The regular examinations during pregnancy are necessary in order to recognize risks of pregnancy at an early stage and treat them if necessary. During the initial examination, the maternity card will be issued for the pregnant women. In this all important examinations and events of the pregnancy are documented. Up to two pregnancies can be entered in a maternity card. The initial examination includes first a detailed conversation between the pregnant woman and the responsible gynecologist. In this conversation, any illnesses of pregnant women and their family environment are addressed. If past pregnancies are also present, they will also be asked about these and possible complications. It then goes into the social circumstances of the pregnant woman and her profession, so that the doctor can assess whether they represent a risk for pregnancy. In many cases, in the course of the initial examination, a consultation of the pregnant women on topics such as nutrition, influenza vaccine and HIV test. In addition, the date of birth is calculated with the help of information from pregnant women and ultrasound.
A detailed gynecological examination should also take place during the initial examination. An assessment of the internal genitalia is made by means of the speculum. In early stages, the doctor may find a bluish discoloration of the vaginal mucosa, which is a sign of pregnancy. In addition, a smear is taken at the end of the speculum setting, which is processed in the laboratory. Among other things, the tissue material for cancer detection and infection with Chlamydia is being investigated. Chlamydia are bacteria and, if not previously treated, can be transmitted to the newborn and cause various infections, such as pneumonia. This is followed by a palpation of the uterus, fallopian tubes and ovaries. In this study, the size, location and consistency of the uterus is assessed. From the 6th week of pregnancy, the uterus can feel enlarged and it seems looser compared to a non-pregnant uterus. Next, the cervix is assessed by palpation. This is important to determine if the cervix has opened prematurely, which would require a quick intervention. During the examination, attention is paid to the length of the cervix and its consistency, among other things.
During the initial examination, certain blood tests are performed. The results or the performance of the tests are recorded in the passport. First the blood type and the rhesus factor of the pregnant women are determined. In Rhesus negative women, there may be a need for so-called Rhesus prophylaxis, so it is important to determine the rhesus factor. Furthermore, a so-called antibody screening test is performed. The antibody screening test is repeated between the 24th and 27th week of gestation. An antibody is a protein that binds to certain surface features of, for example, blood cells. The test is there to determine if there are any antibodies in the pregnant women's blood that could bind to the unborn child's blood cells. At each screening appointment, the hemoglobin content in the blood is also determined. Hemoglobin is the red blood pigment that carries the oxygen in the blood. The hemoglobin content can provide information about whether anemia is present. Low levels should be monitored and the gynecologist should consider whether further diagnostics should be performed to determine the cause of the anemia.
With the help of the blood sample, which is taken during the initial examination, tests are carried out in the laboratory to check for the presence of harmful pathogens. A screening test for the causative agent of syphilis is carried out. In addition, it is determined whether there is adequate immunity to rubella, as infection during pregnancy poses risks to the unborn child. If in the 32nd week of pregnancy there are doubts as to whether there is sufficient immunity to hepatitis B, a protein in the blood, which is located on the surface of the hepatitis B virus, is determined. If the test is positive, the neonate must be vaccinated immediately after birth against this virus. In addition to these prescribed tests, further tests can be carried out. The gynecologist should advise every pregnant woman about an HIV test and document this in the passport. Whether the test is to be performed is decided by the pregnant woman. In pregnant women who have regular contact with cats, it is advisable to carry out a test for toxoplasmosis, as the pathogen can be transmitted to humans via cat feces and also raw meat.
At each check-up appointment body weight is determined and blood pressure is measured. Excessive weight gain may indicate water retention in the legs, as may occur in pre-eclampsia. Pre-eclampsia is a pregnancy-related condition that is associated with high blood pressure and can complicate both pregnancy and the puerperium. For this reason, the blood pressure is also measured regularly, so that hypertension is not overlooked because it can harm the unborn child. In addition, a physical examination is carried out in which, among other things, the height of the upper edge of the uterus is determined. In the 6th week of pregnancy this protrudes straight beyond the pubis. At birth, the upper edge is under the costal arch. From the 20th week of gestation can also be determined with another palpation examination, as the child is in the uterus and on which side is the back. In addition to these specific examinations, a conventional physical examination of the other organ systems is also undertaken. This is ideally done at the initial examination. Furthermore, the physique of the pregnant women is of interest because it can give indications as to whether, for example, there will be difficulty in labor.
