Nutrition and diet 

Registration with a gynecologist in the first weeks of pregnancy. My light, mirror, tell me…. Rights of a pregnant woman under the policy of compulsory health insurance

Shows convincing two stripes, and you, listening carefully to yourself, find at least five more signs of pregnancy. There are so many joyful, pleasant minutes ahead, and there are so many fantasies in my head. But there is still a lot of trouble ahead, the lion's share of which falls on visits to doctors' offices. Of course, going through numerous studies and being tested is not the most pleasant experience. This is especially true for examination on a gynecological chair.

More than once I have witnessed a conversation between future and mature mothers about how many times I had to undergo this examination during pregnancy. Some are proud that it was literally a couple of times, others lament that not a week passed without this procedure. Where is the golden mean? It should be noted right away that we will talk about the tradition of observing pregnant women in the conditions of a domestic antenatal clinic. Ignorance breeds mistrust. Mistrust breeds fear. This article is an attempt to break this vicious circle and answer the main questions. How, when and why a pregnant woman is examined on an armchair.

Getting ready for inspection

Be prepared to be examined on a chair on your first pregnancy visit with a gynecologist. In order for the examination to bring a minimum of discomfort and maximum information about your condition, prepare for it at home. Make up a calendar for yourself in advance, on which you mark approximately the days on which you would have your period if you had not become pregnant. This is not difficult if you have a regular cycle. For these days, do not schedule a visit to the doctor, they are considered dangerous, critical periods for the development of pregnancy. For the same reason, if nothing bothers you, postpone all medical examinations and ultrasounds until the eighth week from the first day of your last menstrual period.

Take a shower or bath and put on fresh underwear before leaving the house. At the same time, you should not wash yourself especially carefully, and even more so, douche, as the doctor must see the state of the vagina in a normal, "everyday" state. Do not use intimate deodorants or perfumes, they often provoke an allergic reaction, which can be regarded by a doctor as inflammation. Should you shave your crotch before going to the doctor? Of course, it is not very convenient for a doctor to examine a woman with excess hair on the external genital organs, but if you usually do not do this, then you should not shave, because this can cause severe skin irritation. Empty your bladder. This is necessary in order to evaluate exactly the sensations of the internal genital organs during the examination, and not a full bladder. The intestines, if possible, should also be empty.
A day before the visit to the doctor, exclude sexual intercourse, since a small amount of semen often remains in the vagina, which interferes with making reliable tests. If you are sitting in line for a long time to the gynecologist - do not be lazy to go to the ladies' room when it’s your turn to empty your bladder.

Think over your clothes. The main thing is that it is comfortable for you, and you can quickly undress from the bottom or free your chest. Bring your socks with you so that, having prepared for the gynecological examination, you do not go to the gynecological chair on the cold floor and your own towel, despite the fact that there will probably be unnecessary pieces of paper in the gynecologist's office. In order not to overload yourself with thoughts about the conscientiousness of sterilizing instruments for examination, purchase a disposable gynecological kit. They are quite inexpensive and are available in most pharmacies. This usually includes a plastic mirror for examining the cervix, it is not as cold as ordinary metal instruments, sterile gloves, special sticks or brushes for taking material for analysis, and a disposable diaper (instead of a towel).

Usually, a gynecological examination is invited after a preliminary conversation, pressure measurement, weighing and examination on the couch. If the office has a separate examination room, leave your shoes in front of the entrance. Ask your doctor or midwife where you can undress, do not attach your clothes to a sterile table or a battery, you may stumble upon a not very friendly nurse. Take your clothes off slowly, the medical staff will fill in the necessary documents during this time. Put on your socks, place the diaper or towel on the chair so that it reaches the edge, but does not hang from it. Climb the steps onto the chair itself and lie on it so that your buttocks are at the very edge of it. Then place your feet on the supports, the slingshots should be in the popliteal fossa. Do not hesitate and do not hesitate to ask the gynecologist how to properly fit in the gynecological chair if this design is unfamiliar to you. Place your hands on your chest and try to calm down and relax. You still have to go through this, the better you relax, the clearer your condition will be to the doctor, the faster the examination will end. Do not try to see everything that the doctor is doing or help (hinder?) The doctor with your hands, this complicates the examination and aggravates the discomfort, it is better to ask the doctor about everything in advance or after the examination.

My light, mirror, tell me ...

The study begins with an examination of the external genital organs: the doctor assesses the condition of the skin and mucous membrane of the perineum, large and small labia, clitoris and external opening of the urethra. At the same time, the inner surfaces of the thighs are also examined, which makes it possible to identify varicose veins, the presence of areas of pigmentation or elements of a rash. The area of ​​the anus must be examined, which allows you to immediately identify the presence of hemorrhoids, cracks and some other violations.

Then the doctor proceeds to the examination in the mirrors. This type of examination is aimed primarily at identifying any diseases of the vagina or the condition of the cervix. Mirrors are of two types: folding and spoon-shaped. The flap mirror is inserted in a closed form, then the flaps are opened, and the cervix becomes accessible for examination. The walls of the vagina are examined with the gradual removal of the speculum from the vagina. When examining with spoon-shaped mirrors, the back (lower) mirror is first driven, it is placed on the back wall of the vagina and slightly pressed on the perineum; then the anterior (upper) mirror is inserted parallel to it, with which the anterior wall of the vagina is raised. Mirror insertion is the most frustrating part of the inspection. In order to make it less painful, it is better to relax and push for the mirror, open up to meet you when you feel that it has touched you. Then it will go in by itself, and you will not even notice it. After inserting the mirror, light is directed onto the cervix and examined. During pregnancy, the cervix is ​​bluish, this is one of the signs of pregnancy. This research method also allows you to identify diseases of the cervix and vagina (inflammation, erosion, polyp, cancer). When examining the cervix, attention is paid to the presence of redness (spots) on the outer surface of the cervix. This is what they say " erosion". Many diseases can be hidden under this sign, but only examination of the cervix using a special microscope - "colposcope" will help to make an accurate diagnosis. Perhaps the doctor will conduct a colposcopy immediately if his office is equipped with this device or appoint another day. In addition, they look at the state of the external os (opening of the cervical canal). The appearance of this hole, even without further investigation, helps to establish a diagnosis of the threat of interruption, even at a very short time. In addition, according to the state of the external pharynx, ischemic-cervical insufficiency... In this case, the canal is slightly open, the shape of the pharynx is often incorrect due to ruptures of the cervix in previous births.

