Signs of pregnancy. The first visit to an obstetrician-gynecologist during pregnancy. Compulsory health insurance policy. The right to be admitted to a specialized maternity hospital

It is best to contact an antenatal clinic for registration at a gestational age of 6–8 weeks. For registration, you need to present a passport and a compulsory health insurance policy (MHI). By the way, with early registration (up to 12 weeks), a lump sum is entitled to. In the normal course of pregnancy, it is recommended to visit a gynecologist at least seven times during the entire period of gestation. In the first trimester - once a month, in the second trimester - once every 2-3 weeks, from week 36 to childbirth - once a week. Also, during pregnancy, it will be necessary to undergo three screening ultrasound examinations: at 11-14 weeks, 18-21 weeks and 30-34 weeks.

At the first appointment, the obstetrician-gynecologist examines the woman, confirms the fact of pregnancy, assesses the condition of the walls of the vagina and cervix. The doctor also measures the weight, height, blood pressure and pelvic size of the expectant mother - in the future, these parameters will be recorded at each examination. In addition, the doctor fills out the necessary documents, gives recommendations on nutrition and taking vitamins, prescribes referrals for tests and other specialists.

A smear on flora during pregnancy. The doctor must take a smear for flora and cytology for microscopic examination. Repeated smear on flora during pregnancy is taken at the 30th and 36th week. The analysis allows you to determine the development of the inflammatory process, to identify infections. For any deviations from the norm, additional studies are prescribed, for example, a test for sexually transmitted diseases (STDs). If they are found, the doctor decides on the appropriateness of treatment. Some infections pose a danger to the normal development of the fetus, can lead to the appearance of chromosomal abnormalities, damage to the placenta and various organs of the child - it makes sense to treat them. Of the medications, topical agents that do not contain antibiotics (suppositories, creams) are most often used; starting in the second trimester of pregnancy, your doctor may prescribe antibacterial drugs.

General analysis of urine during pregnancy. Allows you to quickly assess the general health of a pregnant woman and the work of her kidneys. In the future, it is carried out at each visit to the doctor during the entire period of bearing the child. You need to collect urine in a special plastic container (you can buy them at the pharmacy) in the morning, immediately after waking up. At night, the kidneys work more actively, as a result, the urine becomes more concentrated - this allows for more accurate diagnosis.

Normal urine should be light yellow and almost clear. Dark, cloudy urine is a sure sign of abnormalities in the body. This can be, for example, diseases of the kidneys, organs of the genitourinary system, the development of infections or diabetes, and much more. More precisely, the doctor will be able to determine what is wrong after studying the results of the urine test. According to changes in some indicators, one can suspect the development of gestational pyelonephritis (an infectious inflammation of the kidneys, often occurring in pregnant women due to obstructed outflow of urine) or gestosis (a complication of pregnancy, which is manifested by increased pressure, edema and the appearance of protein in the urine). Thus, a regular urine test allows you to timely track the occurrence of many serious diseases and begin their treatment.

General (clinical) blood test during pregnancy. One of the most informative analyzes, along with urine analysis, allows you to assess the state of a woman's health as a whole, indicates the presence of problems in the work of certain body systems. A blood test during pregnancy is taken three times: when registering and then in each trimester (at 18 and 30 weeks), and more often if necessary. This allows the doctor leading the pregnancy to monitor the dynamics of the patient's condition and monitor important indicators. According to the results of a clinical blood test during pregnancy, the number of leukocytes, platelets, hemoglobin is determined, ESR and other indicators are assessed. For example, a high level of white blood cells and neutrophils indicates that an inflammatory process is taking place in the body. A low level of hemoglobin indicates an iron deficiency in the body and the likelihood of developing anemia. This disease is dangerous because the fetus does not receive enough oxygen, this negatively affects its development, and the risk of miscarriage and premature birth also increases. High rates of ESR (erythrocyte sedimentation rate) indicate the possible development of several serious diseases at once, up to oncological ones, in this case additional studies are carried out to clarify the diagnosis. Platelets are responsible for blood clotting, so high levels of platelets indicate that there is a risk of blood clots.

