The general practitioner deals with all issues related to pregnant women that do not relate to gynecology. The first appointment with a therapist should take place in the first trimester of pregnancy.
During the first appointment, the therapist:
- Measure blood pressure;
- It will calculate the pregnant woman’s body mass index for further monitoring of the pregnant woman’s weight, in order to know what weight gain during pregnancy will be normal for you.
- She will tell you about the diet that you need to follow during pregnancy.
- He will recommend a menu that will contain all the products that a pregnant woman needs for the normal development of the child and the normal well-being of the woman throughout the entire period of pregnancy. Which products should be consumed to a greater extent, and which ones are better to abstain from or consume in small quantities.
- Finds out about the diseases that the pregnant woman had, possible diseases suffered in childhood, chronic diseases, surgical operations, if the pregnant woman had them.
The therapist also pays great attention to blood tests - the level of sugar and hemoglobin in the blood, whether the indicators are normal. If abnormalities are detected, the therapist prescribes an appropriate diet or treatment.
At an appointment with a therapist, a pregnant woman tells all her complaints about her health. After examining and studying the tests, the doctor gives a conclusion.
If necessary, the therapist prescribes the patient to see specialists.
- If a pregnant woman is bothered by veins in her legs, the therapist will schedule a consultation with a surgeon.
- If there are complaints of pain in the heart, the therapist will refer you to a cardiologist and recommend an ECG (electrocardiogram).
Colds in pregnant women may sometimes not go well, because most antiviral drugs cannot be used during pregnancy. Therefore, a consultation with a therapist will be simply necessary; it is the therapist who will prescribe the necessary therapy, prescribe medications that are not contraindicated during pregnancy, and monitor the state of health.
Repeated appointments with a therapist during pregnancy are in the second and third trimesters of pregnancy. Consultation with a therapist during this period is necessary to monitor the health of the pregnant woman and the health of the unborn child. Also, consultation with a doctor is necessary in order not to miss deviations from the norm and, if deviations are detected, to begin treatment on time.
- Pregnancy 24 weeks. I feel good. In the blood test, glucose is 5.2 mmol/l. The doctor refers me to a consultation with an endocrinologist. For what?
In your case, consultation endocrinologist Most likely, it is needed to exclude gestational diabetes mellitus, or diabetes during pregnancy. This disease first occurs during gestation and can lead to a pathological course of pregnancy and childbirth, as well as affect the health of the child. The fact is that in non-pregnant women, the fasting blood glucose level is 3.3–5.5 mmol/l, and while expecting a baby, the normal blood glucose level is 4.0–5.2 mmol/?l.
This is due to the fact that by the 20th week the level pregnancy hormones is already quite high, and they partially block the action of insulin, a hormone that promotes the absorption of glucose in the body. Therefore, the pancreatic cells that produce insulin must produce it 2-3 times more than usual. If the organ cannot cope with the increased load, then insulin deficiency develops, the mother’s blood sugar rises and gestational diabetes mellitus develops.
- I am 19 years old, first pregnancy, 15 weeks. Difficult situation at work, I’m worried, I don’t sleep well. Can I take sedatives?
You are in the second trimester of pregnancy, when the formation of the main organs and systems of the fetus is almost complete. At this time it can be used according to the recommendation of a doctor. sedatives of plant origin, unless, of course, the mother is allergic to their components. These are VALERIAN EXTRACTS ( valerian in drops or tablets), MOONON EXTRACTS in the form of tablets, as well as ready-made combination preparations on a plant basis - PERSEN, NOVO-PASSIT.
Deficiency also affects the emotional background B vitamins, therefore, you should take multivitamin complexes for pregnant women prescribed by your doctor; it is also recommended to introduce more foods into your diet that contain this group of vitamins: dairy products, cereals, meat, fish, legumes, nuts. All sedatives of chemical origin are strictly prohibited, as they affect the development of the fetus and the health of the pregnant woman.
- I am 32 years old, this is my 2nd pregnancy, the 1st was at the age of 20, it proceeded normally, nothing bothered me except nausea. I'm 20 weeks now and I feel it from time to time. rapid heartbeat. This happens both when I am resting and when I am doing something. The doctor says that this happens in pregnant women, does not prescribe anything significant, says that the pressure is normal, they did an ECG, but found nothing. What do i do?
