Pregnancy care and full diagnostics.

Pregnancy is a unique experience for every woman and scientifically amazing period in human life. The changes that occur in mother's body enabling the development of a new life are unparalleled with any other situation. This period requires special care and supervision due to the developing foetus and hazards connected with, for example, poor nutrition or unhealthy lifestyle. Mothers-to-be often experience the symptoms characteristic of this period such as nausea, heartburn, swelling and constipation. Pregnancy also requires special care and regular check-ups to prevent pregnancy complications such as anaemia, gestational diabetes, or hypertension. We offer full medical care during the pregnancy including all the examinations, from biochemical tests to foetus genetic diagnostics, to all future mothers. Feel invited to come to the comprehensive obstetric consultations, which will save your time and money. In SOFIMED, we will perform all the necessary tests and examinations and you will get professional help.

Recommendations of the Board of the Polish Gynaecological Society concerning antenatal care in the normal course of pregnancy:

NUTRITION

Rational nutrition during pregnancy is an essential factor in proper foetus development and maternal health.
In the female population:

• with pre-pregnancy BMI <19,8 (underweight) weight gain during pregnancy may be 12,5-18 kg
• with pre-pregnancy BMI from 19,8 to 26 (normal weight) weight gain during pregnancy may be 11,5-16 kg
• with pre-pregnancy BMI 26-29 (overweight) weight gain during pregnancy may be 7-11,5 kg
• with pre-pregnancy BMI >29 (obesity) weight gain during pregnancy may be over 7 kg

Daily energy needs of a pregnant woman should be from 2200 to 2500 kcal per day, and during the postpartum period it is 3000 kcal per day.

It is recommended to consume products that are the source of:

• complex carbohydrates (cereal, wholemeal bread, pasta, rice, vegetables)
• fat containing mostly polyunsaturated fatty acids - linoleic acid, linolenic, deoxy-hexane acid (soybean oil, corn, sunflower, olive oil, nuts, saltwater fish)
• proteins, mainly of animal origin (meat and meat products, fish, eggs and dairy products)
• Grain products provide proteins of a lower nutritional value

There is no justification to limit the consumption of salt in your diet if you do not have hypertension. A pregnant woman should consume minimum 2 litres of fluids a day, including about 1 litre of milk.

It is also important to supply a pregnant woman in minerals and vitamins. Insufficient supply of folic acid, iodine, iron and zinc may result in foetal growth disorders. These substances are included in
everyday food, but there are significant differences in their occurrence, for example in areas of iodine deficiency, where it is necessary to use iodized salt. In addition, each pregnant woman in Poland should receive 150-200 mg iodine per day in a pill. From 13 week of pregnancy it is recommended to take 25 mg of iron daily. Additional demand for calcium may be covered by an increased intake of milk and its products made from, so-called, full milk volume which means without removing the whey.

It is recommended to consume 0.4 mg of folic acid a day during preconception period. In women who have previously given birth to a child with neural tube defect the dose should be 4 mg per day. Vitamin-mineral supplementation should be individualized and varied according to dietary habits and belonging to a risk group. There is no scientific evidence to suggest the absolute need for vitamins, minerals and microelements administration to a pregnant woman.

It is important to identify the risk groups which there may be nutritional deficiencies:

• very young pregnant women, or women after a number of consecutive pregnancies in short periods of time
• pregnant women coming from adverse socioeconomic backgrounds
• pregnant women with chronic medical conditions that result in reduced absorption
• pregnant women with deficient body weight and insufficient supply of nutrients
• pregnant women with specific eating habits (vegetarian, vegans, etc)

PHYSICAL ACTIVITY

Nie zalecane:

• hyperthermia - sauna, extreme physical exertion
• activities with considerable risk of injury, such as: skiing, surfing, horseback riding, skating, skating, etc.
• General information: level of physical activity in uncomplicated pregnancy should be subject to reduction!

Taking up the new activities or increasing physical activity during pregnancy is forbidden.