Coagulogram. How the blood coagulation system works is also judged by the coagulogram, this analysis is done once every trimester, if there are no abnormalities. The indicators here are normally higher than before the onset of pregnancy, since during it the activity of the coagulation system increases.

Biochemical blood test during pregnancy. It is usually done at the same time as other blood tests. It helps to identify malfunctions in the work of various organs. For example, high levels of creatinine and urea indicate impaired renal function. High bilirubin indicates possible liver problems, including the development of jaundice in pregnant women. A very important indicator is glucose level (blood sugar test). Allows you to evaluate the work of the pancreas and not miss the onset of the development of a rather frequent complication of pregnancy - gestational diabetes. This is because the pancreas has a lot of stress during pregnancy. An elevated blood glucose level indicates that the gland is not performing well.

Analysis for blood group and Rh factor. Doctors are required to do this test, even if you have done it before. It is very important to accurately determine the blood group of the expectant mother, since in the event of a large blood loss or an unscheduled operation, this information may be urgently needed by doctors, and there will be no time to do an analysis. If a woman has a negative Rh factor, and the child's father has a positive one, it is possible that a Rh conflict may occur, when the mother's body perceives the child as a foreign body and produces antibodies to eliminate it. This can have serious consequences: cause the development of anemia, miscarriage or intrauterine fetal death. Therefore, if it turns out that a woman has a negative Rh factor, the child's father donates blood. If he has a positive Rh factor, the expectant mother regularly takes an analysis to track the appearance of antibodies: once a month until the 32nd week of pregnancy, and after this period until the end of pregnancy - twice a month. If this is the first pregnancy and antibodies have not appeared before the 28th week, doctors suggest introducing a special drug that blocks the production of antibodies in the future.

. The incubation period of these diseases is long, they may not manifest themselves immediately or not at all during pregnancy, the test results may also be negative for some time. Therefore, blood is checked for HIV and hepatitis twice - at the beginning of pregnancy and at the 30-35th week. To diagnose syphilis, a Wasserman test (RW) is used - it is done when registering, for a period of 30–35 weeks and 2-3 weeks before the expected date of birth. If any of the listed serious diseases is detected at an early stage, the option of terminating the pregnancy is possible, if at a later stage, the doctor prescribes treatment, if possible.

Blood test for. These include: toxoplasma, rubella, cytomegalovirus, herpes, and some other infections. They are dangerous not so much for the health of the mother as for the development of the child. If a woman before pregnancy has suffered diseases that cause the listed infections, then she should develop immunity to potentially harmful TORCH infections for the fetus, and special antibodies will be present in the blood - their presence allows this analysis to be detected. If there are no antibodies, the doctor will tell the expectant mother about the preventive measures that she must follow.

Also, in the first two weeks after contacting the antenatal clinic, a woman will need to visit a therapist, endocrinologist, ophthalmologist and otolaryngologist, and do an electrocardiogram. If the expectant mother has health problems, any chronic diseases, consultations from other specialists and additional examinations during pregnancy may be needed.

If the pregnancy is late or there are other indications, between the 10th and 12th weeks, the doctor may prescribe a chorionic villus test (PVC) - a study of the tissues of the placenta to determine chromosomal abnormalities in the fetus.

"Double test"
At 11-14 weeks of pregnancy, the first screening, or "double test", is done during pregnancy. It is also used to find out if the fetus is at risk of developing chromosomal abnormalities, such as Down's syndrome. Screening includes ultrasound, a blood test to determine the level of human chorionic gonadotropin (hCG) and a protein that is produced by plasma (PAPP-A).

Pregnancy check-ups: second trimester (14th to 27th weeks)

In the second trimester, it is recommended to visit a gynecologist once every 2-3 weeks, from the 16th week, during the examination, the doctor begins to measure the height of the fundus and the volume of the abdomen in order to determine whether the child is developing correctly. These parameters will be recorded at each visit. A second screening or "triple test" is performed at 18-21 weeks. With its help, the presence of hCG, alpha-fetoprotein (AFP) and free estriol (a steroid hormone) is again determined. Together, these indicators allow doctors to make a fairly accurate prognosis. However, even if it turns out that the risk of developing pathology in a child is high, this is not yet a sentence. In this case, additional clarifying studies are carried out, for example, analysis of amniotic fluid (between the 14th and 20th weeks).