During pregnancy in cardiovascular system The expectant mother undergoes certain changes. They are compensatory mechanisms in response to the increasing load on a woman’s body while expecting a baby. In particular, the heart rate increases by 10–20 beats/min (reaching 100 beats/min or more), reaching maximum values at the end of the second or beginning of the third trimester of pregnancy, which can be felt by the woman as frequent heartbeat.
It is often detected and extrasystole– manifested by a feeling of irregular contraction of the heart and its periodic freezing. All these phenomena relate to arrhythmia. Most arrhythmias during pregnancy are benign, i.e. do not threaten the life of the mother and fetus, usually disappear after childbirth and do not require treatment.
However, if complaints persist, rhythm disturbances are accompanied by loss of consciousness, pain in the heart, cough, swelling, it is necessary to exclude a more serious pathology. Cardiologist can prescribe you not only an ECG, but an ECG during an attack, ultrasound of the heart (echocardiography or ECHO-CG), ultrasound of blood vessels, if necessary, Holter monitoring of the ECG during the day (recording the ECG during the day), examination of the thyroid gland.
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Visiting a therapist during pregnancy
The first person to see a pregnant woman after the obstetrician-gynecologist is a general practitioner. Therapy (internal medicine) is a field of medicine that deals with diseases of internal organs. The scope of therapy includes diseases of the respiratory system (ARVI, influenza, bronchitis, pneumonia), cardiovascular (arterial hypertension, essential hypertension, heart rhythm disturbances, heart failure), urinary system (pyelonephritis, urolithiasis, cystitis), gastrointestinal tract ( gastritis, peptic ulcer of the stomach and duodenum, cholecystitis, constipation, colitis), blood (anemia), connective tissue (arthritis), etc.
A consultation with a therapist is prescribed for all pregnant women when a woman is registered for pregnancy monitoring and at the 30th week of pregnancy. It is better that at the time of the examination, the general practitioner undergoes basic tests (blood, urine, biochemical blood test, coagulogram) and undergoes an ECG.
During the appointment, the therapist asks the woman in detail about past illnesses, studies medical documentation and test data. Based on these data, the presence of chronic diseases not related to pregnancy is determined. It is possible to prescribe additional studies: an extended biochemical blood test, ultrasound of the heart, internal organs, kidneys, 24-hour blood pressure monitoring (ABPM) or ECG (Holter monitoring), consultations with doctors with a narrower specialty. Women with severe pathology (heart defects, arterial hypertension, glomerulonephritis) may require planned hospitalization in the therapeutic department for a full examination.
When chronic diseases are detected, their severity is determined, the issue of their compatibility with pregnancy is decided, treatment is prescribed, and observation by doctors is recommended.
During pregnancy, the load on internal organs increases several times. Therefore, all chronic diseases can become aggravated, their course worsens, and sometimes even new diseases appear, which are precisely the therapist’s task to identify or prevent. When treating diseases of internal organs, medications are often required, not all of which have the best effect on the child’s health. Some common medications are contraindicated during conception and pregnancy; they must be replaced with safe analogues or the dose significantly reduced. The general practitioner, together with the obstetrician-gynecologist, selects the most effective and safe treatment for mother and child. Taking any medications during pregnancy should be carried out exclusively under the strict supervision of a doctor.
In addition to consultation on diseases, during the appointment the therapist gives recommendations on maintaining a work and rest schedule, diet, and taking multivitamins and mineral supplements. Explains how to protect yourself from seasonal colds and allergies in your baby.
If a woman needs to take medications due to a disease of the internal organs, she will visit a therapist throughout her pregnancy once every 2-4 weeks. In fact, for such women, the therapist manages the entire pregnancy together with the obstetrician-gynecologist. Most often this concerns women with arterial hypertension, kidney disease and anemia.
The peak of exacerbation of all these diseases occurs in the second half of pregnancy, so at 30 weeks you will be asked to see a therapist again. The need for such consultation is also determined by the fact that after 30 weeks, even in absolutely healthy women, the likelihood of gestosis increases - a formidable complication of pregnancy, characterized by a disorder of all organs and systems of the body. This disease is also often called late toxicosis, nephropathy or preeclampsia.