Special attention is paid to the nature of the discharge from the cervix. If the discharge is streaked with blood, this always indicates a possible threat of termination of pregnancy. If the discharge is cloudy or has an unusual odor, it indicates an infection.

What's for analysis?

The first analysis, which is always done when registering for pregnancy, is smear on flora... With a special spoon, the doctor "scoops up" the substance from the cervical canal, vagina, urethra and applies it to the glass. The extracted material is examined in a laboratory under a microscope. This method can detect the inflammatory process (by the number of leukocytes), detect some types of infection (fungal, candidiasis, gonorrhea, trichomoniasis, bacterial vaginosis).
A smear on flora is repeated 3-4 times during pregnancy, even if it was absolutely normal. And this is not accidental, because often during pregnancy, infections "wake up" that did not make themselves felt for a long time. For example, candidiasis (thrush) in pregnant women occurs 2-3 times more often than in the rest. During this period, the woman's body is rebuilt, the level of female sex hormones rises. The vaginal environment becomes more acidic, which is very "to the taste" of candida.
At the same time, hormonal changes in the body lead to a local decrease in cellular immunity and the activity of leukocytes, which also contributes to the increased reproduction of the fungus in the genital tract of the expectant mother. The longer the gestation period, the higher the number of microorganisms, therefore, it is in the last trimester that candidiasis worries expectant mothers especially often. The aggressive environment that forms in the vagina of a pregnant woman suffering from candidiasis, especially with isthmic-cervical insufficiency, can "melt" the lower pole of the fetal bladder and lead to the outpouring of amniotic fluid, which means miscarriage or premature birth.

The second required analysis is cytological examination... In a cytological study, the structural features of the surface cells and the canal of the cervix are studied. A smear for cytological examination is taken with a special instrument - a spatula or a brush. This analysis is very important for detecting various cancers at the earliest stages. And during pregnancy, it is simply necessary, because pregnancy aggravates the course of these diseases. Often, another cytological smear is taken from the fornix of the vagina. This analysis allows you to assess the hormonal status of a woman, to predict the threat of termination of pregnancy or disturbances in the uteroplacental blood flow.

In recent years, in the overwhelming majority of antenatal clinics, pregnant women are examined for sexually transmitted infections ( STI). Most often, these tests are not taken on the first visit, but during a second examination on the chair. The analysis is taken from the cervical and urethra on several glasses or in a test tube, depending on the method for diagnosing infections. If in your antenatal clinic it is not possible to do such an analysis, check with your doctor where you can do it and at what stage of pregnancy it is safe. STIs need to be treated, as primary placental insufficiency can form, which indirectly leads to fetal hypoxia. Thus, the child can die from a lack of oxygen while still in the mother's stomach.

Smart hands

The mirror can finally be removed. It is necessary to push and open up during its removal, then it will pass easily and painlessly. After examination using mirrors, a two-handed vaginal examination is usually performed, which determines the size, position and condition of the uterus, fallopian tubes, and ovaries. First, the doctor opens the labia majora and then gently inserts the index and middle fingers of the right hand into the vagina. The doctor places his left hand on your stomach. Your hands are on your chest, you do not look at the doctor, breathe deeply and calmly. First, the condition of the vagina is assessed: the width of the lumen and the extensibility of the walls, the presence of scars, tumors, septa, and other pathological conditions that can affect the course of pregnancy and childbirth.

Then the doctor finds the cervix and determines its shape, size, consistency, location. So, in a normal pregnancy, the cervix is ​​tilted back, its length is more than two centimeters, it is dense to the touch, and the canal is not passable for the finger. With the threat of termination of pregnancy, the neck is shortened, softened, shifted to the center, the canal opens. It should be noted that an experienced doctor only needs to touch the cervix to evaluate it. The doctor will not specifically examine the patency of the cervical canal during a premature pregnancy, so as not to provoke a miscarriage or premature birth by his actions. A simple touch of the cervix does not provoke a miscarriage; during normal intercourse, the "load" on this organ is ten times higher than during examination. Information about the state of the cervix, obtained by the doctor at the first examination, is a sample for subsequent comparison. After all, every woman is individual. And the fact that for one is a clear sign of the threat of interruption, for the other - the norm.

Next, palpation of the uterus is carried out. The size of the uterus most often exactly corresponds to the gestational age, but it can be larger if a woman suffers from uterine fibroids, is carrying a third or fourth pregnancy, is expecting twins, or less in the case of a combination of pregnancy and some gynecological diseases. In addition to size, the doctor pays attention to the consistency and shape of the uterus. During pregnancy, the uterus is softer than non-pregnant, especially the part of the uterus close to the cervix (the so-called isthmus) softens. Uterine irregularities can be a sign of abnormalities in the development of the uterus or the presence of fibroids. In the short term, the uterus is mobile and occupies an average position in the small pelvis. If its mobility is limited or it is deviated to the side, then more often it is associated with an adhesive process or an inflammatory disease of the uterine appendages.

