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Monitoring of pregnancy

 

Detection of pregnancy

The gynaecologist specifies the size of pregnancy and date of birth with the help of vaginal ultrasound sensor. The fetal viability and existence of twin pregnancy are assessed. All primary analyses needed for the registration with pregnancy – blood test,  analyses from reproductive tracts, urine sample - are prescribed. Tests can be taken on each workday in the morning at 8.00-11.30. In the interests of better service one should register before giving the blood test.

 

Registration with pregnancy

It is reasonable to register oneself during pregnancy weeks 10-11. During each visit to the gynaecologist urine sample is taken, blood pressure and weight is measured. Since pregnancy week 20 the uterine fundus is also measured and the fetal heartbeat is checked to assess the welfare condition and growth of the fetus. When registering with pregnancy the glucose load test for early detection of gestational diabetes is performed for the pregnant with high risk group endangered of diabetes during pregnancy.

 

Pregnancy weeks 11-14

During pregnancy weeks 11-14 OSCAR test combined with Panorama test is offered, in the course of which the risk of fetal chromosomal diseases and pre-eclampsia of the pregnant are assessed and the fetal growth is checked to detect possible developmental disorders that can be assessed in the given stage of pregnancy. In case of twin pregnancy the number of placentas and the existence of transfusion syndrome risk between twins are assessed. If the fetal chromosomal risk has increased, the pregnant is referred to Tallinn Genetics Centre to the consultation of geneticist to assess the indications of additional invasive tests.

 

Pregnancy weeks 15 - 17

If the risk of neural tube pathology or cardiac diseases was detected for the fetus in OSCAR test, the ultrasound test is performed for excluding the pathology. In case of monochorial twins the ultrasound is performed to assess the existence of transfusion syndrome between twins.

 

Pregnancy weeks 20 - 21

During pregnancy weeks 20-21 the ultrasound screening of the second trimester is made, in the course of which the development of fetal organ systems is examined in detail. Special attention is paid to the assessment of fetal brain and heart structures. The reassessment of pre-eclampsia risk for the assessment of efficiency of prophylactic treatment is made and the pregnancy management plan is prepared for the pregnant who had increased risk for pre-eclampsia in OSCAR test. The vaginal ultrasound for the assessment of the length of cervix and risk of premature birth and need of prophylactic treatment is performed for the pregnant who had higher risk for premature birth in OSCAR test. The fetal heart echocardiography for the thorough assessment of fetal heart is performed for the pregnant with higher risk for the fetal congenital heart failures.

 

Pregnancy weeks 24 - 28

During pregnancy weeks 24-28 the blood test will be taken by specifying also blood sugar. If required, the blood sugar load test is made to exclude the occurrence of diabetes during pregnancy. The rhesus negative women will have repeated test for setting the rhesus antibodies. The pregnancy weeks 26-32 are the best time to come to 3D/4D ultrasound test, as the mimic muscles of the child have already developed, it opens its eyes and shows its face.

 

Pregnancy weeks 28 - 34

During pregnancy weeks 28-34 the blood tests of the second half of pregnancy are taken. The rhesus antibodies are set for the rhesus negative women who have not performed rhesus prophylactics. During pregnancy weeks 30-36 (30-70 days before the expected birth) the insured pregnant is entitled to pregnancy and birth leave. The complaints such as headache, upper stomach pain or vision disorders could be symptoms related to the considerable rise of blood pressure. In case of such complaints in the future one should immediately address gynaecologist or hospital doctor on duty.

 

Pregnancy weeks 35 - 36

During pregnancy weeks 35-36 the ultrasound of the third trimester is made with the aim to assess the position and welfare condition of the fetus. The sample is taken from the vagina for the detection of streptococcus and, if required, other infections, if these occurred at the beginning of pregnancy. Also, the blood test is taken for setting the hemoglobin which could start falling in this period of pregnancy. The occurred pregnancy – related anemia requires treatment. If needed, the doppler scan of the fetus is performed for accurate assessment of the welfare condition of the fetus. In case of premature birth risk the assessment of maturity of fetal lungs is performed for the assessment of starting the dexamethasone treatment. During pregnancy week 36 the assessment for late pre-eclampsia risk for the assessment of birth management plan is offered.

 

Pregnancy weeks 37 - 41

During pregnancy weeks 37-40 the blood test for the detection of anemia is made. The readiness for birth is assessed. If a woman has not given birth by the 41st pregnancy week, the length of the cervix with the help of vaginal ultrasound test is measured and the possibility of spontaneous birth is assessed. If the pregnant has not given birth by the 42nd pregnancy week, she will be referred to the maternity hospital to prepare the cervix and induction of labour.

 

If deviations from the normal course of pregnancy occur: the tests during pregnancy are not good, it is risk pregnancy or the pregnant has some internal disease, the interval for monitoring pregnancy and the plan of tests depend on the specific medical case.

 

In cooperation with the best specialists of the field, the pregnant is referred, if required, to further trials and treatment to the hospital.