1. Ultrasound screening test (at 12-13 weeks):
The examination is the first important examination of developmental disorders during pregnancy.
During the examination, we examine the fetal vital signs, development rate, size, nasal bone, and the thickness of the neck skin fold. However, the result of the occiput measurement alone does not provide a diagnosis, therefore, if the result of the test indicates a chromosomal abnormality, further genetic counseling and tests may be necessary.
The first trimester ultrasound examination covers the following:
General assessment of the fetus:
- fetal dimensions
- development rate, determination of gestational age
- morphological examination of limbs, torso and skull
- amount of amniotic fluid
- placenta location
- looking for abnormalities already visible at this age
Special screening for chromosomal abnormalities:
- neck fold thickness measurement
- nasal bone examination
- various flow measurements
1.1. Combined test (weeks 12-13):
The combined test aims to estimate the risk of the most common chromosomal abnormalities. The method used in the first trimester of pregnancy, which can be performed from the 11th to the 14th week of pregnancy, optimally in the 12th week. Taking into account the parameters that can be measured during the ultrasound examination, the biochemical indicator (marker) values that can be measured in the mother's blood, as well as other parameters (mother's age), it can be used with an average of 92-93% safety.
1.2 NIFTY Test:
The NIFTY™ (Non-Invasive Fetal TrisomY test) test is a simple, safe, highly accurate test that measures the probability of chromosomal abnormalities with more than 99% sensitivity, and the gender of the child can also be determined with the NIFTY™ test.
The test requires only 10 ml of maternal blood sample.
2. Fetal echocardiogram:
During the fetal echocardiogram, in addition to checking the anatomy of the heart, the heart muscle, valves, flow, and heart rhythm are monitored, which can reveal many developmental abnormalities.
3. OGTT (2-point sugar load):
The test is used to screen for gestational diabetes (gestational diabetes). Gestational or gestational diabetes is a condition that develops in the second or third trimester of pregnancy and disappears after the pregnancy. Gestational diabetes usually has no noticeable symptoms. In the vast majority of cases, pregnant women do not even suspect that they are affected until it is revealed during screening.
The examination is carried out on pregnancy 24-28. per week, as part of the so-called OGTT (oral glucose tolerance test, commonly known as sugar load) screening. During the test, after 10 hours of fasting (you must arrive in the morning on an empty stomach), you must consume 75 g of glucose dissolved in a glass of water. The patient's blood sugar level is measured using a venous blood sample before consuming the glucose, and if this is the so-called If the fasting blood sugar level is above 7 mmol/liter, the diagnosis of gestational diabetes can be established - without consuming the sugar solution. If this value is below 7 mmol/liter, it is necessary to drink the sugar solution, followed by a repeated blood sample after 120 minutes. If this time the blood sugar value is 7.8 mmol/liter or above, the diagnosis of gestational diabetes can be made. There is no need for a test to diagnose the disease if the (so-called random) blood sugar value measured at any time is above 11 mmol/l on 2 occasions.
It is important to constantly monitor gestational diabetes, because improper treatment can cause complications for both the mother and the fetus. With proper treatment, the pregnancy can proceed smoothly for both of them. A healthy lifestyle, a diet recommended by your doctor, and regular, light exercise may be enough to suppress the disease. If these do not prove to be sufficient, it is necessary to start insulin treatment.
4. TORCH test:
According to the current professional protocol, this examination is not mandatory. TORCH is an acronym made up of the initial letters of the tested pathogens: Toxoplasma gondii, "Others" (other microbes), Rubeola virus, Cytomegalovirus, Herpes simplex viruses. These are the microorganisms that, if the expectant mother becomes infected during her pregnancy, can make the fetus sick to varying degrees. Based on the results of the tests, the gynecologist can recommend further steps to protect the fetus. According to the current professional protocol, this examination is not mandatory.
5. TSH test as part of a laboratory test:
Thyroid-stimulating hormone, the amount of which differs from the normal level can seriously affect the development of the fetus, so it is important to measure it during pregnancy.
6. Pregnancy toxemia screening:
Gestational toxemia (toxicity of pregnancy) occurring in the second half of pregnancy is characterized by high blood pressure and proteinuria, but the exact cause is not yet known. The exact diagnosis of the disease is made from a sample taken from the mother's blood, by measuring blood pressure and checking the protein content of the urine.
With cardiotocography, i.e. fetal heart rate monitoring, we can primarily check the condition of the fetus and get information about the intensity of uterine pain activity. When the results are represented graphically, we get two curves printed on a paper strip. The curves show whether the placenta supplies the fetus with enough oxygen, i.e. we can also conclude whether the fetus feels good in the womb. If the CTG indicates that there is a problem with the oxygen supply to the fetus, immediate medical intervention may be necessary.
During the examination, two sensors are attached to the mother's abdomen with a soft strap. One of these monitors heart function, and the other monitors uterine activity. The test is completely painless.
8. Ultrasound examination (biometrics, flow measurement) in sections 30-32. week:
The purpose of ultrasound screening tests during pregnancy is to recognize as soon as possible those deviations that affect the course of pregnancy, the health and development of the fetus. The 30-32. the ultrasound examination carried out during the week is aimed at screening for late-onset developmental disorders, fetal biometry is performed to detect growth disorders (growth failure, large fetus), and the amount of amniotic fluid, the position and maturity of the placenta are examined. With the color-coded Doppler flow test (flowmetry), the blood flow of the maternal and certain fetal vessels supplying the pregnant uterus is examined. Its purpose is to assess the condition of the fetus inside the uterus and the functioning of the placenta.