After examining the uterus, the doctor will definitely check the appendages - the ovaries and fallopian tubes. In the early stages, this is especially important to exclude an ectopic pregnancy. Examination during an ectopic pregnancy is sharply painful. In addition to an ectopic pregnancy, an increase in one of the ovaries is often determined due to the corpus luteum (a formation that provides hormonal support for early pregnancy). This condition requires repeated examination and observation.

At the end of the study, the inner surface of the sacrum, symphysis and the lateral walls of the pelvis is palpated. Feeling the pelvis reveals the deformation of its bones and diagnoses anatomical narrowing of the pelvis. This information will become especially necessary in childbirth.

How often?

Pregnancy is a long process and your condition can change significantly over time. Therefore, the study must be repeated periodically. For example, timely recognition of isthmic-cervical insufficiency is possible only if, during regular visits to the antenatal clinic, the doctor examines the woman on the chair. This condition is painless, it may not affect the state of health in any way. With it, the cervix gradually shortens and opens slightly, the lower pole of the ovum becomes infected, the membranes lose their strength, the amniotic fluid and miscarriage occur. If you have been told such a diagnosis, do not be alarmed, the main thing is to take action in time. The pathology of the cervical canal is "removed" both surgically and conservatively. The doctor will determine which method is right for you. Usually, to monitor the condition of the cervix and analyze a smear for flora, the study is carried out at 20, 28, 32, 36 weeks of pregnancy. This is if nothing bothers you, and the initial examination did not reveal any pathology. The doctor is obliged to see you if you complain of abdominal pain or a change in the nature of the discharge. In addition, after the end of the course of treatment, there should also be a control examination.

The first consultation with a gynecologist if you suspect pregnancy is a responsible event. Readers are interested to know how the first consultation is going. Read about it on the pages of our site.

The timing and purpose of obtaining a consultation

It is advisable to receive a consultation two to four weeks after the delay in the last menstrual period, that is, from 8 to 12 weeks of pregnancy. The consultation is designed to accurately and collect the information that has for further medical monitoring of the course of pregnancy.

He meets the pregnant woman, establishes contact with her, examines the medical history before pregnancy, performs a physical examination, requests all tests and prescribes additional tests. The doctor starts a pregnant woman's card and enters all the data there: the date of the last menstruation, what kind of pregnancy, what kind of childbirth, chronic diseases, etc. This allows the doctor to plan his further actions and predict the course of pregnancy to determine a possible negative situation in which it will be required help.

Physical examination

The first consultation during pregnancy includes a complete physical examination to assess the possible presence of disorders and disorders that may cause complications during pregnancy. For this purpose, the specialist examines the skin, mucous membranes, palpates the abdomen, listens to the heart and lungs. In addition, the doctor conducts a gynecological examination on a gynecological chair using special instruments. The external genitals, the vagina are examined, the uterus is palpated, its size is determined, which allows not only to establish the fact of pregnancy, but also to detect pathologies that can interfere with pregnancy. The doctor also examines the mammary glands of the pregnant woman.

Such a thorough visual examination is necessary to identify risk factors during pregnancy, and in the future, on return visits, such a thorough examination will no longer be necessary.

In conclusion, the gynecologist gives the first advice and recommendations. A woman should take them into account, since the first trimester of pregnancy is key, during which all precautions must be taken for the safety of the fetus - the exclusion of the use of drugs, radiation exposure, a contract with various harmful substances, etc.

Mandatory analyzes when registering

A woman can register for pregnancy not only in her antenatal clinic at the place of residence, but also in any specialized paid medical institution. The list of required analyzes is as follows:

  • , syphilis, hepatitis;
  • general and biochemical blood test;
  • and blood groups;
  • vaginal smear.

If there are indications, the doctor may prescribe additional tests:

  • for urogenital infections;
  • for hormones.

If it turns out that the husband of the pregnant woman has a positive Rh factor, and she herself is negative, she will have to be tested every two weeks for a blood test for antibodies.

The pregnant woman will also need to be examined by narrow specialists.

Pregnancy requires a woman to take maximum responsibility and careful attention to her health. To control the course of pregnancy, in order to avoid possible complications, a specialized gynecologist is called upon, without whose visits a woman cannot do when carrying a baby. Regular examination by a gynecologist during pregnancy is the most important component of a successful pregnancy and subsequent successful childbirth. This means that a woman needs to be prepared "fully armed" for detailed conversations on the topic of well-being and thorough examinations by an obstetrician-gynecologist.

How often should I see my gynecologist during pregnancy?

The frequency of visits to the gynecologist during pregnancy, in the first place, will depend on the indicators of the course of pregnancy. The schedule of appointments with a doctor is always compiled individually, depending on the woman's well-being, on the results of examinations and analyzes. If the pregnancy is proceeding normally and without deviations, after registering the first half of pregnancy, a woman will have to visit a gynecologist once a month. From about 28-29 weeks of pregnancy, visits will become more frequent: from now on, appointments with a doctor should take place every two weeks. And from week 36, weekly visits to the gynecologist are provided.

But this does not mean at all that with each visit to a pregnant woman, an examination in a gynecological chair is shown: this procedure is mandatory on the first "date" and registration, and then 3-4 times during the entire pregnancy. But, again, the schedule of examinations on the chair is strictly individual and can change: everything will depend on the personal indicators of each pregnant woman.

What does a gynecological examination during pregnancy include?