The main risk associated with physical activities is an increase in the risk of preterm delivery!

Moreover, the following risks resulting from excessive physical effort are considered:

• for foetus: abnormal maternal-placental flow, hyperthermia, dehydration, reduction of maternal-foetal exchange and growth disorders
• for mother: trauma, excessive fatigue, fainting, loosening the joints (especially the spine)

PROFESSIONAL ACTIVITY

Particular attention should be paid to the hazards associated with environmental chemical pollution, electromagnetic radiation, noise, handling equipment in motion. In addition, it is not recommended to work in the night hours or longer than 8 hours a day, work that is greatly burdening physically and mentally and the work in one position. It is necessary to draw attention to the patient's ability to change the work post and even removal from the professional activity, if justified by the degree of risk, or the law.

TRAVEL

Probably, travelling while being pregnant has no significant effect on the course of pregnancy. It should be taken into account that in the event of adverse effects of mechanical trauma, the adverse results can be significant to the body of future mother. During the long journey it is necessary to change body position and take short breaks. A negative factor, especially in the case of long journeys may be microtrauma and vibrations. It is not recommended to travel to tropical countries due to the high temperature outside and the possibility of atypical pathogens infection. The patient who is to have a long journey by plane should be advised to use drugs supporting the cardiovascular system (decreasing venous stasis) or a special compression stockings.

When travelling by car it is recommended to wear seat belts!

Pregnant women in the final weeks of pregnancy should be advised to avoid long trips, because of the possibility of giving birth. Before the planned trip after 32 week of pregnancy a patient should make sure that she will be admitted on board of the plane.

SEX LIFE

In the normal course of pregnancy sexual activity is allowed. In the case of infection in the reproductive tract or urinary system, sexual intercourse may increase the risk of miscarriage and premature birth. Sexual activity in the case of: cervical incompetence, placenta praevia, the threat of miscarriage and pre-term labour and multiple pregnancy may involve similar risks.

PROCEEDINGS IN THE CASE OF THE SYMPTOMS ASSOCIATED WITH PREGNANCY

1. Nausea, vomiting, salivation, gastro-intestinal disorders.

Nausea, vomiting, salivation and gastro-intestinal disorders occur as s result of irritation of the autonomic nervous system in about 50% to 70% of pregnant women, mainly in the mornings from 4 week of pregnancy and usually disappear about 14 week of pregnancy. A big impact on their occurrence has an emotional factor.
Treatment: light diet, frequent but small meals, protection of women's emotional state. If needed, the anxiolytic and antihistamines drugs, as well as vitamin B6 are recommended.

2. Heartburn.

Heartburn may concern the whole period of pregnancy. It is the result of irritation of the oesophagus being the consequence of the increase in the pressure inside the stomach and hormonal changes.
Treatment: neutralization of the contents taken into oesophagus, diet: low carbohydrates, soft drinks including carbonated, avoiding greasy food, chocolate and stimulants.

3. Constipation.

Constipation occurs frequently since the beginning of pregnancy and continues until its completion. It is the result of the extension of the gastrointestinal passage because of progesterone, and pelvic floor muscle relaxation.
Treatment: diet high in fibre, large quantities of liquids, reducing of: spices and stimulants (coffee), white bread, potatoes and pasta. Drugs: drugs of plant origin, motility stimulants and emollient laxatives.

4. Swellings.

Swellings appear mainly in the second half of pregnancy. They are generally minor and relate to the lower limbs and hands. They rarely relate to the whole body. The reasons for their occurrence is difficult venous drainage, water and salt excess in the body, but their exact etiology is unknown. They usually subside after night rest.
Treatment: you should rest the lower limbs elevated. In the case of generalized edema, blood pressure and proteinuria should be monitored.

