What is the first screening at 12. Bleeding during pregnancy in the early and late stages. How risks are calculated

How the twelfth week of pregnancy proceeds is interesting to many pregnant women. This week is the final week of the 1st trimester. The most dangerous time, when the child was very vulnerable to outside interference, and the main task was to preserve his life, passed. Of course, this does not mean that a pregnant woman can now: lead an unhealthy lifestyle, take medications without control, and not be afraid of germs.

Fetal development at 12 weeks of pregnancy

The size of the baby, when twelve weeks of gestation have passed, is approximately 60-70 mm, and it weighs approximately 13-20 grams. Now the fetus is becoming more and more human-like. But the baby at the twelfth week still has a fairly large head relative to the body. The baby's hands and feet are small and thin, but they already have palms and fingers with delicate transparent nail plates.

The first hairs can be seen on the body. All tissues and organs have formed.

At this time, they are being improved and they develop further. And a number of systems even begin to work in the 12th week of gestation. The small heart functions, contracting at 100-160 r/min, and blood vessels are formed. The thymus gland, which has matured, forms immune cells - lymphocytes. Such an important organ as the liver begins to produce bile. Amniotic fluid swallowed in small quantities is filtered by the fetal kidneys and goes into the surrounding amniotic fluid in the form of urine.

The production of hormones begins, which regulate all processes important for life - growth, sexual development, etc. The baby’s bone tissue is still soft. But ossification processes occur quickly. And the baby is constantly moving.

Feel

The 12th week of pregnancy has already arrived, which means that from this moment on, the future mother, if she suffered from toxicosis, will most likely begin to feel better. Yes, yes, the placenta is slowly taking over life-supporting functions, the corpus luteum has “done” its work, and therefore, nausea and vomiting will most likely now be a thing of the past. But, unfortunately, this applies more to “traditional” pregnancy, but if the pregnancy is designated as multiple, the symptoms of toxicosis may remain with it for some time. As well as emotional outbursts, irritability and nervousness caused by hormonal changes in the body.

Even if a woman, due to toxicosis, has lost a little weight in the first weeks of pregnancy, starting from the 12th week, her body weight will begin to increase: plus 500 grams weekly is considered the norm. Growing in a woman's womb new life requires the mother’s body “to the maximum”, and therefore all its systems and organs work at full capacity. Blood volume increases, its circulation increases, the lungs and kidneys work more actively, the heart beats faster. At the same time, urination is “adjusted” - the frequent urge to go to the toilet “little by little” will no longer bother the woman, as at the beginning of pregnancy. But there may be a problem with bowel movement: the growing uterus puts pressure on it, bowel function slows down, which can lead to constipation.

Stomach

At the 12th week of pregnancy, the expectant mother can already feel how her belly is slowly beginning to enlarge. Usually, if pregnancy is new for a woman, the tummy begins to grow later; at week 12 it has practically not increased, the expectant mother feels comfortable and regular clothes It still fits her. If this is not the woman’s first pregnancy, then the belly usually begins to enlarge earlier, often forcing the expectant mother to start looking for looser-fitting clothes already at 12 weeks. Often, the growth of the abdomen is accompanied by itching; this is a kind of “hint” for a woman to worry about choosing suitable products that will help avoid the formation of stretch marks, not only on the stomach, but also on the chest and hips. In addition, on the stomach, at the 12th week of pregnancy, it may also appear age spots, and a dark stripe that, starting from the navel, goes down. Experts reassure: there is nothing wrong with this, these phenomena are temporary and are not a cause for concern.

Uterus at 12 weeks of pregnancy

It is probably not difficult to guess that the belly begins to grow precisely in connection with the gradual increase in the size of the uterus. Thus, the uterus at 12 weeks of pregnancy usually increases to such a size that it simply becomes cramped in the hip area. At this stage, the width of the uterus “grows” to about 10 centimeters, therefore, it goes beyond its usual location and rises into abdominal cavity. A woman can even fully feel and palpate its increased size.

Ultrasound

Typically, at the 12th week of pregnancy, the first ultrasound examination occurs, with the help of which the doctor determines the size of the fetus and also establishes the estimated delivery date. An ultrasound at the 12th week of pregnancy becomes a real revelation for the expectant mother: her first acquaintance with the baby takes place, she already distinguishes him as a tiny person who is destined to be born in the near future. Although such indicators are extremely important in an ultrasound examination, ultrasound at 12 weeks of pregnancy can also show other, much more important results.