An examination in a gynecological chair is, although an important procedure for diagnosis and control, but not the only one that involves meetings with a doctor. So, if the "internal examination" is provided only a few times during the entire pregnancy, at each meeting the woman will have several other examinations. This is the measurement and measurement of the pulse, weighing, at the first visit also the measurement of the pelvis. From 14-15 weeks of pregnancy, the doctor will also measure the height of the uterus. From the same moment, the specialist will also listen to the baby's heart - from 14-15 weeks, the heartbeat is heard already in an ordinary stethoscope. At each meeting, palpation, or probing, of the abdomen is necessarily carried out in order to determine the tone of the uterus and the location of the fetus. And, of course, according to indications, the doctor will conduct an internal examination several times during pregnancy.

How is the internal examination carried out?

The woman will be invited to the gynecological chair after preliminary weighing and measuring blood pressure, as well as after being examined on the couch. During the examination, do not hesitate and strain - this is a standard procedure that every pregnant woman undergoes. And the freer the woman feels, the easier it will be for the doctor to examine her.

Internal examination takes place in "two stages", so to speak: first, the gynecologist examines the pregnant woman using mirrors, then a manual examination is provided. In any case, it all begins with an assessment of the condition of the external genital organs: skin, perineal mucosa, labia minora and majora, urethra. Also, the doctor will examine the surface of the thighs - for varicose veins, for the same purpose, the area of ​​the anus is examined (in order to timely identify the presence of hemorrhoids, cracks and other disorders).

This is followed by an examination with mirrors: a special device that keeps the vagina open. During this procedure, the doctor assesses the condition of the uterus and determines the absence or presence of vaginal diseases. In addition, the doctor pays attention to the nature of the discharge (bloody is a symptom of a threat of pregnancy, cloudy or with an unpleasant odor indicates an infection), and takes a cytological examination. A smear for flora is taken at each examination on a gynecological chair - and its laboratory study excludes a possible inflammatory process and some infections (candidiasis, trichomoniasis, gonorrhea). A smear for cytology, as a rule, is taken at the beginning and at the end of pregnancy, the main task of this study is to study the structural features of the surface cells and the canal of the cervix.

After examination with mirrors, a so-called two-handed vaginal examination is also provided: the gynecologist inserts the middle and index of the right hand into the vagina, and puts the left hand on the pregnant woman's stomach. During a two-handed examination, the state of the vagina, the cervix (shape, size, consistency, location), the uterus itself (shape and consistency, correspondence of the size to the gestational age) are examined. Also, the doctor examines the appendages (ovaries and fallopian tubes), and at the end of the examination - the inner surface of the sacrum, pubic symphysis and the lateral walls of the pelvis.

Preparing for the examination on the chair

With the onset of pregnancy, it is advisable to have a special calendar for yourself: to mark the days on which there was menstruation before the onset of pregnancy. The fact is that on such days it is undesirable to conduct an internal examination - they are considered dangerous, critical periods for pregnancy.

Knowing about the upcoming vaginal examination, you should definitely take a shower on the eve of going to the consultation. At the same time, doctors do not recommend washing with soap or douching. The day before the vaginal examination, sexual contact should be excluded - the remnants of semen can interfere with an adequate assessment of the vaginal microflora. Before going to the gynecological chair, it is also necessary to empty the bladder and intestines: even if you have to wait a long time for your turn at the gynecologist's office, it is better to go to the toilet again. Well, and definitely, going for an examination, you should purchase an individual kit for a gynecological examination - such kits are sold today in every pharmacy and do not cost a lot of money.

Specially for Tatiana Argamakova

In all national health systems, great attention is paid to women's health, on which both the demographic situation and, in many respects, the politics and economy of each country depend. A woman becomes especially vulnerable during pregnancy and breastfeeding. The World Health Organization pays great attention to healthy pregnancy and lactation.

Constantly acquaints the general public with new achievements in this area. However, for many thousands of years of human existence, the course of pregnancy has not changed, although today the most modern knowledge and new diagnostic technologies are available for expectant mothers.

Routine check-ups in early and late pregnancy: check-ups by week

A normal pregnancy lasts 280 days, or 40 weeks from the first day of the last menstrual bleeding. During the entire time of carrying a child, a doctor should monitor the pregnancy, therefore it is very important for a pregnant woman to register with an antenatal clinic on time, pass all the necessary tests and tests and regularly visit the attending physician in accordance with an individual schedule.

All studies that are carried out at the beginning of pregnancy will need to be repeated several times during the gestation period, since the condition of the expectant mother during pregnancy and as the fetus develops and grows inevitably changes. An important task of regular examinations by a gynecologist is to avoid some complications of pregnancy and / or their timely prevention.

During regular scheduled examinations of a pregnant woman, it is possible to identify isthmic-cervical insufficiency, which does not make itself felt in any way, but can pose a serious danger to maintaining pregnancy. The fact is that with isthmic-cervical insufficiency, the cervix for various reasons begins to gradually shorten and open slightly, which entails a high probability of infection of the ovum.

As a result of infection, the membranes, which hold both the fetus and the amniotic fluid, become thinner and lose their strength, as a result of which they can no longer perform their functions, therefore the membranes rupture, the amniotic fluid (amniotic fluid) is poured out and spontaneous abortion occurs, that is miscarriage - the pregnancy ends.

Isthmic-cervical insufficiency does not necessarily lead to serious consequences, since modern medicine is able to correct this pathology - pregnancy can be saved if the necessary measures are taken on time.

Attention! To avoid the danger of spontaneous abortion, a woman should visit a doctor in a timely and regular manner, take all the necessary tests and tests, and also undergo all the necessary studies.

  • The first visit to the gynecologist is recommended for a period of 6-8 weeks. During this visit, the obstetrician-gynecologist conducts an examination and initial examination and makes a smear to determine the flora, as well as for cytological examination. During the same period, the pregnant woman must pass a general urine test, blood tests for RW, HIV, HbS, HCV, as well as blood to determine the group and Rh status of the blood. In addition, at the same time, the pregnant woman undergoes a general blood test, an analysis for blood sugar, a biochemical blood test and a coagulogram.

