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Pregnancy care
Pregnancy care is a series of scheduled visits, laboratory tests and ultrasound scans, from the confirmation of the pregnancy through to the birth. The aim is a smooth course of pregnancy for both mother and baby.
The first steps
The pregnancy is confirmed by measuring beta-hCG (the pregnancy hormone) in the blood, a few days after a missed period, provided your cycle is regular. We suggest repeating the measurement after 48 hours. When the pregnancy is progressing normally, the second value is at least double the first. In this way, at a stage when the gestational sac cannot yet be seen on ultrasound, we rule out an ectopic pregnancy as far as possible.
A visit to the practice follows, where we take your history and explain what comes next. If you or your family have a history of thrombosis, or if you have had repeated pregnancy losses, we discuss thrombophilia testing with you. Thrombophilia is the body's tendency to form clots in the blood vessels, and pregnancy and the weeks after birth add to that tendency. If the result is positive, it is managed with anticoagulant treatment.
Between the 6th and 7th week the baby's heart begins to beat. At that point we can see the gestational sac and the embryo on ultrasound. From the crown-rump length (CRL) we date the pregnancy accurately, which is especially useful for women with irregular cycles.
The laboratory tests
Once the heartbeat has been detected, we recommend the standard laboratory work-up of pregnancy. It includes a full blood count, urinalysis, urea, blood sugar, blood group and Rhesus, haemoglobin electrophoresis, iron and ferritin.
We also test IgM and IgG antibodies for toxoplasma, rubella and cytomegalovirus (CMV), as well as hepatitis B and C, HIV, syphilis (VDRL) and listeria. You bring the results with you to your next visit.
The schedule of visits
An ultrasound scan is done at 9–10 weeks, followed by the nuchal translucency scan between 11 and 14 weeks. After that we see you every month, with the results of the laboratory tests we have recommended. From the 32nd week, visits take place every two weeks until the birth.
Pregnancy and nutrition
Pregnancy brings increased nutritional needs, both for the baby's growth and for your own body. More vitamins and minerals are needed, for example more than twice as much folic acid and 50% more calcium than before pregnancy. Energy needs, however, are relatively modest: in the second and third trimesters, about 300 extra calories a day are enough.
Weight gain varies from woman to woman and depends on your body mass index (BMI) before pregnancy. It is generally small in the first 12 weeks and then about 150–200 grams a week. Prefer small, frequent meals to two or three large ones. Long periods without food are not good for the baby.
Alcohol, smoking and caffeine are best avoided. Alcohol is linked to developmental problems, miscarriage and low birth weight, smoking to preterm birth and underweight newborns. For morning sickness, five or six small meals, avoiding fatty and fried food, and a few crackers by the bed can help. For constipation, vegetables, fruit, plenty of fluids and a daily walk help.
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Frequently asked questions
When should I have my first blood test for pregnancy?
The beta-hCG test is done a few days after a missed period, if your cycle is regular. It is repeated after 48 hours so that we can see whether the value has doubled. Bring both results to your first visit.
How often will I come to the practice?
After the initial tests, every month until the 32nd week. From then on, every two weeks until the birth. At each visit you bring the results of the tests we have recommended. If anything worries you in between, get in touch with us.
Do I need thrombophilia testing?
Not every pregnant woman. Thrombophilia is the body's tendency to form blood clots, and testing has a place when you or a close relative have had a thrombosis, or after repeated pregnancy losses. If the result is positive, it is managed with anticoagulant treatment. Discuss your history at the first visit.
How much weight is it normal to gain?
It depends on your body mass index before pregnancy. In the first 12 weeks the gain is small, and after that usually 150–200 grams a week. If you are gaining weight too slowly or too quickly, we discuss it at your next visit and adjust your diet.
When is a CTG needed?
A CTG is done in the third trimester when there is an indication. Such indications include reduced growth or reduced movements of the baby, high blood pressure or pre-eclampsia, diabetes, a pregnancy going beyond 40 weeks, maternal age over 35 and a history of stillbirth. If you feel the baby moving less, let us know.