Once they are pregnant women need routine prenatal care in order to ensure their own health and the health of the fetus. Investigations are needed often for symptoms and signs of disease. Common symptoms include, often associated with pregnancy,
Ideally, visit a doctor before conceiving women who plan to become pregnant, so that they can learn about pregnancy risks and ways to reduce it. As part of preconception care clinicians should all women of childbearing age advise a vitamin (0.4 mg) folic acid 400 mcg to take 1 time / day. Folic acid reduces the risk of neural tube defects. When women have already given birth to a fetus or a child with a neural tube defect, the recommended daily dose 4000 micrograms (4 mg). The intake of folic acid before and after conception may also reduce the risk of other birth defects (1). Once they are pregnant women need routine prenatal care in order to ensure their own health and the health of the fetus. Investigations are needed often for symptoms and signs of disease. Common symptoms that are often associated with pregnancy include vaginal bleeding Pelvic pain vomiting edema of the lower extremities for special obstetric diseases, pregnancy abnormalities; for non-obstetric diseases in pregnant women, pregnancy complications caused by the disease. The first routine pregnancy test should be carried out 6 to 8 weeks of pregnancy (SSW). Follow-up visits should take place at approximately 4-week intervals to 28 Weeks 2-weekly intervals from 28 to 36 weeks Weekly thereafter until delivery Prenatal visits may be scheduled more frequently when the risk of a poor pregnancy outcome is high or less frequently if the risk is very low. Prenatal care. Includes screening for disorders collection of measurements to reduce fetal and maternal risks (Note d. Talk .: The medical care provided to pregnant women in Germany [through the “maternity guidelines” guidelines of the Federal Committee of Physicians and Health Insurers on medical care regulated during pregnancy and after delivery from 12 July 2003]) consulting Clinical calculator:. pregnancy progress based Naegele’s rule and ultrasound biometry Notes 1. Shaw GM, O’Malley CD, Wasserman CR, et al: Maternal periconceptional use of multivitamins and reduced risk for heart defects and limb deficiencies conotruncal among offspring. Am J Med Genet 59: 536-545, 1995. doi: 10.1002 / ajmg.1320590428. History During the first examination will be charged a full medical history, including Past and present diseases use of medicines and drugs (therapeutic, socially acceptable and illegal) presence of risk factors for pregnancy complications (see Table: Risk factors for pregnancy complications) Pregnancy history with the course all previous pregnancies, including maternal and fetal complications (eg. as gestational diabetes, preeclampsia, congenital malformations, stillbirth) The family history should include all chronic diseases by family members to identify potential hereditary diseases (genetic study). During the subsequent investigation, the questions focus on intervening events, so especially on a vaginal bleeding or liquid effluent, headache, visual disturbances, edema of the face or fingers and changes in frequency or intensity of fetal movements. Pregnancy and pregnancy parity refers to the number of confirmed pregnancies; a pregnant woman is a Gravid. Parity is the number of births after 20 weeks. A multiple pregnancy is one in terms of pregnancy and parity as one. Abort denotes the number of pregnancy losses (abortion) before the 20th week, regardless of the cause (z. B. spontaneous, therapeutic or elective abortion and ectopic). The sum of parity and abortion is equal to the pregnancy. Parity is often given in four figures: Number of on-time deliveries (after 37 weeks) number of premature births (> 20 and <37 weeks) number of miscarriages number of children living Thus, a pregnant woman giving birth at term, a pair of twins to be born in the 32nd week of pregnancy and has two miscarriages in medical history, a fifth-Gravida, 1-1-2-3-Para. Physical examination First, a full general examination, including height and weight (d. Talk .: maternity guidelines note. In Germany s.) Is performed. BMI should be calculated and recorded. Clinical Calculator: Body Mass Index (Quetelet's index) In the first pregnancy examination is a speculum and a bimanual examination of the vagina for the following reasons: In order to detect abnormal changes or discharge To determine color and consistency of the cervix in order to take cervical samples for testing also, the fetal heart rate and, in patients who present later in pregnancy, the position of the fetus judged (the Leopold's handles.). The capacity of the basin can be clinically assess by inspection at the bimanual examination with the middle finger different dimensions. If the distance from the bottom edge of the symphysis is> 11.5 cm from the promontory of the sacrum, the pelvic inlet is (n. D. Übers .: Conjugata diagonalis, “Midwives diameter”) likely reasonably well. Normally, the distance between the spines ischiadicae is ? 