At the same time, the presence / absence of TORCH infections (toxoplasmosis, rubella, herpes and cytomegalovirus infection) is determined, which can provoke intrauterine infection of fetal systems and organs with a high risk of congenital malformations and malformations, increase the risk of spontaneous abortion (miscarriage), as well as the risk stillbirth.

  • The next visit to the gynecologist is scheduled for 10 weeks. In addition to being examined by a gynecologist, a pregnant woman should consult with narrow specialists, including an endocrinologist, therapist, otolaryngologist and ophthalmologist. If necessary, other consultations can be appointed.

At this time, it is necessary to control the indicators of a general urine test and a general blood test. Also at this time, a so-called double test is done, which includes the PAPP test (cellular changes in the cervix that can lead to cancer) and the hCG test (human chorionic gonadotropin hormone).

  • At 12 weeks of pregnancy, the next compulsory visit to the doctor is planned.

At this time, in addition to examination by an obstetrician-gynecologist and urinalysis, an ultrasound examination is planned to make sure that the child is developing normally and nothing threatens him.

  • If the pregnancy develops normally and the results of all analyzes and tests do not cause any concern, then the next visit to the doctor is scheduled in four weeks, that is, at the 16th week, when the first trimester of pregnancy is already over.

During this visit, the gynecologist conducts the necessary examination, measures the abdominal circumference, controls weight and blood pressure. If the pregnancy develops normally and does not cause any concern, then of all the tests and analyzes, only urine analysis is taken.

  • After two weeks, that is, for a period of 18 weeks, another visit to the doctor will be required. At this time, some women already feel the fetal movement, although others will feel it a little later.

In addition to the examination by a gynecologist, during this visit you will need to pass a urine test and blood tests - general and to determine AFP (alpha-fetoprotein) + (human chorionic gonadotropin) + the level of unbound estriol - the so-called triple test, which allows you to identify many developmental pathologies fetal growth, including Down syndrome, trisomy 18, fetal growth retardation and even fetal death. During the same period, the pregnant woman is offered to undergo genetic counseling.

  • At a period of 20 weeks (and this is just the middle of a normally developing pregnancy), the next visit to a gynecologist is necessary.

In addition to the usual examination and measurement of blood pressure and weight, the pregnant woman will need to pass a general urine test.

  • Within two weeks, at 22 weeks, the pregnant woman will have to visit her doctor again.

It is very important that, in addition to the usual examination and general analysis of urine, ultrasound and Doppler ultrasound (Doppler study of blood flow in the placenta) are performed at this time.

  • In the second half of pregnancy, gynecological examinations become a little more frequent. The next time to see the doctor should be at the 24th week.

At this time, in addition to the standard examination by a gynecologist, you will need to pass a general urine test and a general blood test.

  • At 26 weeks after the examination, the pregnant woman must pass a general urine test.
  • Two weeks later, at 28 weeks, the gynecologist again examines the expectant mother, who, after the examination, must pass a general urine test and a general blood test.
  • At a period of 30 weeks, when the last trimester of pregnancy began, in addition to the usual examination by an obstetrician-gynecologist, you will need to donate blood and blood to determine dangerous infections: RW, HIV, HbS, HCV.

In addition, an ophthalmologist consultation is planned at the same time.

  • In the third trimester of pregnancy, visits to the doctor become more intense with various studies, since it is very important to know how the fetus is feeling and how ready it is for birth. During the visit at 32 weeks after the doctor's examination, the pregnant woman must pass a general urine test and a general blood test.

In addition, ultrasound examination (ultrasound) with fetometry and Doppler blood flow of the placenta are carried out in the same week.

  • The next visit to the obstetrician-gynecologist is planned for a period of 34 weeks

During this visit, in addition to examination and general analysis of urine, fetal cardiotocography is planned.

  • The 36th week visit is going to be quite eventful. During the examination and examination, the gynecologist must take a vaginal smear on the flora.

In addition, the pregnant woman undergoes a general urine test and a general blood test, as well as a blood test for hemolysins and again a blood test for RW, HIV, HbS, HCV.

At the 36th week, the woman's sensitivity to various antibacterial drugs is necessarily clarified in order to avoid any surprises during childbirth.

If the pregnancy develops normally, then at this time the doctor determines whether the cervix is ​​ready for labor. If the pregnancy is considered full-term, then the doctor determines the presentation of the fetus, that is, how the child is located - upside down or downside down. In breech presentation, the obstetrician will try to turn the fetus into the correct position. For successful childbirth, presentation of the fetus is quite important.

  • A very responsible visit to the doctor at the 38th week, when the fetus is almost ripe and is considered quite viable, that is, the child can be born.

In addition to the usual examination and general analysis of urine, a pregnant woman should visit a general practitioner and take a vaginal smear for flora. In the same week, it is necessary to do a fetal cardiotocography.

  • The last week of pregnancy is considered to be the 40th week. In addition to the mandatory examination, in order to find out the readiness of the body for childbirth, the pregnant woman takes a general urine test. In addition, a fetal ultrasound scan may be ordered for the pregnant woman if the doctor wants to make sure that the pregnancy ends normally.

By this time, the cervix becomes shorter, but it stretches more and more, and the cervical canal is located exactly in the center.

If labor does not begin after the 41st week, then the pregnant woman is hospitalized to stimulate labor.

Attention! Each pregnancy develops uniquely and has its own characteristics, therefore, as the pregnancy develops, some changes can be made to the standard observation calendar that will allow you to effectively monitor the condition of the mother and fetus and ensure the timely birth of a healthy baby.