5. Verices and rectal nodules.

Verices, especially in the legs, vulva, and rectal nodules are the result of rectal venous stasis, increased intraabdominal pressure and hormonal factors. These symptoms relate to approximately 25% of pregnant women. Their occurrence increases with age and the number of pregnancies.
Treatment: rest, avoidance of high temperatures, elimination of constipation, compression therapy (elastic stockings), anti-inflammatory, antibacterial and anaesthetic agents.

6. Bleeding in the first weeks of pregnancy.

Several-day spotting may occur during due periods. This is a temporary effect not requiring treatment which should be clarified to all pregnant women.

7. Increased vaginal discharge

Increased vaginal discharge includes cervical mucus secretions and sloughed epithelial cells of the vagina. It is white and gray and is caused by hormonal stimuli. After diagnostics it does not require treatment.

8. Frequent urination.

Hormonal (oestrogen and progesterone) activities cause congestion of the urinary tract and pressure on the bladder by an enlarged uterus. The conditions changed to such a degree irritate the bladder receptors and, in result, pollakiuria occurs. After exclusion of the urinary tract infections, it does not require treatment.

9. Breast pain.

Breast pain is the result of hormonal situation. It requires giving a detailed information to the pregnant woman about the symptoms accompanying the normal course of the pregnancy. In case of persistent pain mild painkillers can be used (paracetamol).

10. Fatigue, irritability, breathlessness symptoms.

Fatigue, irritability and general weakness occur in 40% of pregnant women from the early weeks of pregnancy and last until about 20 week of pregnancy. It does not require treatment beyond psychotherapy and explaining the symptoms of pregnancy to the pregnant women.

11. Back pain.

About 50% of pregnant women in the second half of pregnancy suffer from back pain which is caused by excessive lordosis, pressure of the increasing uterine on the surrounding tissues and hormonal factors (relaxin, oestrogen) Treatment: periodic changes in body position during work. Occasionally, mild painkillers after exclusion of preterm birth risk.

12. Stretch marks.

Stretch marks are caused by the hormonal actions. There is no radical measures eliminating their occurrence.

13. Pregnancy Skin Discoloration.

Discoloration of the face, nipples, perineum and anal area are the result of melanin deposition in these places. There are no preventive methods known. The patients should be informed about the greater sensitivity of skin to sunlight.

MEDICAL CONSULTATIONS AND EXAMINATIONS IN THE NORMAL COURSE OF PREGNANCY

Up to 10 weeks of pregnancy - it is desirable that the first medical consultation took place between 7 and 8 weeks of pregnancy.

1. Compiling patient’s medical history and general examination.
2. Compiled examination and medical speculum examination.
3. Vaginal discharge Ph assessment.
4. Cytology.
5. Blood pressure measurement.
6. Breast examination.
7. Determination of height and weight.
8. Pregnancy risk assessment.
9. Developing a healthy lifestyle.

Obligatory tests:

1. Blood group and Rh tests.
2. Immune antibodies.
3. Blood morphology.
4. Urinalysis.
5. Blood glucose test on an empty stomach.
6. Venereal disease research laboratory test (VDRL)

Recommended tests:

1. Dentist consultation.
2. HIV and HCV tests, testing for toxoplasmosis (IgG and IgM), rubella test.

11 – 14 weeks of pregnancy

1. Compiling patient’s medical history and general examination.
2. Compiled examination and medical speculum examination.
3. Blood pressure measurement.
4. Determination of weight.
5. Pregnancy risk assessment.
6. Developing a healthy lifestyle.

Obligatory tests:

1. Ultrasonography.

Recommended tests:

1. Genetic defects test (double test – PAPP-A+HCG)
2. Urinalysis.

15 – 20 weeks of pregnancy

1. Compiling patient’s medical history and general examination.
2. Compiled examination and medical speculum examination.
3. Vaginal discharge Ph assessment.
4. Blood pressure measurement.
5. Determination of weight.
6. Pregnancy risk assessment.
7. Developing a healthy lifestyle.