Also, in the period from the 18th to the 21st week, a second scheduled ultrasound scan is performed, during which the state of the placenta and amniotic fluid is assessed, the child's development conforms to the norms, and it is also possible to determine the baby's gender.

Pregnancy check-ups: third trimester (28th to 40th weeks)

As a rule, on the 30th week, the antenatal clinic doctor takes out maternity leave and issues an exchange card to the pregnant woman. From the 30th to the 34th week, an ultrasound is done for the third time - to determine the growth and approximate weight of the fetus, its position in the uterus, the state of the placenta, the quantity and quality of amniotic fluid, the presence of an entanglement of the umbilical cord. Based on these data, the doctor makes recommendations regarding the method of delivery.

At a period of 32–35 weeks, cardiotocography (CTG) is performed - a study of the work of the cardiovascular system of the embryo and its motor activity. This method can be used to determine how well the child is doing.

From the 36th week until delivery, the doctor conducts a routine examination every week. During the entire period of gestation of the baby, the gynecologist may prescribe additional tests or send the expectant mother for consultations to other doctors - it all depends on the characteristics of the course of pregnancy.

An exchange card is the most important document of a future mother

An exchange card is issued at the antenatal clinic for a period of 22-23 weeks, and it is better to always have it with you. This is an important medical document for a pregnant woman, which will be needed when applying for a maternity hospital.

The exchange card consists of three parts (coupons):

• Information of the antenatal clinic about the pregnant woman. Here, an obstetrician-gynecologist, observing a woman throughout the entire period of pregnancy, enters basic information: personal data of the expectant mother, blood group and, past and chronic diseases, information about previous pregnancies and childbirth, the results of examinations, analyzes, screenings, ultrasound, CTG, conclusions other specialists. After reviewing these data, the doctor in the maternity hospital will be able to find out all the necessary information about the features of this pregnancy and assess the woman's health status.
• Information from the maternity hospital about the woman in childbirth. It is completed by the doctor before the woman is discharged from the hospital - he enters information about how the childbirth went and the period after it, about the presence of any complications, makes notes about the need for further treatment. This part of the card will need to be given to the antenatal clinic doctor.
• Information from the maternity hospital about the newborn. All the parameters of the baby are recorded here: height, weight, Apgar score (summary analysis of five important criteria for the baby's condition) and others. This part of the card will need to be handed over to the pediatrician, who will observe the child, he will keep a medical record and transfer all the necessary data there.

Approximate examination schedule during pregnancy:

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

Signs of pregnancy.

In the life of almost every woman, sooner or later the question arises regarding the likelihood of pregnancy. For expectant mothers, the appearance of the first symptoms of this condition becomes the starting point for a new life, full of joyful expectations for the miracle of the birth of a baby.
The onset of pregnancy is inextricably linked with a number of physiological changes occurring in the body of the expectant mother, which forms the signs of pregnancy. These signs are considered to be probable, since they may indicate some diseases and conditions of the woman's body.

Only an obstetrician-gynecologist can establish the fact of pregnancy and in the future carry out medical supervision of a pregnant woman.

In obstetrics, it is customary to distinguish between objective and subjective, reliable and indirect signs of pregnancy.

A woman may suspect that she is pregnant if she identifies several signs related to indirect signs of pregnancy:

• delayed menstruation
• the mammary glands increase in size, pain in the mammary glands may appear,
• many women may experience nausea, vomiting, dizziness in the morning,
• some women start to gain weight
• frequent mood swings occur,
• hypersensitivity to minor odors develops,
• often there is a change in appetite and taste preferences,
• frequent urination may occur.

If a woman thinks that she has become pregnant, she needs to visit an obstetrician-gynecologist to confirm the fact of pregnancy.