Every woman should remember the importance of timely visits to a gynecologist, especially if there is a reason to think about pregnancy. First of all, it is very important to get up on time so that the doctor can start monitoring the development of pregnancy as early as possible. In addition, gynecological examinations at very early stages of pregnancy make it possible to diagnose many unwanted and sometimes dangerous pathological conditions as early as possible, including ectopic pregnancy.

A visit to a gynecologist about a possible pregnancy provides for a detailed conversation about the health status of the expectant mother, about past illnesses, about possible chronic diseases and about any hereditary pathologies - all this information will help the doctor draw up the most accurate observation plan during pregnancy.

During pregnancy, during the first visit, the doctor will necessarily measure the height and check the woman's weight so that in the future it is possible to observe how the body mass indicator changes, which may indicate the normal development of pregnancy or the presence of some deviations.

A gynecological chair is a special medical furniture in which it is convenient to carry out both external and internal examination of a woman, who takes the most comfortable position for herself and for the doctor. After the woman has taken a seat in the gynecological chair, the doctor begins the gynecological examination.

First, the gynecologist carefully examines the external genital organs of a woman in order to find out the condition of the skin and the condition of the mucous membranes. Particular attention is paid to the examination of the labia majora; small labia; clitoris and urethra, perineum, and inner thighs. With such a visual examination, it is possible to detect vein pathologies, pigmentation, skin rashes. When examining the area of ​​the anus (anus), anal fissures, if any, and hemorrhoids (if any) are immediately revealed.

After the external examination is completed, the gynecologist proceeds to the internal examination. A vaginal speculum is used for internal examination. In fact, there are several varieties of this instrument, but they are all designed to painlessly and reliably expand the opening of the vagina. A gynecological examination using vaginal speculum allows you to find out the condition of the cervix and identify any diseases of the vagina.

Since all women are different and the internal sizes of their genitals are also different, then in gynecological practice mirrors of different sizes are used - from XS to L:

  • For a XS-size vaginal speculum, the inner diameter is 14 mm, the leaf length is 70 mm;
  • For a vaginal speculum of size S, the inner diameter is 23 mm, the length of the flaps is 75 mm;
  • For a vaginal speculum of size M, the inner diameter is 25 mm, the length of the flaps is 85 mm;
  • For a vaginal speculum of size L, the inner diameter is 30 mm, the length of the flaps is 90 mm.

In addition, gynecological mirrors can have different shapes - they can be folded and spoon-shaped. In each case, the doctor chooses for examination exactly the mirror that will be most convenient for a particular woman.

When examining the vagina with the help of a folding mirror, a closed mirror is first inserted into the vagina, and only then the shutters are pulled apart so that it is possible to examine the cervix. When removing the speculum, the walls of the vagina are examined.

If the doctor decided that in a particular case it is better to use spoon-shaped mirrors, then first the lower (back) mirror is inserted, which is located on the back wall of the vagina, slightly pressing on the perineum. Then the upper (front) mirror is inserted, with the help of which the anterior wall of the vagina rises.

Attention! When inserting a speculum of any type into the vagina, it is very important not to strain or pinch the muscles - at this moment it is necessary to completely relax.

After a gynecological speculum of any type is installed, light is directed into the vagina onto the cervix of the uterus (sometimes bright daylight is enough).

On examination, the doctor can almost immediately notice a visually noticeable cyanosis of the cervix, which is almost always considered one of the indirect signs of pregnancy.

In addition, when examined with a vaginal speculum, the doctor can detect inflammation, erosion, the presence of polyps and the presence of any neoplasms, including malignant ones.

Erosion of the cervix looks like redness and spots on its outer surface, but other diseases can look like this. For an accurate diagnosis, an additional study may be needed, which is called a colposcopy.

When examining the cervix, the doctor carefully examines the external os of the cervix (opening of the cervical canal). By the appearance of the cervical canal, the doctor can determine the threat of spontaneous abortion, even at very short periods. In addition, the appearance of the external os of the cervical canal allows one to determine isthmic-cervical insufficiency - the pharynx is partially open and often has an irregular shape.

During a vaginal examination, the gynecologist must determine the nature of the discharge from the cervical canal of the uterus:

  • If the discharge has (streaks of blood), then this should alert, because in this case, one should beware of spontaneous abortion (miscarriage);
  • If the cervical discharge is not transparent, but cloudy and has a specific unpleasant odor, then this is one of the signs of an infectious process caused by viruses, bacteria or protozoa. To identify the cause of the infection, it is necessary to do laboratory tests of the secretions, including the polymerase chain reaction method or other methods. It is very important to obtain reliable information at the very beginning of pregnancy in order to take the necessary measures for the safe development of the fetus.

How to Prepare for a Chair Exam?

A visit to a gynecologist includes an examination in a gynecological chair. A modern gynecological chair is the most convenient way of high-quality, efficient and maximally gentle internal examination of a pregnant woman. A gynecological examination, which is carried out in a gynecological chair, is completely safe, but at the same time very informative - a doctor with such an examination can obtain the maximum amount of necessary and completely objective information about the condition of the pregnant woman and the fetus.

To make the medical examination in the gynecological chair as comfortable as possible and not cause any awkwardness, and also for its maximum information content, some rules for preparing for a gynecological examination during the period of gestation should be followed.

It is very important that the expectant mother does not stop keeping a special calendar, in which, before pregnancy, the days of the onset of menstrual bleeding and all days of menstrual bleeding are marked.

After the onset of pregnancy, menstrual bleeding stops, since the hormonal background of the female body has changed and ovulation does not occur, that is, the egg does not leave the ovary, but the hormonal cycle does not disappear completely without a trace - the days on which menstrual bleeding could presumably begin can be dangerous for anyone external interference in the female reproductive system.

