Monitoring pregnant women is the main task of the antenatal clinic. The outcome of pregnancy and childbirth largely depends on the quality of outpatient follow-up.

Principles of clinical examination of pregnant women:

1. Early clinical examination of pregnant women.
2. Identification of risk factors for the development of perinatal, obstetric and extragenital complications during registration with a dynamic assessment of the changing status.
3. Timeliness and completeness of examination of a pregnant woman.
4. Prevention of purulent-septic complications, including mandatory dental, urological and ENT sanitation.
5. Regular follow-up of pregnant women.
6. Obligation of prenatal care.
7. Timeliness of a woman's hospitalization during pregnancy and before delivery.
8. Obligation and completeness of physiopsychoprophylactic preparation of pregnant women for childbirth and work with their husbands.
9. Obligatory postpartum patronage.

A woman must be registered when the pregnancy is up to 12 weeks. This will make it possible to diagnose extragenital pathology in a timely manner and resolve the issue of the possibility of further preserving pregnancy, rational employment, establish the degree of risk and, if necessary, ensure the recovery of the pregnant woman. It was found that when women are observed from early pregnancy and when they visit a doctor 7-12 times, the level of perinatal mortality is 2-2.5 times lower than in all pregnant women in general, and 5-6 times lower than when visiting a doctor in gestation after 28 weeks.

When registering a pregnant woman, regardless of the gestational age, the antenatal clinic doctor must familiarize himself with the outpatient card of a woman from the outpatient network (or an extract from it) to identify risk factors for the development of perinatal and extragenital complications. It is also necessary to interact between consulting doctors and workshop therapists and gynecologists, if a woman works in an industrial enterprise and is under constant medical supervision in a medical unit. It is important to take into account the specifics of production, since in some cases, immediately after establishing the fact of pregnancy, it is necessary to resolve the issue of more rational employment of a pregnant woman.

When registering a pregnant woman, they carry out:

• a general blood test (at the first visit, with a period of 18 and 30 weeks, then once every 2 weeks);
• urinalysis at each visit;
• microscopic examination of the vaginal discharge 2 times (at the first visit and at 30 weeks);
• determine the blood group, Rh-affiliation (with Rh-negative affiliation - examination of the husband for group and Rh affiliation);
• blood sugar and coagulogram at 36-37 weeks;
• conduct a blood test for RW 3 times (at the first visit, for a period of 30 weeks, 2-3 weeks before delivery);
• blood test for HIV 3 times (at the first visit, 30 weeks and 3 weeks before childbirth);
• blood test for AFP and hCG at 16-20 weeks.

The antenatal clinic doctor is also obliged to as soon as possible send the pregnant woman to a therapist for consultation and, if extragenital pathology is detected, together with specialist doctors, decide the issue of the possibility of prolonging pregnancy, obtain information about the pregnant woman at the district tuberculosis dispensary. If a pregnant woman becomes ill with any form of tuberculosis, including inactive, and in the presence of active forms of tuberculosis in relatives living with her, the pregnant woman is sent to a specialized tuberculosis obstetric department for examination or specific treatment.

It is necessary to start a timely (within 12-14 days) examination.

The effectiveness of early registration of a pregnant woman will be completely leveled if minimum terms do not examine it completely. As a result of the examination, the possibility of carrying a pregnancy and the degree of risk are determined, and a plan for the management of pregnancy is developed.

Pod pered. V. Radzinsky

"Monitoring pregnant women" and other articles from the section

The news that a woman will become a mother implies the need to decide who will take care of the pregnancy in order to receive the necessary medications, vitamins, do tests, and be examined by a good specialist. Pregnancy care takes place in antenatal clinics in Moscow and the region, but there are clinics where paid monitoring of pregnancy is carried out, there are courses for preparing for childbirth. The choice is for the parents-to-be, depending on their capabilities.

What is pregnancy management

A pregnant woman must register, the specialists of the medical institution will observe her before delivery, monitor the development of the fetus, timely identify pathologies, and prevent dangerous diseases. Vaginal examination is carried out at least three times during pregnancy, blood pressure, weight, abdominal circumference, height of the uterine fundus are measured, fetal heartbeat is heard, and tests are taken. You also need a visit:

• otolaryngologist;
• dentist;
• a surgeon;
• venereologist;
• ophthalmologist;
• endocrinologist.