9 cm, the length of the ligaments. sacrospinous ? 4 to 5 cm and the width of the pubis angle ? 90 °. During the subsequent investigation is the determination of blood pressure and weight is important. The obstetric investigation focuses on uterine size fundus (in cm above the symphysis), heart rate and activity of the fetus as well as on nutrition, weight gain and overall well-being of the mother. Speculum and bimanual vaginal examination are usually unnecessary unless there are vaginal discharge or bleeding, fluid outlet or pain. Tests Laboratory tests Prenatal evaluation includes urine tests and blood tests. The first laboratory examination is very thorough; Some of these findings are raised repeatedly in the course of care (see table:.. component of routine prenatal care (Editor’s note .: does not apply to Germany)) (Editor’s note .: in Germany’s maternity guidelines…). Components of routine prenatal care (n. D. Talk .: does not apply to Germany) Type initial examination follow-up Clinical examination sizing weight and blood pressure measurement X examination vonSchilddrüse, heart, lungs, chest, abdomen, extremities and back of the eye Investigation on ankle edema X Complete vaginal examination study to determine the length Beck examination of the uterine size and location of Fetena X examination of fetal Herztönea X Blutuntersuchungb Large Blutbildc Blood group determinations and Rh0 (D) antibody-Spiegeld hepatitis B serology test human immunodeficiency virus (HIV) rubella and varicella Immunitäte Serological testing for syphilis tests of the cervix to cervical smears and gonorrhea Chlamydienf Cervical smear Papanicolaou (Pap test) urine tests urine culture urine protein and glucose determination X Other tests tuberculosis screening Genetic (in the case of risk) screening, including first-trimester screening for aneuploidy Beckensonographieg a component possibly can not be detected depending on the stage of pregnancy at the time of the investigation. b A test for diabetes is done only once – routinely 24-28. SSW, but earlier in high-risk patients. c hematocrit is determined again in the third trimester. dRh0 (D) -Antikörperspiegel be in the 26th-28th SSW repeated at Rh-negative pregnant women. eRöteln and varicella titers are measured, unless women were vaccinated or had a documented previous infection, which immunity is confirmed. FWhen women at high risk to repeat cervical smears on gonorrhea and chlamydia infection in the 36.SSW. g Ideally, an ultrasound of the pelvis in the 2nd trimester 16 to 20 SSW is performed; this is not routinely performed by all doctors. X = repetition Subsequent investigation. If a woman has Rh-negative blood is in her risk of developing Rh0 (D) antibodies (Prätransfusionsuntersuchungen; and – if the father has Rh positive – to the fetus, a possible risk for the development of fetal erythroblastosis Rh0. (D) should -Antikörperspiegel in pregnant women at the first prenatal visit and be determined again in the 26th-28th week of pregnancy. at that time women were given with Rh-negative blood a prophylactic dose of Rh0 (D) immunoglobulin. additional provisions may be required to prevent the development of maternal Rh antibodies (fetal erythroblastosis). in general, 24 to 28 SSW women routinely using a glucose tolerance test (50 g, 1 h) are tested for gestational diabetes. Women with significant risk factors for gestational diabetes, were studied during the first trimester. these risk factors include Gestational diabetes or macrosomia in newborns (weight> 4500 g) at birth in a previous pregnancy Unexplained miscarriage A strong family history of diabetes first degree a history of persistent infections body mass index (BMI)> 30 kg / m2 polycystic ovary syndrome with resistance to insulin, when the first trimester test is normal, the 50 g test in the 24th should be repeated to 28 weeks followed, if abnormal, by a three-hour test. Abnormal results in both tests confirmed the diagnosis of gestational diabetes. Women at high risk for aneuploidy (z. B. those> 35 years