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Ideally, a couple who is thinking of having a baby should see a doctor or other health care practitioner to discuss whether pregnancy is advisable. Usually, pregnancy is very safe. However, some disorders can become severe during pregnancy. Also, for some couples, the risk of having a baby with a hereditary disorder is increased.
If the couple decides to try to have a baby, they and the doctor discuss ways to make the pregnancy as healthy as possible. The woman should ask the doctor about factors that could impair her health or the health of the developing fetus. Factors or situations to avoid include the following:
Chickenpox and shingles are caused by herpes viruses. During delivery, these viruses can be spread to the fetus and cause severe illness. The virus can also cause pneumonia, which is occasionally severe, in the woman.
Knowing about and dealing with such factors before pregnancy may help reduce the risk of problems during pregnancy (see Pregnancy at High Risk: Risk Factors Present Before Pregnancy). In addition, the woman can discuss her diet and her social, emotional, and medical concerns with the doctor.
When a woman sees a doctor or another health care practitioner before she is pregnant, she can be given any needed vaccines, such as the rubella vaccine. She can also start taking prenatal multivitamins containing folate (folic acid). If needed, genetic screening can be done to determine whether the woman and her partner are at increased risk of having a baby with a hereditary genetic disorder (see Genetic Disorders Detection: Genetic Screening).
First Examination:
After pregnancy is confirmed, the woman should have a physical examination, preferably between 6 and 8 weeks of pregnancy. At this time, the length of the pregnancy can be estimated and the date of delivery can be predicted as accurately as possible.
The first physical examination during pregnancy is very thorough. It includes the following:
Other tests may be done, depending on the woman's situation. If the woman has Rh-negative blood, it is tested for antibodies to the Rh factor (see Pregnancy at High Risk: Rh Incompatibility). Having Rh antibodies can cause severe problems (even death) for a fetus that has Rh-positive blood. If antibodies in a pregnant woman's blood are detected early, the doctor can take measures to protect the fetus.
Women of African descent are tested for sickle cell trait or disease if they have not been tested previously. Skin tests for tuberculosis are advisable for all women. X-rays are not routinely taken during pregnancy, but they can be taken safely when necessary. If an x-ray is required, the fetus is shielded by placing a lead-filled garment over the woman's lower abdomen to cover the uterus.
Follow-up Examinations:
After the first examination, a pregnant woman should see her doctor every 4 weeks until 28 weeks of pregnancy, then every 2 weeks until 36 weeks, then once a week until delivery. At each examination, the woman's weight and blood pressure are usually recorded, and the size of the uterus is noted to determine whether the fetus is growing normally. The heartbeat of the fetus is also checked to determine whether it is normal. The woman's ankles are examined for swelling.
At each visit, urine is tested for sugar. Sugar in the urine may indicate diabetes. If the urine contains sugar, a blood test to check for diabetes is done as soon as possible. This test is also done as soon as possible and preferably prior to 20 weeks for women who
If the initial test is negative, these women should be retested at 26 to 30 weeks. All other women should have a screening blood test for diabetes at around 28 weeks of pregnancy.
At each visit, the urine is also tested for protein. Protein in urine may indicate preeclampsia (a type of high blood pressure that develops during pregnancy (see Pregnancy at High Risk: Preeclampsia).
If women have a high risk of conceiving a baby with a genetic disorder, prenatal diagnostic testing can be done (see Genetic Disorders Detection: Prenatal Diagnostic Testing).
Most doctors believe that ultrasonography, the safest imaging procedure, should be done at least once during a pregnancy to make sure the fetus is normally formed and to verify the expected date of delivery. For the procedure, a device that produces sound waves (transducer) is placed on the woman's abdomen. The sound waves are processed to form an image that is displayed on a monitor. Sometimes, particularly during early pregnancy, the doctor uses an ultrasound device that can be inserted in the vagina. Ultrasonography produces high-quality images, including live-action images that show the fetus in motion. These images provide the doctor with useful information and can reassure a pregnant woman.
Ultrasonography can show the fetus's beating heart at 6 weeks of pregnancy and thus can confirm that the fetus is alive. Doctors may periodically use an ultrasound device to listen to the fetus's heartbeat. Or they may use a stethoscope designed to listen to a fetus's heartbeat (fetoscope). The fetoscope can detect the heartbeat as early as 18 to 20 weeks of pregnancy.
Ultrasonography can also be used to do the following:
Toward the end of pregnancy, ultrasonography may be used to identify premature rupture of the fluid-filled membranes containing the fetus. Ultrasonography can provide information that helps doctors decide whether to perform a cesarean section.
Experts recommend that all pregnant women be vaccinated against the influenza virus during the influenza (flu) season.
Last full review/revision November 2007 by Haywood L. Brown, MD
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