Pregnancy management at the maternity hospital

An important condition for bearing a healthy child is a systematic visit to an obstetrician-gynecologist, who determines how the pregnancy is progressing and records this in an exchange card. Reception is conducted by the antenatal clinic at the clinic or maternity hospital. Such free pregnancy support is convenient: close to the place of residence, you can easily get all documents, referrals to specialists and to the hospital. But there are downsides:

• queues are indispensable;
• for additional advice, you should contact the specialists of other medical institutions;
• antenatal clinics are not always provided by highly qualified doctors;
• often inattentive attitude towards the patient;
• choosing a doctor is difficult;
• lack of modern equipment, good conditions, so wealthy women choose complex management at a certain price.

Pregnancy management plan

Registration takes place no later than 12 weeks. The pregnancy management plan in the antenatal clinic involves a clear system of examinations and recommendations. The pregnant woman's card will record the results of tests and examinations, doctor's appointments, a schedule of consultations; the decision on their number is made depending on the development of the fetus and the condition of the woman. The plan includes screenings, there are two of them, they determine the degree of risk of congenital defects. So, the main points of the plan:

1. In the early stages - examination by a gynecologist, referral for tests, filling out an individual card, ultrasound - to avoid the threat of miscarriage, to determine an ectopic or complicated pregnancy, problems of the uterus, placenta, and multiple pregnancy.
2. 14-16 weeks - study of test results, referral to a second ultrasound of the fetus, to other specialists - according to indications.
3. 18-20 weeks - ultrasound to determine size, age, position, possible pathology fetus.
4. 22 week - study of the survey results.
5. Week 26 - inspection.
6. Week 30 - blood tests, urine tests, sick leave (if necessary).
7. 32 - 36 weeks - ultrasound to monitor the development of the fetus, clarify the date of delivery.
8. Visits to the gynecologist in the last weeks.

Required analyzes

Laboratory tests are mandatory:

• clinical blood test - 3 times;
• urine analysis - at each visit;
• microscopic examination of a vaginal smear - 2 times (first visit and for a period of 30 weeks);
• examination for the pathogens of the TORCH complex and hepatitis B and C (repeat the test for hepatitis in the third trimester);
• analysis for blood group and Rh factor;
• blood test for RW - 3 times (first visit, 30 weeks, 2-3 weeks before delivery);
• screening for HIV infection (first appointment, 30 weeks);
• Ultrasound - 3 times (10-14 weeks, 20-24 weeks, 32-34 weeks);
• biochemical screening (for a period of 10-14 weeks); at 16-20 weeks - a triple test for the determination of AFP and hCG to determine the risk of developing a heart defect in a child, the presence of Down syndrome, chromosomal problems.
• blood for antibodies - every month.

Additional examinations

Sometimes the doctor prescribes additional types of examination for the patient. It can be sent for tests if there is a history of herpes, chlamydia, toxoplasmosis, chronic inflammation of the appendages, miscarriages, ectopic or frozen pregnancies, placental insufficiency, polyhydramnios. According to the indications, a hemostasiogram is performed to study the processes of blood coagulation and research for diseases that are sexually transmitted. With a negative Rh blood, the mother is examined the father of the child.

Pregnancy management in a paid clinic

Doctors of private clinics in Moscow competently, according to established standards, but taking into account the peculiarities of the condition of expectant mothers, conduct comprehensive monitoring of pregnancy. A big plus is the absence of queues; surveys are carried out at the appointed time, in one place, even on weekends. But often the price of services becomes a disadvantage when choosing, as well as the fact that it is more difficult to get sick leave if necessary than in a antenatal clinic, and an emergency situation prohibits consulting a pregnant woman.

Pregnancy management contract

This document must be concluded with the institution where proven specialists work - obstetricians and gynecologists, who will timely detect changes in fetal health and future motherwhere there is a good laboratory. The contract regulates the system of examinations of a pregnant woman; round-the-clock telephone contact with a doctor is possible. You can also conclude a contract for childbirth: there will be "your" doctor to take them and engage in postpartum supervision. The document must contain all the required services and the possibility of issuing an exchange card.

Benefits of paid pregnancy management

The professionalism of doctors, the possibilities of a medical institution - this is what is put at the forefront when choosing a medical institution, and more and more women choose paid services, although it is not cheap. Especially in need of expectant mothers with uterine fibroids, Rh-blood conflict, oncological diseases, problems with the heart, vision, thyroid gland, kidneys, blood, bacterial and viral infections. The reasons for choosing are the following advantages of a paid institution:

• possibility of holding additional examinations on modern equipment;
• comfortable conditions, psychological support for staff;
• qualified medical control over the course of pregnancy, timely assistance.

The cost

Paid or free to see a doctor - the pregnant woman and her family decide. The experience of friends and feedback from patients help make a choice. Here are the approximate prices for some commercial services (region - Moscow):

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