old, those who have had a child with Down’s syndrome) should be a screening with maternal serum cell-free DNA werden.Sonographie offered Most obstetricians recommend at least one ultrasound (n. . d. Talk .: in Germany’s maternity guidelines) during each pregnancy, best 16 to 20 week of pregnancy if the expected date of birth can be fairly accurately determined (calculated date of birth) still and placental localization and anatomy of the fetus still good must be assessed. Estimate of gestational age based on measurements of the fetal head circumference, the biparietal diameter of the abdominal girth, and the femur length. The measurement of fetal crown-rump length in the first trimester is very safe to predict the expected date of delivery: on up to 5 days if the measurements are <12th week of pregnancy and about 7 days in measurements between the 12th and 15th week of pregnancy. Ultrasound during the third trimester can predict the probable date of birth on up to 2-3 weeks exactly. Clinical Calculator: Pregnancy progress based Naegele's rule and ultrasound biometry Specific indications for ultrasonography include evaluation of anomalies during the first trimester (eg indicated by abnormal results on noninvasive screening tests in the mother.) Risk assessment for chromosomal abnormalities (eg. B. down syndrome) including nuchal translucency need (for a detailed assessment of fetal anatomy usually in about 16 to 20 weeks), optionally including fetal echocardiography at 20 weeks when the risk of congenital heart defects is high ( z. B. in women who have type 1 diabetes, or a child with a congenital heart defect had previa) finding of a multiple pregnancy, a molar pregnancy, polyhydramnios, placenta and ectopic B DENTIFICATION placental localization, position and size of the fetus and the size of the uterus in relation to the given pregnancy data (too small or too large), sonography is also used for guiding the needle during a chorionic villus sampling, amniocentesis and fetal transfusion. The high-resolution ultrasound involves techniques that maximize the sensitivity for the detection of fetal malformations. If the ultrasound is required during the first trimester (z. B. for evaluation of pain, bleeding, or the viability of the pregnancy), one can maximize diagnostic accuracy by using an endovaginal transducer. The detection of an intrauterine pregnancy (gestational or Embryonalschild) at the earliest possible in the 4th-5th SSW and is in the 7th-8th SSW provided in> 95% of cases. With the real-time sonography movements and heartbeat of the fetus can already in the 5th-6th werden.Andere observed imaging radiographs can, especially during early pregnancy, induce a spontaneous abortion or congenital malformations. The risk associated with each X-ray image of a limb or the neck, of the head or the thorax is low (up to 1 / m.), When the uterus is protected. When X-rays of the abdomen, of the pelvis and lumbar spine, the risk is greater. Therefore, all women of childbearing age an imaging study with less ionizing radiation (eg., Ultrasound) should alternatively be chosen, or the uterus must, if absolutely radiographs are required to be protectively covered (as the patient may be pregnant). Medically necessary x-rays or other imaging procedures should not be reset because of a pregnancy, elective x-rays be postponed until after pregnancy. Treatment on problems that can be identified during the investigation, must be received. Women were counseled about exercise and diet and they were advised to follow the guidelines of the Medical Institute for weight gain, based on the gestational body mass index (BMI see table: guidelines for weight gain during pregnancy *). Dietary supplements are prescribed. It explains what to avoid and what to expect and when further investigations are perceived. Couples are encouraged to participate in courses on child birth. Guidelines for weight gain during pregnancy * Pregnancy Weight category BMI total weight gain Approximate weight gain during the 2nd and 3rd trimester Underweight <18.5 12.5 to 18 kg (28-40 pounds) 0.4 kg / week (1 pound / week) Normal weight 18.5-24.9 11.5 to 16 kg (25-35 pounds) 0.4 kg / week (1 lbs / week) About 7.0 to 11.5 weight 25.0-29.9 kg (15-25 pounds) 0.27 kg / week (0.6 pounds / week) Obese (includes all classes) ? 