Thus, during an ultrasound examination, the doctor assesses the condition of the uterus and determines its tone, analyzes the location of the placenta, eliminates the possibility of ectopic pregnancy and clearly establishes how many fetuses develop in the womb. A woman can already observe her unborn baby on an ultrasound monitor, but without the help and explanation of a doctor she will not always be able to make out where everything is and how the baby is feeling now. Don’t be shy about asking the doctor for clarification - he can answer all the mother’s questions, thereby introducing her closer to her baby.

The doctor compares the ultrasound results at the 12th week of pregnancy with the indicators indicated in the table of normal values. This will make it possible to determine whether everything is going “as usual”, and in the future the indicators of the first ultrasound examination will be compared with the indicators of repeated ultrasound examinations. Thus, the specialist will be able to monitor whether the pregnancy is progressing normally and whether there are any abnormalities.

It happens that early diagnosis becomes a disappointing “surprise” for parents: an ultrasound at the 12th week of pregnancy can already give an answer as to whether the baby is at risk of congenital defects or chromosomal abnormalities. Unfortunately, such diseases cannot be treated, and parents, learning about the abnormalities, are tormented by a difficult choice: keep the baby or still resort to termination of pregnancy.

Screening at 12 weeks of pregnancy

An even more informative method for assessing fetal development and the course of pregnancy according to the norm can be screening at the 12th week of pregnancy. This is a comprehensive study that covers not only ultrasound, but also a biochemical blood test. A blood test involves measuring two markers in a woman’s body - free b-hCG (free beta subunit of human chorionic gonadotropin) and PAPP-A (pregnancy-associated plasma protein A). In this regard, the first screening is also called a double test.

Optimally, screening is carried out three times throughout pregnancy, and the first is recommended to be carried out just between 11 and 13 weeks. The fact is that screening at the 12th week of pregnancy, which necessarily includes an ultrasound of the fetus, is aimed at studying the so-called “collar zone” of the fetus. Such a study makes it possible to exclude gross malformations of the fetus and even anomalies that are incompatible with life. The collar zone is the area of the neck between the skin and soft tissues, in which liquid accumulates, is a non-permanent marker. As the baby develops, the norms of the collar space change, and therefore its examination must be carried out strictly within certain periods. And, in addition, an analysis of the state of the collar zone can be carried out provided that the operator is highly qualified and specially trained, otherwise the presumptive diagnosis can be strongly doubted.

In turn, a study of hormone levels (free b-hCG and PAPP-A) carried out as part of screening makes it possible to determine the degree of risk of developing certain abnormalities in the fetus. For example, an average increase in the values of free b-hCG by half may be a reason for suspicion of the presence of trisomy 21 (Down syndrome) in the fetus, a decrease - trisomy 18 (Edwards syndrome).

However, despite the high information content, screening at the 12th week of pregnancy is by no means a reason for a final analysis. This study only establishes the degree of risk and the possibility of having trisomy 21, trisomy 18, as well as a neural tube defect. Screening results become the basis for further research using special methods. Among other things, if the tests are questionable, the doctor usually refers the expectant mother to a geneticist, who, in turn, recommends other additional studies.

Analyzes

In addition to ultrasound examination and biochemical blood test, the doctor may prescribe to the expectant mother and some other tests at 12 weeks of pregnancy. Usually, a woman has to undergo all scheduled tests when registering at the antenatal clinic. But it happens that tests at the 12th week of pregnancy may be needed due to a woman’s late visit to the gynecologist about pregnancy. Or it happens that tests at the 12th week of pregnancy are needed for an extended examination of the expectant mother in connection with her condition - as an additional control tool.

In addition to the traditional blood test for AIDS, syphilis, hepatitis B, blood type and Rh factor, by this time a blood test for sugar, as well as a biochemical analysis, should already be taken. Among other things, a test at 12 weeks of pregnancy examining “biochemistry” will determine hCG level in the body of the expectant mother. And a biochemical blood test is carried out, as mentioned above, as part of a screening examination of the pregnant woman. If there are any suspicions of specific diseases, the woman may also be sent for hormone tests and tests for urogenital infections.

Fetus at 12 weeks of gestation

All these actions are necessary both to monitor the condition of the expectant mother and to carefully monitor the formation and normal development of the fetus at 12 weeks of pregnancy. At this stage, it has already grown significantly: the fetus is at the 12th week of pregnancy, 10 weeks old, weighs about 14 g, and reaches a length of 6 to 9 cm (from the crown to the tailbone). From this moment on, by the way, his growth rate and length are a much more important indicator for doctors than his weight.