9. Vaginal secretion culture (GBS screening) on 35-36. week:
Group AB Streptococcus (Streptococcus agalactiae) bacteria is carried by 5-25% of pregnant women in their vagina. The presence of the bacterium is important in neonatal infections. Infection of the newborn most often occurs during birth in the birth canal, less often during the mother's pregnancy. In the case of a positive result of the smear taken from the mother's vaginal discharge, the antibiotic therapy used during childbirth protects the newborn from infection, thereby avoiding possible complications.
10. Fibrinogen test on 35-36. week:
Fibrinogen plays an essential role in the blood clotting process. The test helps to find out if your fibrinogen level is adequate to promote normal blood clotting.
11. Antibody screening in 35-36. week:
The fetus developing in the mother's body receives its cells from both the father and the mother, therefore the blood group of the fetus differs from the mother's blood group in many cases. For this reason, the mother will also have foreign parts in the blood of the unborn fetus, so when the mother's body recognizes the different blood group, it produces antibodies against the fetus that is recognized as foreign in her own body. Antibody production is most often associated with childbirth, because during childbirth the blood of the mother and the fetus meet. In rarer cases, it happens that the process already develops during pregnancy, sometimes due to some pregnancy complication, but sometimes without any identifiable reason.
11.1 Blood group incompatibility occurs when the blood group of the mother is Rh-negative, but the blood group of the fetus is Rh-positive.
The antibodies produced can potentially harm the health of the fetus. The antibodies are able to reach the fetus through the placenta and the umbilical cord, where they attack the red blood cells and damage them. The process is called hemolysis, and the disease that develops in the baby is called hemolytic disease of the newborn.
In order to prevent this, in the case of an Rh-positive newborn of an Rh-negative mother, an injection of Anti-D immunoglobulin is given within 72 hours after birth.
Thanks to antibody screening during pregnancy, it can be detected in time if antibodies are produced in the mother's body.
12. Anesthesiology consultation:
Anesthesiology is the branch of medicine that specializes in anaesthesia. His expert is the anesthesiologist, colloquially an anesthesiologist, whose main task is to eliminate and alleviate pain during and after surgical interventions, as well as to control and balance the patient's vital functions. An anesthesiology consultation takes place before planned operations - and in preparation for a caesarean section that may become necessary during childbirth. During this, the doctor examines the patient, as well as laboratory tests, blood pressure measurement, EKG test, but additional tests (e.g. heart ultrasound, respiratory function) may also be necessary. The anesthesiologist learns about the type of surgery planned and reviews in detail previous illnesses, possible surgeries, medications taken by the patient, and the patient's drug sensitivities. The anesthesiologist then selects the most suitable anesthesia method together with the doctor performing the procedure and the patient.
Electrocardiography (ECG for short) is a non-invasive (non-penetrating) diagnostic procedure that provides useful information about the functioning of the heart, examines its electrical phenomena by recording the changes in the electrical voltage generated during the contraction of the heart muscle. During the EKG examination, we can deduce the condition of the heart through the electrical activity of the heart. It can be used to analyze the rhythm of the heart, the place where the stimulus originates, the speed of the impulse conduction, the thickness of the heart muscle, possible blood supply disorders of the heart muscle, and possible pulmonary embolism can be deduced.
13. Epidural pain relief:
Of all the pain-relieving drugs and methods, the spinal techniques (epidural, spinal, combined spinal-epidural anesthesia) can be used to relieve labor pain most effectively. Regional anesthesia is an effective, easy-to-implement method that can be repeated if necessary, and all of this is achieved without interfering with the pregnant woman's state of consciousness, as a result of which the mother can cooperate with her doctor and midwife during the entire delivery.
During epidural anesthesia, medication is administered continuously or repeatedly through an inserted cannula into the epidural space. As a result, a loss of sensation develops in the lower half of the body after about 10-15 minutes. (Epidural anesthesia is often confused with another type of near-spinal anesthesia, called spinal anesthesia, which causes a loss of sensation and movement for about 4-6 hours after a single drug injection.)
Epidural anesthesia should be prepared. During this, the vein is secured, then fluid replacement is performed in the form of an infusion, and the routine monitoring devices are placed, such as the blood pressure monitor, the EKG, and the pulse oximeter that measures the blood oxygen level. Afterwards, the patient is made to sit up, and then the back is washed with disinfectant. If you have this, we will inject a local anesthetic under your skin.
As the next step in the process, a thin plastic cannula is inserted into the epidural space, passing between the vertebral projections. The part of the cannula that is outside the skin is attached to the patient's back with a bandage, and the drug dispensing part is attached to the shoulder. The patient can lie comfortably on the cannula. Due to blocking of the innervation of the bladder (anesthesia also blocks it), spontaneous urination may fail, so in the case of epidural anesthesia, insertion of a bladder catheter is necessary. When the operation is over, the epidural cannula is removed in a single movement.
Epidural anesthesia, including preparation, is a process that takes about 25 minutes.
Cytological examination: a diagnostic procedure during which the gynecologist separates cells from the cervix with a special device, and then these are examined in a laboratory with the help of a microscope, in order to detect pathological changes.
15. HIV test:
A test for the detection of the virus that causes AIDS, which determines the possible existence of the infection from blood or bodily secretions.
16. PKU screening:
Neonatal screening is a special blood test that enables the early detection of 26 metabolic diseases.
17. BCG vaccination:
The BCG vaccine protects infants and young children from purulent meningitis caused by mycobacterium (the causative agent of TB) and from miliary (whole body) TB.
For this reason, babies must receive the BCG vaccine as soon as possible after birth.