30.0 5-9 kg (11-20 lb)) 0.23 kg / week (0.5 pounds / week) * recommendations for weight gain based on the BMI before pregnancy. For women who are pregnant with twins, are the preliminary recommendations for total weight gain as follows: Normal Weight: 16.8 to 24.5 kg (37-54 pounds) overweight: 14.1 to 22.7 kg (31 to 50 pounds) overweight women: 11.5 to 19.1 kg (25-42 pounds) A weight gain of 0.5-2 kg (1.1 to 4.4 lb), it is assumed during the first trimester. BMI = body mass index (kg / m2) Adapted from the Institute of Medicine: Report Letter: Weight Gain During Pregnancy: Reexamining the Guidelines. 2009. Accessed 9/16 Clinical Calculator: to ensure Body Mass Index (Quetelet's index) diet and substitutions To ensure adequate nutrition of the fetus, pregnant women also need about 250 kcal / day, most of the calories should come from protein. If the maternal weight gain excessively high (> 1.4 kg / month during the first months) or insufficient (<0.9 kg / month), the diet must be adjusted accordingly. A weight-reducing diet during pregnancy - even in morbidly obese women - not recommended. Most pregnant women need a daily oral substitution of ferrous sulfate or ferrous gluconate 300 mg, 450 mg, which is sometimes better tolerated. A woman with anemia should be 2 times / use the preparation day. All women should be given during pregnancy vitamins, folic acid 400 micrograms (0.4 mg) contained, taken 1 time / day; Folic acid (d. Talk .: Note. In Germany are recommended for the first 8 SSE 800 micrograms [0.8 mg] folic acid) reduced the risk of a neural tube defect. For women who have already given birth to a fetus or a child with a neural tube defect, the recommended daily dose 4000 micrograms (4 mg) .Körperliche activity Pregnant women can resume physical activities and exercise in moderation, but they should make sure her stomach not to damage. Sexual intercourse can take place during the whole pregnancy, as long as no vaginal bleeding, pain, oozing of amniotic fluid or uterine contractions auftreten.Reisen The safest time to pregnancy to travel while, is 14 to 28 weeks of gestation., But there is no absolute contraindication to travel outside these times. Regardless of the gestational age and the means of locomotion, the pregnant woman should wear a seat belt. Traveling by plane is safe to do so until the 36th week of pregnancy. The primary reason for this limitation is the risk of labor and delivery in a foreign environment. While all types of travel, pregnant women should stretch their legs and ankles at regular intervals and stretch to prevent venous stasis and the possibility of thrombosis. For example, they should run every 2 to 3 hours on long flights or stretch their legs. In some cases, the clinician may be a thromboprophylaxis for longer travel empfehlen.Impfungen vaccinations against measles, mumps, rubella and varicella should not be done during pregnancy. If it is indicated, a hepatitis B vaccine can be done safely; Influenza vaccination is pregnant or postpartum women in the flu season highly recommended. Booster immunization against diphtheria, tetanus and pertussis (Tdap) after the 20th week of pregnancy or after birth is recommended, even if women are fully vaccinated. Women with Rh-negative blood have the risk Rh0 (D) antibodies to develop, they will Rh0 (D) immunoglobulin 300 micrograms i.m. given in the following situations: After each significant bleeding or other signs of placental blood flow or separation (placental abruption) After a spontaneous or therapeutic abortion after amniocentesis or chorionic villus sampling prophylactically in the 28th week, when the newborn Rh0 (D) -positive blood after birth has Influenceable risk factors for pregnant women to consume no alcohol or tobacco, and also avoid passive smoking. You should also avoid: Exposure to chemicals or paint fumes Direct editing of stray Longer (because of the risk of toxoplasmosis) temperature increase (eg in a hot tub or sauna.) Exposure to people with active viral infections (eg. . rubella, parvovirus infection [fifth disease], varicella) Pregnant with problems caused by drug abuse should be supervised by a physician experienced in the care of high-risk pregnancies specialists. Study on domestic violence and depression should be made. Of drugs and vitamins that are not medically indicated, should be discouraged (drugs during pregnancy; drug during pregnancy) .Abzuklärende symptoms pregnant women should be advised to report unusual headaches, blurred vision, pain or cramps in the lower abdomen, vaginal bleeding, to seek rupture, severe swelling of the hands or face, decreased urine output, any prolonged illness or infection or continuing signs of labor for an investigation. Multipara with rapid birth in the history should inform the doctor at the first signs of labor.