On examination, the doctor may find objective signs of pregnancy.

Objective signs of pregnancy are:

• an increase in the size of the uterus and its softening,
• the acquisition of the mucous membrane of the cervix of a bluish tint,
• darkening of the halo of the nipples of the mammary glands.

The presence of a uterine must necessarily be ascertained by a doctor. Unfortunately, pregnancy can also be ectopic. Early diagnosis is all the more necessary, since the earlier measures are taken to terminate an ectopic pregnancy, the less likely it is for a woman to have negative consequences.

What does the doctor see during the examination? During a routine examination, an obstetrician-gynecologist can see the following objective signs of pregnancy:

• venous congestion of the external genital organs,
• discoloration of the vagina and cervix (the cervix becomes bluish),
• softening of the isthmus with a two-handed study.

The pregnant uterus is large, soft, and can be asymmetric due to bulging at the site of the ovum.
The appendages of the uterus are necessarily palpated: fallopian tubes and ovaries on both sides.
There are cases that even with a properly developing uterine pregnancy, formations are found at the location of the uterine appendages. It is often a corpus luteum of pregnancy or a cyst of the corpus luteum in one of the ovaries. This condition is functional and does not require special treatment. But formations can, alas, turn out to be pathological. To identify this, you should resort to additional research methods.

The simplest, most affordable and safe method for health is considered Ultrasound of the pelvic organs... Already starting from 2.5 - 3 weeks of pregnancy, you can get information about the presence of pregnancy and its localization.

Starting from 10 -12 days from the alleged conception, reliable information about the developing pregnancy (uterine and ectopic) carries hCG blood test... For differential diagnosis, this study is used in dynamics, since the level of hCG value during developing pregnancy increases significantly as pregnancy progresses.

Credible signs of pregnancy:

• Detection of the embryo during ultrasound of the pelvic organs. Possibly from 4-6 weeks after fertilization.
• Fetal heartbeat. Determination is possible from 10-20 weeks (depending on the ultrasound machine).
• Various movements of the fetus, which the woman senses through the abdominal membrane. Usually appear after 16 weeks.

At home, if your period is delayed by two days or more, you can use test for diagnosing pregnancy. It is very easy to use and reliable. The reliability of the answer will be higher if the studies are carried out more than 2 times. Despite the external differences in the tests, they are based on a reaction to a specific hormone (chorionic gonadotropin - hCG), which begins to be produced in a woman's body during pregnancy. The hormone and waste products can be found in urine.
For research, they usually take a morning portion of urine: after a night's sleep, the concentration of the hormone and its decay products increases.

Thus, in modern conditions, confirmation of the fact of pregnancy is not difficult.
The main thing is that the pregnancy is desired and planned.
And when a woman plans to have a baby, the first signs of pregnancy will not go unnoticed for her.

How to determine the duration of pregnancy and the expected date of birth.

Determination of gestational age and due date is based on the assumption that a woman has a 28-day menstrual cycle with ovulation on days 14-15 of the cycle. The duration of pregnancy is on average 280 days (40 weeks) from the start of the last menstrual period. The obstetric month has 4 weeks or 28 days. Therefore, the duration of a normal pregnancy is 10 obstetric months. However, 280 days is a conditional number of days of pregnancy. Determining the true duration of pregnancy is difficult due to the fact that it is difficult to establish the exact time of ovulation, the time of movement of sperm and fertilization, it is difficult to take into account all the features of the woman's body and predict the time of the baby's "readiness" for birth. Therefore, a baby is considered full-term if it is born between 266 and 294 days (38-42 weeks) of pregnancy.

To calculate the expected due date, use the Negele formula - add 9 months and 7 days to the date of the first day of the last menstruation. A simplified method of these calculations - from the first day of the last menstruation, they are counted 3 months ago and added to the resulting number 7.

When determining the due date, it should be borne in mind that ovulation does not always occur in the middle of the cycle. In addition, the duration of pregnancy is increased by about 1 day for every day of the menstrual cycle exceeding 28 days. For example, with a 35-day cycle, ovulation occurs on day 21, and then the due date will be shifted one week later.