The fetus at the 12th week of pregnancy is already practically formed, all its systems and organs are actively working and continue to develop. So, the fingers are divided and marigolds form on them, a unique imprint is formed on the pads of the fingers, the top layer of skin is renewed, and where eyebrows and eyelashes will appear in the future, fluff appears. Vellus hairs also appear on both the chin and upper lip.

By the way, the fetus at the 12th week of pregnancy already actively “expresses emotions” with its face: it grimaces, opens and closes its mouth, and even puts a finger in its mouth. At the same time, the baby waves its arms and legs, and also tumbles and “swims” freely in the mother’s womb.

At this stage, the baby’s internal organs, in parallel with the fact that they are functioning, still continue to develop. The baby’s intestines, having “taken” their place, periodically contract, the liver synthesizes bile, and the pituitary gland and thyroid gland produce hormones and iodine. Bone tissue continues to mature, the baby’s muscles become stronger, the heart beats quickly, the kidneys and nervous system work fully. And at this stage, in addition to erythrocytes, leukocytes also begin to form in the fetal blood - the the immune system.

Pain

All this “magic” that happens in mom’s tummy should not normally be accompanied by painful sensations. True, mild and mild pain in the 12th week of pregnancy, felt in the lower abdomen, can be explained by the tension of the ligaments that support the growing uterus. At the same time, doctors often justify lower back pain by a change in the center of gravity due to a gradually growing abdomen, and also by a softening of the supporting ligaments and discs under the influence of progesterone.

At the same time, lower back pain can also be caused by a bladder infection, so in such a situation it is still better to consult a doctor and, if necessary, undergo an examination. It would also be useful to consult a specialist if pain in the lower abdomen appears periodically during the 12th week of pregnancy, is aching and pulling, and also if pain in the lower abdomen lasts for 2-3 hours. And, moreover, they are accompanied by bloody discharge - this danger sign indicates a threat of premature termination of pregnancy. If a woman reacts in time when painful sensations appear, a miscarriage can be avoided, so it is necessary to seek help immediately.

Discharge

Bloody discharge at the 12th week of pregnancy, even minor, should always alert a woman. Moreover, if they are also accompanied by abdominal pain - all this indicates the risk of spontaneous abortion. But spotting that appears after a gynecological examination or sexual intercourse can be explained by erosion of the cervix. And this condition is also a sufficient reason to contact a specialist and undergo additional examination.

Normally, discharge at the 12th week of pregnancy is moderate, light or with a milky tint, uniform consistency and a slight sour odor. No pus, mucus, green or yellow, curdled or sharp discharge unpleasant smell there should not be: such discharge becomes a sign of the presence of infection. A change in the consistency and color of the discharge may be a symptom of thrush, chlamydia, or trichomoniasis, which require mandatory treatment, because the infection is quite capable of affecting the fetus.

Bleeding

Bleeding at the 12th week of pregnancy always requires consultation with a doctor, because it is always defined as a very dangerous sign. Although bleeding of various types is considered a fairly common occurrence in early stages pregnancy, nevertheless, in no case should you take risks and let the situation take its course - in order to prevent a possible miscarriage, the harbinger of which is bleeding at the 12th week of pregnancy.

Bleeding, which is accompanied by cramping or nagging pain in the lower abdomen and painful sensations in the lower back, is especially dangerous. Indeed, in addition to the threat of spontaneous abortion, such bleeding may also indicate an ectopic pregnancy - a complex and pathological pregnancy that poses a threat to the health and life of a woman.

Cold at 12 weeks of pregnancy

The twelfth week ends one of the critical periods of pregnancy - the first trimester, after which the baby will no longer be afraid of most anomalies and malformations. But for now, in this last and important week of the first trimester, you still need to take care, including colds.

A cold in the early stages can cause a lot of trouble: provoke the development of placental insufficiency, fetal hypoxia, and significantly increase the risk of miscarriage. After all, if suffered on the feet and “untreated,” a cold at the 12th week of pregnancy still remains a significant danger: it can cause malformations of the baby, even incompatible with life, which can ultimately result in spontaneous abortion.

The situation is significantly complicated by the fact that in order to avoid colds in the early stages of pregnancy negative consequences It is prohibited to treat with medications. In this case, only means traditional medicine, and some more herbal remedies- and then only after consultation with a doctor.