To prevent spontaneous abortion of pregnancy, it is extremely undesirable to conduct an internal examination on a gynecological chair on such days, because it is on these days that there are most spontaneous abortions of pregnancy, that is, miscarriages.

Hygiene procedures before visiting a gynecologist are required. However, it is very important to limit yourself to a regular shower.

Before visiting a gynecologist, washing the external genitals with soap and, moreover, douching is categorically not recommended, since in this way the entire vaginal flora will be washed and destroyed for several hours. Thus, the doctor will not be able to take a vaginal swab to determine the presence of inflammation and / or any infections.

It should be understood that the destruction of any infectious agents in this way is impossible - they will still remain, however, the doctor will not get an objective picture, which may turn out to be dangerous both for the health of the pregnant woman and for the health of the fetus.

It is very important to refrain from sexual intercourse at least a day before the gynecological examination, and both open sex and protected sex (that is, using a condom) are undesirable.

The fact is that for an adequate assessment of the state of the vaginal microflora, seminal fluid, even in residues, will be a significant obstacle. As for protected sexual intercourse (meaning the use of a condom), in which semen does not enter the woman's genital tract, during intercourse, special lubricant and special mucus are still produced in the woman's genital tract - and they can also distort the analysis results.

Before the examination in the gynecological chair, it is necessary to visit the toilet - except for certain cases, which the doctor stipulates separately, the visit to the gynecologist must be carried out with an empty bowel and bladder.


The fact is that when examined in a gynecological chair, the doctor presses the abdominal wall in both the bladder and intestines, which can stimulate the separation of urine and / or feces.

For a visit to a gynecologist, you can purchase an individual gynecological kit, which contains both a mirror and a disposable diaper that can be placed on a chair.


However, the entire instrument in gynecological offices is always thoroughly sterilized, so it poses no danger. As for the advisability of buying a disposable sterile kit, it is better to clarify this issue with a doctor - not all gynecologists like to work with plastic equipment.

As for the disposable diaper, this is optional, although desirable. Instead of a disposable diaper, you can use any small towel, which you can simply wash later. In addition, for the same purposes (so that a woman can sit on the surface of a gynecological chair without fear), disposable multi-layer towels are used.

When planning a visit to a gynecologist, it is better to take thin cotton socks with you - it will be more convenient to walk to the chair in them.

As for clothing, clothing should be as comfortable as possible. First, for a gynecological examination in a chair, you will have to remove all clothing below the waist. Secondly, in order for the doctor to see and examine the breasts, you will have to take off your clothes above the waist. So the dress in this case will not be the best choice.

Attention! If, before or during the examination, a pregnant woman has any questions or becomes uncomfortable and / or unpleasant, she should immediately inform the doctor about it.

Continuation of a series of articles.

As soon as a girl begins to have sex life, she should consult a gynecologist annually for preventive purposes. But few of us do this, and for sure none of us likes this procedure. Meanwhile, with the onset of pregnancy, it is mandatory, and neglect of such a visit to the clinic can end in tears. Therefore, the expectant mother herself should be interested in registering on time and diligently visiting the gynecologist, how many times it will be required.

The first examination by a gynecologist during pregnancy

In the first weeks of pregnancy, all women have different "relationships" with doctors. Most of us, on our own initiative, go for an ultrasound scan to confirm our assumptions after a home test. But some immediately go to the gynecologist, and this is a good decision (however, it is best to visit the doctor closer to the eighth week from the date of the last menstruation). An experienced doctor, even without equipment, will be able to diagnose the presence of an ovum in the uterus, as well as assess the state of the reproductive system and the health of the expectant mother as a whole. He will direct the patient to an ultrasound scan, indicating exactly when it is better to do it, and will tell you when to come to him again, what to register (this must be done no later than 12 weeks of the period). If the terms already allow, then the first visit to the gynecologist and registration can occur simultaneously. Therefore, it will be useful to take your passport with you.

During such a meeting, the doctor will certainly be interested in many facts from your past and present life, in particular, regarding the state of your (and your close relatives) health, the presence of chronic diseases and bad habits, the number of sexual partners and pregnancies, and he will definitely specify which some of them ended in interruption, and some ended in childbirth. It is extremely important to provide the doctor with the most reliable information, because all these facts can significantly affect the course and outcome of this pregnancy. The date of the patient's last monthly period will help determine the approximate gestational age and the expected date of delivery.

To get more information and see a broader diagnostic picture, the doctor will send the newly baked pregnant woman for additional examinations, the obligatory of which are blood and urine tests, consultation with a surgeon, ophthalmologist, dentist, therapist. In the future, according to the results of these examinations, there may be a need for additional: the more extensively a woman is examined with the pathologies identified in her, the greater the chances of bearing and giving birth to a healthy baby, therefore, such "adventures" among doctors should be taken with all seriousness and understanding.

During the first visit to the gynecologist, he examines the patient on the couch (assessing the location, size and condition of the uterus), measures her height and weight, blood pressure and pulse, pelvic size. A gynecological examination on a chair is also mandatory, during which smears will be taken for research: a smear on the flora (which allows you to identify some genital infections) and a cytological smear (which examines the state of cells for the presence of oncological and other pathological changes). To do this, when going to the doctor, you must bring with you a set for a gynecological examination, which is sold in any pharmacy.

Thus, already the first visit to a gynecologist is able to reveal a number of pathological conditions that threaten pregnancy: increased uterine tone and the threat of miscarriage, inflammation in the genitals, erosion, fibroids, polyps, infectious diseases (vaginosis, gonorrhea, trichomoniasis, thrush, etc.) ), isthmic-cervical insufficiency, etc.