In addition to the physical examination, an examination of the urine takes place at each screening appointment. This is examined using a test strip for proteins, glucose, blood components and nitrite. Proteins in the urine may indicate pre-eclampsia, a pregnancy condition with high blood pressure. The proteins in the urine show that there is damage to the kidneys. Glucose, ie a sugar, is then in the urine, when the kidneys are no longer able to adequately filter it because of the high amounts of sugar in the blood. Sugar in the urine could therefore speak for a gestational diabetes and must be confirmed or excluded with further tests. If blood components, such as white or red blood cells, as well as nitrite in the urine, there is a suspicion that there is a urinary tract infection. A urinary tract infection should be treated even if the pregnant woman no complaints are perceived. Before the antibiotic administration, the pathogen should be identified by culturing it in the laboratory, so that a targeted antibiotic administration can take place.
According to the Maternity Guidelines, three ultrasound examinations are planned during pregnancy. The first takes place between the 9th and the 12th week of pregnancy. In this first examination, it is checked whether the embryo is really in the uterus and whether a multiple pregnancy is present. Subsequently, it is examined whether the embryo shows a timely development and whether a heart action is detectable. Lastly, the crown-rump length is measured and the pregnancy duration may be corrected. The second ultrasound examination takes place between the 19th and 22nd week of pregnancy. First, it checks to see if the placenta has a normal fit in the uterus and assesses the amount of amniotic fluid. Thereafter, the sonographic examination of the child takes place. It is again paid attention to the heart action and now also on child movements. Furthermore, the entire body of the unborn child is examined and some measurements are carried out, which may indicate deviations in deviant values. The third ultrasound is performed between the 29th and 32nd week of gestation. Again the placenta is assessed and a proper development of the child is checked. In addition, the weight can be estimated based on measured values.
Doppler sonography is used to visualize and measure blood flow in the vessels. In pregnancy, this examination is used to check the blood supply to the unborn child to detect a condition of deficiency early. In most cases, Doppler sonography is performed in the second half of pregnancy, especially when slower growth or malformation of the child is suspected. Other reasons for carrying out this study include pregnancy hypertension, past failures or fetal deaths, a conspicuous CTG (cardiotocogram) or a multiple pregnancy with non-parallel growth of the children. During the examination, the blood flow is measured in different places, both in the mother and in the child. Flow velocity is measured in the uterine artery of the mother, in the umbilical artery and in one of the unborn baby's cerebral vessels. These measurements can be used to assess whether there is a child shortage.
Cardiotocography (abbreviated CTG) is an ultrasound-based method to measure the fetal heart rate.
At the same time, the labor of the mother is recorded via a pressure gauge ( tokogramm ). A CTG is routinely recorded in the delivery room and at birth.
Other reasons for a CTG examination include:
Maternity Guidelines do not require CTG during the check-up. However, some gynecologists additionally carry out this examination from the 30th week of pregnancy. The CTG can be used to determine whether the unborn baby's heart is beating properly, or perhaps too fast or too slow. Reasons for an increased heart rate are, for example, stress or a deficiency supply of the tissue with oxygen ( hypoxia ).
A lack of oxygen, as well as the vena cava compression syndrome can also lead to a reduced heart rate.
In the curves that the CTG spends, doctors also look for baseline rashes up or down. An upstroke ( acceleration ), ie a brief acceleration of the fetal heart rate, is normal and is triggered by child movements. A downward rash, which corresponds to a deceleration of the heart rate, must be closely monitored and will result in different measures depending on the labor activity.
Prenatal diagnosis includes a number of different invasive and non-invasive examination options that are performed on the pregnant woman and on the fetus. They are to be regarded as additional examinations and are therefore usually not covered by the statutory health insurance. The procedures given here are just a selection of the many possibilities. In the first trimester between about the 12th and the 14th week of pregnancy, a sonographic nuchal translucency measurement can be made. The examination is non-invasive and increased transparency of the neck area may indicate an abnormality of the unborn child. This can be further clarified after a risk assessment by means of an amniocentesis. In amniocentesis, amniotic fluid is taken and an analysis of the child's chromosomes is performed. The triple test is a blood test in which three markers in the mother's blood are determined and an algorithm is used to calculate the risk of a fetal anomaly. In addition, the child's DNA can be filtered from the maternal blood and examined for abnormalities. An invasive method that can be used very early in pregnancy is chorionic villus sampling. In this procedure, tissue is removed from the placenta and subjected to genetic testing.