Sometimes, when determining the duration of pregnancy and childbirth, the time of the first movement of the fetus is taken into account. To the date of the first movement, add 5 obstetric months in primiparous and 5.5 obstetric months in multiparous and get the estimated date of delivery. It should be remembered that this feature has only an auxiliary meaning. Some mothers may feel the baby wiggle between 16 and 18 weeks of pregnancy.

Objective research data help the doctor to determine the due date: measuring the length and size of the fetus, the circumference of the pregnant woman's abdomen, the height of the fundus of the uterus, the degree of its excitability and other signs.

More than 10% of all pregnancies last more than 42 weeks, of which 14% last more than 43 weeks. Pregnancy lasting more than 42 weeks is called post-term. This condition is more often observed in primary pregnant women, whose age is more or less than the average childbearing age, and in women who have had 5 pregnancies or more. The reasons for a post-term pregnancy can be different. Often this is just a hereditary feature, sometimes - a pathology associated with a violation of hormonal balance, metabolism in the mother's body, obesity, delayed biological maturation of the neuromuscular apparatus of the uterus, intrauterine fetal growth retardation.

The absence of labor at the expected date of birth is often unfavorable for the baby. Normally, after 40 weeks of pregnancy, fetal growth slows down, and at 42 weeks it practically stops. Therefore, the so-called maturational disorder is observed in 30% of post-term children. To stimulate labor, the expectant mother is recommended to move more, with ineffectiveness, special gels are currently most often used, which are found in the cervix to stimulate labor.

In turn, childbirth before the end of the normal period of intrauterine development (before the expiration of 37 weeks of gestation) is considered premature. Among the total number of births, the frequency of premature births is 5-10%. Premature babies are born as a result of premature birth. Prematurity is a condition of a fetus born earlier than expected, weighing less than 2,500 g, growth less than 45 cm, characterized by immaturity of organs and systems, insufficient resistance to environmental factors. Currently, in modern maternity hospitals, it is possible to care for babies born after 28 weeks of gestation and weighing more than 500 g.

How to prepare for your first visit to an obstetrician-gynecologist during pregnancy.

Many women who plan pregnancy in advance, or even those who did not plan to have a baby in the near future, may suspect, by their well-being, an impending change in their life - the expectation and birth of a baby.
It's good if this is a planned pregnancy and the future parents prepared for it by going through in advance medical examination and following all the doctor's recommendations.

In any case, if pregnancy is suspected, it is recommended to register as early as possible (before 12 weeks of pregnancy) for monitoring pregnancy in the clinic of obstetrics and gynecology.
In our country, there is an encouragement for expectant mothers who apply for registration with an obstetrician-gynecologist for pregnancy up to 12 weeks: they are paid a cash allowance in the amount of one minimum wage (minimum wage).

What is necessary for the initial visit to the obstetrician-gynecologist?

First of all, you will need:

1. Passport.
2. Medical documentation: the results of previous tests, medical reports of other specialists, extracts from the medical history after hospitalization in a hospital (if any), etc. (note that these may be photocopies of the originals).
   Later, when you are given an exchange card - the main medical document of a pregnant woman - you will also need to carry it with you.
3. You may need a notepad and pen for your personal recommendation notes.
   Before the consultation, make a list of questions that you would like to ask the doctor, and during the interview, you can write down the recommendations received in a notebook.

Disposable towels and diapers, disposable gynecological instruments are used for gynecological examination in the "Health Clinic".

What you need to pay attention to.