Predisposing factors to its appearance are: high blood pressure, kidney disease, diabetes, stress, hereditary predisposition, multiple pregnancy, young or mature age of the pregnant woman.
Symptoms of gestosis are: the appearance of edema, protein in the urine, increased blood pressure. It is to exclude late toxicosis that the doctor so meticulously evaluates your weight gain and measures your blood pressure. The insidiousness of late toxicosis is also in the fact that if a woman does not have obvious edema, she may not feel an increase in blood pressure at all, a headache occurs already in the later stages of the disease, and often a woman notices something is wrong when the process is already in full swing.
And at this time, serious changes occur in the body: water and salt metabolism are disrupted, water and sodium are retained, blood circulation is disrupted, nutrition and oxygen supply to tissues deteriorate. As a result, the child suffers, because poor circulation leads to the placenta being less well supplied with oxygen and nutrients. Timely treatment can help avoid serious consequences for the mother and fetus.
In addition to advice on the prevention of anemia and gestosis, at the second consultation the therapist gives recommendations on preparing the body for the normal course of childbirth, the postpartum period, lactation and breastfeeding.
It is best to contact an antenatal clinic for registration at 6–8 weeks of pregnancy. To register, you must present a passport and a compulsory health insurance policy (CHI). By the way, if you register early (up to 12 weeks), you are entitled to a one-time cash benefit. During a normal pregnancy, it is recommended to visit a gynecologist at least seven times during the entire period of bearing a child. In the first trimester - once a month, in the second trimester - once every 2-3 weeks, from 36 weeks until birth - once a week. Also, during pregnancy it will be necessary to undergo three screening ultrasound examinations: at 11–14 weeks, 18–21 weeks and 30–34 weeks.
At the first appointment, the obstetrician-gynecologist examines the woman, confirms the fact of pregnancy, and assesses the condition of the vaginal walls and cervix. The doctor also measures the weight, height, blood pressure and pelvic size of the expectant mother - in the future, these parameters will be recorded at each examination. In addition, the doctor fills out the necessary documents, gives recommendations on nutrition and taking vitamins, writes out referrals for tests and to other specialists.
Flora smear during pregnancy. The doctor must take a smear for flora and cytology for microscopic examination. A repeat smear for flora during pregnancy is taken at the 30th and 36th weeks. The analysis allows us to determine the development of the inflammatory process and identify infections. For any deviations from the norm, additional tests are prescribed, for example, a test for sexually transmitted diseases (STDs). If they are detected, the doctor decides on the advisability of treatment. Some infections pose a danger to the normal development of the fetus and can lead to chromosomal abnormalities, damage to the placenta and various organs of the child - it makes sense to treat them. Among medications, topical agents that do not contain antibiotics (suppositories, creams) are most often used; starting from the second trimester of pregnancy, the doctor may prescribe antibacterial drugs.
General urine test during pregnancy. Allows you to quickly assess the general health of a pregnant woman and the functioning of her kidneys. In the future, it is carried out at every visit to the doctor during the entire period of gestation. You need to collect urine in a special plastic container (you can buy them at the pharmacy) in the morning, immediately after waking up. At night, the kidneys work more actively, as a result, the urine becomes more concentrated - this allows for more accurate diagnosis.
Normally, urine should be light yellow and almost transparent. Dark, cloudy urine is a sure sign of abnormalities in the body. This could be, for example, kidney disease, genitourinary system diseases, the development of infections or diabetes, and much more. A doctor will be able to more accurately determine what exactly is wrong after studying the results of a urine test. Based on changes in some indicators, one can suspect the development of gestational pyelonephritis (infectious inflammation of the kidneys, often occurring in pregnant women due to obstructed outflow of urine) or gestosis (a complication of pregnancy, which is manifested by increased pressure, swelling and the appearance of protein in the urine). Thus, regular urine testing allows you to timely monitor the occurrence of many serious diseases and begin their treatment.