How is an examination by a gynecologist on a chair in the early stages of pregnancy

Of course, there is nothing pleasant about such manipulation, but if you approach the issue calmly and rationally, then you can go through it absolutely normally.

First, a woman's genital tract is examined using a gynecological speculum inserted into the vagina. At this point, try to completely relax (folding your arms over your chest): this will allow the doctor to perform the manipulation as efficiently and painlessly as possible. Do not be too active during the examination, do not turn around and do not distract the doctor: it is better to ask all the questions you are interested in immediately after the end of the manipulation (or even before it starts).

After examining the mucous membranes and tissues of the cervix and vagina in the mirrors, the doctor will draw a conclusion about their condition and, if necessary, prescribe a colposcopy for the patient (if modified cells are found on the cervix) or perform it immediately, if such an apparatus is at his fingertips. Then the gynecologist performs a finger examination of the vagina, examining it with the fingers of one hand, and probing with the other from the outside, through the abdominal wall.

Many women are worried if such an examination by a gynecologist is not dangerous and not harmful to the chair, because the ovum is still very tiny and vulnerable. But in reality it is nothing dangerous (obstetricians compare that the effect on the cervix during intercourse is much more intense). Moreover, sometimes, making an examination on a chair, a gynecologist can determine an ectopic pregnancy, which is extremely important.

During a gynecological examination, the condition of the genitals of the expectant mother and the external surfaces adjacent to the vagina is assessed:

  • anatomy (structure) of the genital organs;
  • size, consistency and location of the cervix;
  • the state of the external os (canal opening) of the cervix;
  • condition of the mucous membranes of the vagina;
  • the nature of the mucous discharge;
  • location and condition of the fallopian tubes, ovaries, uterus;
  • type and condition of the external opening of the urethra, clitoris, labia;
  • the condition of the skin of the perineum and inner thighs (to assess the likelihood of varicose veins, detect a rash or irritation);
  • the condition of the anus (for the presence or predisposition to the appearance of hemorrhoids or cracks);
  • the size and condition of the bones of the pelvis, pubis, sacrum.

All these data are of great importance for the management of the current pregnancy. After all, any deviations in the state of the mother's health (varicose veins, hemorrhoids, genital infections and other inflammatory processes, the anatomical features of the structure of the genitals) can interfere with the normal development and birth of the unborn child.

Therefore, such an inspection should in no case be neglected. Moreover, during the entire period of gestation, it will have to be repeated several times, since the state of a woman's body can change under the influence of hormonal fluctuations and suppression of the immune system.

In addition, you should properly prepare for a gynecological examination so that its results are as informative and reliable as possible:

· Take a hygienic shower (but without the use of cosmetic hygiene products).

· Exclude sexual intercourse the day before the visit to the clinic.

· Empty the bowels and bladder before the examination (that is, it will not be superfluous to go to the toilet before entering the doctor's office, especially if you had to wait in line).

Examination by a gynecologist in late pregnancy

Closer to the 16th week and further, the gynecologist during each of your visits will additionally measure the height of the fundus of the uterus, abdominal circumference and listen to the fetal heartbeat with a stethoscope. Such studies will help him draw conclusions about the well-being of the development of the baby and the state of health of the mother herself. It is imperative that blood pressure is measured and weighed so as not to miss the onset of gestosis (a serious and dangerous condition that develops in the second half of pregnancy).

Closer to the 28-29th week, you will need to see a doctor every 2 weeks, and after the 36th - every week. Moreover, shortly before the expected date of birth, a woman must again undergo an examination on a chair so that the doctor can assess the readiness of the birth canal for the child to pass through it. Typically, this examination is carried out at 36 weeks. The doctor assesses the estimated size of the baby (in particular, its head), their correspondence to the pelvic ring, determines the location of the fetus in the uterus and the method of future childbirth, the readiness of the cervix for them (as the date of birth approaches, it begins to shorten and soften), and also takes a smear again on the flora.

If necessary, sanitation is performed - that is, preparation of the birth canal (it includes anti-inflammatory, antifungal or antibacterial therapy if infection is detected).

How often a gynecologist's examination is required during pregnancy: visit schedule

From the moment of registration, you will have to visit a gynecologist approximately once a month, and each time you will need to go to him with the result of a fresh urine test. But the examination of the gynecologist on the chair during pregnancy is not carried out every time: if there are no violations, no pathologies have been identified, then for the entire period of gestation, it will be necessary to lie down in the gynecological chair 3-4 times, and each time the doctor will re-take a smear on the flora, since it is capable change (now many factors are joining that can cause pathological processes in the genital tract of the expectant mother).

Obstetricians do not recommend performing gynecological examinations on days when you had your period before pregnancy, because these periods are considered dangerous. It happens that after examining on a chair, a woman has a stomach ache or pulls the lower abdomen, sometimes even smears. There is nothing dangerous in such consequences if they are quickly passing (this happens from micro-damage to blood vessels and cells that occurs when the speculum is inserted into the vagina). But if, after examining the gynecologist, blood has gone, the spotting does not disappear after a day or (even more dangerous) intensifies, then it is necessary to urgently call the doctor or go to the hospital.

In general, how many times a gynecologist's examination on a chair during pregnancy will be needed depends largely on its course. This schedule is individual. It is not worth diminishing the importance of such examinations: this simple and affordable method allows you to timely identify and prevent a number of pathologies that negatively affect the course of pregnancy. This is a preventative measure, but it can also be curative. When undergoing treatment for some painful condition, an additional examination on the chair may be required at the end of it - for control.

However, we wish you only good medical reports!

Especially for - Ekaterina Vlasenko