Obligatory tests:

1. Blood morphology.
2. Urinalysis.
3. Anti-Rh antibodies.

Recommended tests:

1. Genetic defects test (triple test – HCG, Estriol, AFP)

21 – 26 weeks of pregnancy

1. Compiling patient’s medical history and general examination.
2. Compiled examination and medical speculum examination.
3. Examination of foetus heartbeat.
4. Blood pressure measurement.
5. Vaginal discharge Ph assessment.
6. Determination of weight.
7. Pregnancy risk assessment.
8. Developing a healthy lifestyle.

Obligatory tests:

1. Blood glucose test after oral administration of 75g of glucose (between 24-28 weeks of pregnancy).
2. Ultrasonography.
3. Urinalysis.

Recommended tests:

1. In women with a negative result in the first trimester, the toxoplasmosis test is recommended.

27 – 32 weeks of pregnancy

1. Compiling patient’s medical history and general examination.
2. Compiled examination and medical speculum examination.
3. Examination of foetus heartbeat.
4. Blood pressure measurement.
5. Vaginal discharge Ph assessment.
6. Determination of weight.
7. Pregnancy risk assessment.
8. Preparation for childbirth, postpartum, breastfeeding and parenthood.

Obligatory tests:

1. Blood morphology.
2. Urinalysis.
3. Immune antibodies.
4. Ultrasonography.

• the administration of Rho(D) immune globulin should be recommended to all the women with RH negative without the anti-D antibodies between 28-30 weeks of pregnancy

33 – 37 weeks of pregnancy

1. Compiling patient’s medical history and general examination.
2. Obstetric examination.
3. Pelvis size assessment.
4. Compiled examination and medical speculum examination.
5. Vaginal discharge Ph assessment.
6. Examination of foetus heartbeat.
7. Blood pressure measurement.
8. Breast examination.
9. Determination of weight.

Obligatory tests:

1. Urinalysis.
2. Blond morphology.

Recommended tests:

1. In women with increased population risk or individual infection risk of: VDRL, HIV, HCV.
2. Haemolytic streptococcus culture.

38 – 39 weeks of pregnancy

1. Compiling patient’s medical history and general examination.
2. Obstetric examination.
3. Examination of foetus heartbeat.
4. Blood pressure measurement.
5. Determination of weight.

Badania obowiązkowe:

1. Urinalysis.

After 40 weeks of pregnancy

1. Compiling patient’s medical history and general examination.
2. Obstetric examination.
3. Compiled examination and medical speculum examination.
4. Blood pressure measurement.
5. Determination of weight.

Recommended tests:

1. Ultrasonography with foetus Wright assessment.
2. Cardiotech tomography.

Vaccination in pregnancy

Bacillus Calmette-Guérin (BCG) vaccine*:
Do not administer.
The safety of the vaccine in pregnancy is not stated.

Cholera:
The safety of the vaccine in pregnancy is not stated.

Hepatitis A:
Administer if necessary.
Administered in some cases; consult the use with a doctor.

Hepatitis B:
Administer if necessary.

Influenza:
Administer if necessary.
Administered in some cases; consult the use with a doctor.

Japanese encephalitis**:
Do not administer.
The safety of the vaccine in pregnancy is not stated.

Measles*:
Do not administer.***

Meningococcal infections:
Administer if necessary.
Administer only when the risk of infection is high.

Mumps *:
Do not administer.***

Oral polio vaccine:
Administer if necessary.

Inactivated polio vaccine:
Administer if necessary.
Under normal conditions, should be avoided.

Rabies:
Administer if necessary.

Rubella*:
Do not administer.***

Tetanus, typhoid:
Administer if necessary.
The safety of the vaccine in pregnancy is not stated.

Smallpox:
Do not administer.

Chickenpox*:
Do not administer.

Yellow fever:
Administer if necessary.
Administer only when the risk of infection is high.

* Attenuated vaccine, do not use in pregnancy.
** In contradiction to WHO recommendations, different reports indicate that vaccine is safe in pregnancy and that it can be administered during pregnancy.
*** Avoid to get pregnant for 3 months after vaccination.