1. You should know the date of your last menstrual period, the nature (heavy, not heavy flow) and the length of your menstrual cycle.
2. It is better not to plan visits to the obstetrician-gynecologist on those days when, in the absence of pregnancy, menstruation should have begun. Experts consider these days to be critical for the development of the fetus, and examinations and examinations during a dangerous period can cause termination of pregnancy. Therefore, by marking the dates of the expected menses on the calendar, unnecessary risks can be avoided.
3. Do not hesitate to ask your doctor about intimate features and the specifics of your sex life, do not hide information regarding your health. A qualified gynecologist will never judge you, but, on the contrary, will try to help and explain the situation.
   There is no need to set yourself up in advance for the occurrence of unpleasant, painful sensations during the examination.
4. The day before the visit to the doctor, it is recommended to exclude sexual intercourse, otherwise the test results may be unreliable due to the possible presence of semen.
5. Before visiting a doctor, empty your bladder and, if possible, intestines, so that during the examination they do not interfere with assessing the condition of the internal genital organs. Take a shower, change your underwear.
   In this case, you cannot douche, since such a procedure can change the microbial flora of the vagina, and the test results will also be unreliable.
   In addition, the doctor will not be able to assess the nature of the vaginal discharge.
   If the waiting line for the gynecologist will take too long, empty your bladder again.

The main thing is a positive attitude, trust in the doctor and a desire to bear and give birth to a healthy child.

A very important component for monitoring pregnancy is the choice of a qualified obstetrician-gynecologist and a clinic that meets modern requirements.

All pregnant women should be regularly examined by an obstetrician-gynecologist. This will allow early detection of emerging complications and prevent their consequences for the mother and baby.

To get an appointment with a doctor, it is best to register with an antenatal clinic or conclude a pregnancy management contract. We do not recommend that you go to a private center from time to time, because the doctors there usually do not bear any responsibility for you.

Frequency of visits

From the moment of registration or conclusion of a contract and up to 12 weeks of pregnancy, a doctor's examination is required once a month.
From 13 to 28 weeks - once every three weeks.
From 29 to 36 weeks - once every two weeks.
From week 36 to delivery - weekly check-up.

Before each visit to the doctor, you must pass a urine test.

What the doctor does at the examination

• Height measurement- carried out on the first visit. Needed for calculating body mass index.
• Weighing- carried out at each examination. According to the weight gain, the doctor determines whether the pregnancy is proceeding normally and whether there are hidden edema.
• Blood pressure measurement(BP) and heart rate - at each appointment. Allows you to detect dehydration with a strong (drop in blood pressure) or the onset of late toxicosis (increase in blood pressure more than 140/90 mm Hg)
• Measuring the pelvis- carried out at the first examination. Indirectly shows the width of the pelvis, since the thickness of the bones also affects the width of the birth canal. When in doubt, the Soloviev index is used: the circumference of the wrist in centimeters. If it is more than 14, then the thickness of the bones is considered large, and the birth canal with the same external dimensions of the pelvis will be narrower.
• Palpation(probing) belly- is carried out at every appointment. With the help of it, the doctor can find out if the tone of the uterus is increased (threat of miscarriage), how the fetus is located, what is its presentation.
• Internal inspection- is carried out at the first reception, later on according to indications (for example, in case of pain and bloody discharge). The doctor inserts his hand into the vagina and determines the condition of the uterus and cervix. In some cases, a small disclosure is already determined by 28 weeks and can be the cause.
• Vaginal swab- taken at the first visit and at 36–37 weeks. With the help of it, you can identify infectious diseases and determine the "cytotype of the smear" - a sign of the stage of readiness for childbirth.
• Measuring the circumference of the abdomen- starting from 14-15 weeks and then at each examination.
• Measuring the height of the fundus of the uterus- from the bosom to the upper edge of the uterus, measured at each examination after 14-15 weeks.
• Listening to the fetal heartbeat- is usually performed starting from 14-15 weeks, when it is heard in a regular obstetric stethoscope. With a Doppler stethoscope (electronic), you can hear your heartbeat earlier. This provides very important information about the child's condition.
• - do starting from 30-32 weeks and further according to indications. In other words, the doctor can refer you to CTG at any time, as soon as he suspects something is wrong with the child.

If you are late

What if you are late or cannot come to your appointment? It is imperative to call the antenatal clinic and inform the doctor about it. The doctor places the patient cards on the shelves at the appropriate attendance dates, if you are late or cancel the attendance, you will be transferred to another date.
If you cannot come because you are not feeling well, call an ambulance, a doctor will examine you and, if necessary, take you to the hospital.