General (clinical) blood test during pregnancy. One of the most informative tests, along with a urine test, allows you to assess the woman’s health as a whole, indicating the presence of problems in the functioning of certain body systems. A blood test during pregnancy is taken three times: upon registration and then in each trimester (at 18 and 30 weeks), and more often if necessary. This allows the doctor managing the pregnancy to monitor the dynamics of the patient’s condition and monitor important indicators. Based on the results of a clinical blood test during pregnancy, the number of leukocytes, platelets, hemoglobin is determined, ESR and other indicators are assessed. For example, a high level of white blood cells and neutrophils indicates that there is an inflammatory process in the body. A low hemoglobin level indicates iron deficiency in the body and the likelihood of developing anemia. This disease is dangerous because the fetus does not receive enough oxygen, this negatively affects its development, and the risk of miscarriage and premature birth also increases. High rates of ESR (erythrocyte sedimentation rate) indicate the possible development of several serious diseases at once, including cancer; in this case, additional studies are carried out to clarify the diagnosis. Platelets are responsible for blood clotting, so high levels indicate there is a risk of blood clots.
Coagulogram. How the blood coagulation system works is also judged by a coagulogram; this analysis is done once every trimester, if there are no deviations. The indicators here are normally higher than before pregnancy, since during pregnancy the activity of the coagulation system increases.
Biochemical blood test during pregnancy. It is usually done at the same time as other blood tests. It helps to identify malfunctions in the functioning of various organs. For example, high levels of creatinine and urea indicate impaired kidney function. High bilirubin indicates possible liver problems, including the development of jaundice in pregnant women. A very important indicator is glucose level (blood sugar test). Allows you to evaluate the functioning of the pancreas and not miss the onset of the development of a fairly common pregnancy complication - gestational diabetes. This happens because during pregnancy the pancreas puts a lot of stress on it. Elevated blood glucose levels indicate that the gland is not coping with its tasks.
Analysis for blood group and Rh factor. Doctors are required to do this test, even if you have had it before. It is very important to accurately determine the blood type of the expectant mother, since in the event of large blood loss or unscheduled surgery, doctors may urgently need this information, and there will be no time to do the analysis. If a woman has a negative Rh factor, and the child’s father is positive, a Rh conflict may occur when the mother’s body perceives the child as a foreign body and produces antibodies to eliminate it. This can have serious consequences: cause the development of anemia, miscarriage or intrauterine fetal death. Therefore, if it turns out that a woman has a negative Rh factor, the child’s father donates blood. If he has a positive Rh factor, the expectant mother is regularly tested to monitor the appearance of antibodies: once a month until the 32nd week of pregnancy, and after this period and until the end of pregnancy - twice a month. If this is the first pregnancy and antibodies have not appeared before the 28th week, doctors suggest administering a special drug that blocks the production of antibodies in the future.
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. The incubation period of these diseases is long, they may not manifest themselves immediately or not at all during pregnancy, and test results may also be negative for some time. Therefore, blood is checked for HIV and hepatitis twice – at the beginning of pregnancy and at 30–35 weeks. To diagnose syphilis, the Wasserman reaction test (RW) is used - it is done upon registration, at 30–35 weeks and 2–3 weeks before the expected date of birth. If any of the listed serious diseases is detected at an early stage, the option of terminating the pregnancy is possible; if at a late stage, the doctor will prescribe treatment if possible.
Blood test for . These include: toxoplasma, rubella, cytomegalovirus, herpes and some other infections. They are dangerous not so much for the mother’s health as for the child’s development. If a woman before pregnancy suffered from diseases that cause the listed infections, then she should develop immunity to TORCH infections that are potentially harmful to the fetus, and special antibodies will be present in the blood - their presence is what this test allows to identify. If there are no antibodies, the doctor will tell the expectant mother about the preventive measures that she must follow.
Also, in the first two weeks after contacting the antenatal clinic, a woman will need to visit a therapist, endocrinologist, ophthalmologist and otolaryngologist, and have an electrocardiogram done. If the expectant mother has health problems or any chronic diseases, consultations with other specialists and additional examinations during pregnancy may be necessary.
If the pregnancy is late or there are other indications, between the 10th and 12th weeks the doctor may prescribe a chorionic villus test (CVS) - a study of placental tissue to determine chromosomal abnormalities in the embryo.
"Double test"
At 11–14 weeks, according to the pregnancy examination plan, the first screening, or “double test,” is performed. It is also used to find out whether the fetus is at risk of developing chromosomal abnormalities such as Down syndrome. Screening includes an ultrasound examination, a blood test to determine the level of human chorionic gonadotropin (hCG) and a protein that is produced in plasma (PAPP-A).
Pregnancy examinations: second trimester (14th to 27th week)
In the second trimester, it is recommended to visit a gynecologist once every 2-3 weeks; from the 16th week, during an examination, the doctor begins to measure the height of the uterine fundus and the volume of the abdomen to determine whether the child is developing correctly. These parameters will be recorded at each visit. At 18–21 weeks, a second screening or “triple test” is performed. It is used to again determine the presence of hCG, alpha-fetoprotein (AFP) and free estriol (a steroid hormone). Together, these indicators allow doctors to make a fairly accurate prognosis. However, even if it turns out that the risk of developing a pathology in a child is high, this is not a death sentence. In this case, additional clarifying studies are carried out, for example, analysis of amniotic fluid (between the 14th and 20th weeks).
Also, in the period from the 18th to the 21st week, a second planned ultrasound is performed, during which the condition of the placenta and amniotic fluid is assessed, the child’s development corresponds to the norms, and it is also possible to determine the sex of the baby.
Pregnancy examinations: third trimester (28 to 40 weeks)
As a rule, at the 30th week, the antenatal clinic doctor arranges maternity leave and issues an exchange card to the pregnant woman. From the 30th to the 34th week, an ultrasound is performed for the third time - to determine the height and approximate weight of the fetus, its position in the uterus, the condition of the placenta, the quantity and quality of amniotic fluid, and the presence of umbilical cord entanglement. Based on these data, the doctor makes recommendations regarding the method of delivery.
At 32–35 weeks, cardiotocography (CTG) is performed - a study of the functioning of the cardiovascular system of the embryo and its motor activity. Using this method, you can determine how well the child feels.
From the 36th week until delivery, the doctor conducts a routine examination every week. During the entire period of bearing the baby, the gynecologist may prescribe additional tests or send the expectant mother for consultations with other doctors - it all depends on the characteristics of the pregnancy.
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Exchange card is the most important document of the expectant mother
An exchange card is issued at the antenatal clinic at 22–23 weeks, and it is better to always have it with you. This is an important medical document for a pregnant woman, which will be needed when registering for a maternity hospital.
The exchange card consists of three parts (coupons):
- Information from the antenatal clinic about a pregnant woman. Here, the obstetrician-gynecologist, who monitors the woman throughout the entire period of pregnancy, enters basic information: personal data of the expectant mother, blood type and past and chronic diseases, information about previous pregnancies and births, results of examinations, tests, screenings, ultrasound, CTG, conclusions other specialists. After reviewing these data, the doctor in the maternity hospital will be able to find out all the necessary information about the characteristics of this pregnancy and assess the woman’s health status.
- Information from the maternity hospital about the postpartum woman. Filled out by the doctor before the woman is discharged from the maternity hospital - he enters information about how the birth and the period after it went, about the presence of any complications, and makes notes about the need for further treatment. This part of the card will need to be given to the antenatal clinic doctor.
- Information from the maternity hospital about the newborn. All the baby’s parameters are recorded here: height, weight, Apgar score (a summary analysis of five important criteria for the baby’s condition) and others. This part of the card will need to be given to the pediatrician who will monitor the child, he will create a medical record and transfer all the necessary data there.
Approximate schedule for examination during pregnancy:
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Upon registration (8–12 weeks) |
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| Within 2 weeks after registration |
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| 11-14 weeks |
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| Week 16 |
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| 18-21 weeks |
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| Week 20 |
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| Week 22 |
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| Week 24 |
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| Week 26 |
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| Week 28 |
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| 30 weeks |
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| 30-34 weeks |
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| 32-35 weeks |
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| 36 weeks (and then once a week before giving birth) |
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