Rest and bed rest are mandatory for a woman during the treatment of a cold. Drinking plenty of fluids (warm, but not hot) is recommended - herbal teas, rosehip decoction, berry fruit drinks made from lingonberries, raspberries, and currants. Honey is also useful - albeit in small quantities, since it has a strong allergenic effect. Honey can be added to tea or drunk with warm milk. Also good remedy in the treatment of colds, primarily against cough, warm milk mixed with Borjomi mineral water is considered. You can also fight a cough with the help of marshmallow mixture, syrup or Doctor MOM lozenges, Gedelix.

It is imperative to consult a doctor again if a cold at the 12th week of pregnancy does not go away within 3-4 days, if its symptoms intensify, headaches are observed against the background of the cold, and a cough accompanied by wheezing does not go away. Moreover, mandatory consultation with a specialist is required if a cold at 12 weeks of pregnancy is accompanied by a high temperature - 38 degrees or more.

Temperature

The temperature at the 12th week of pregnancy, which is slightly above normal and fluctuates around 37-37.5 degrees, can be either a variant of the norm (this is how the body reacts to increased levels of progesterone in a woman’s body) or indicate hidden diseases. Tests will help identify these diseases - usually inflammatory ones provoke changes in the levels of leukocytes, as well as the erythrocyte sedimentation rate (ESR). And yet, more often than not, a slightly elevated temperature at the 12th week of pregnancy is a characteristic feature of the expectant mother’s body.

But a noticeable high temperature at the 12th week of pregnancy, accompanying any disease, poses a significant threat to the baby. Thus, under the influence of high temperatures, pregnancy loss can occur even at this stage, therefore a long-lasting high temperature is simply not acceptable. But most antipyretic drugs are prohibited at the 12th week of pregnancy (the only exception is paracetamol, and then only with the permission of a doctor). So what to do?

First of all, don’t “disdain” traditional methods lowering the temperature - rubbing with cool water with the addition of a small amount of vinegar, wet and cool lotions on the ankles and hands, cool shower. But all this is only after a doctor has been called to your home: he will help determine the degree of danger of high fever and prescribe a dosage in which paracetamol will not cause much harm.

Alcohol

You should also abstain from alcohol during the 12th week of pregnancy, as well as during the entire period of pregnancy. A conscientious mother is clearly interested in ensuring that her baby is born as a full-fledged and healthy baby, while alcohol at 12 weeks of pregnancy, consumed even in the smallest doses, can prevent this.

At this stage, the formation of the brain is still ongoing, and no specialist will take the responsibility to guess how alcohol will affect this process. Thus, alcohol can cause irreparable damage to brain cells - even destroying some of them, which will not recover in the future. The effects of alcohol can appear in this case even several years after the baby is born: at some point it will become clear that the child has difficulty learning, is overly excitable and hyperactive, and suffers from poor memory.

In a more severe case, alcohol at 12 weeks of pregnancy can still cause severe malformations of the child and physical deformities, affecting the formation of bone tissue and muscle development. Alcohol in large quantities, constantly penetrating the placenta to the baby and having a toxic effect on it, can even lead to miscarriage. Therefore, alcohol at 12 weeks of pregnancy should definitely be excluded from the life of the expectant mother.

Sex at 12 weeks pregnant

But if a woman feels satisfactory and there are no contraindications for carnal pleasures, it is not at all necessary to refuse sex. Moreover, at the end of the first trimester of pregnancy, toxicosis and accompanying symptoms slowly recede, the woman enters certain period The “heyday” and dangers that characterized the early stages of pregnancy are also gradually becoming a thing of the past.

The only contraindication to sex, both in the first weeks and in the 12th week of pregnancy, may be the threat of miscarriage. And then, in this case, restrictions on sex are usually imposed by doctors just before the 12th week. Other reasons that will be a reason for a woman to take care may be multiple pregnancy and low position placenta (this will be determined by a routine ultrasound). If pregnancy is not accompanied by such characteristic “features”, sex at 12 weeks can be safely practiced.

The only thing is not to be too active and not “overzealous”, avoiding pressure from the partner on the stomach and monitoring internal sensations after sexual intercourse. For example, cramps that can appear after carnal pleasures are usually classified as normal. But, if cramps do not go away for some time after sex, and are also accompanied by bleeding, you should immediately call a doctor.

You should also, if possible, consult a doctor if you experience spotting after sex at 12 weeks of pregnancy, but it is not accompanied by pain. This sign may indicate that a pregnant woman has cervical erosion.

Nutrition

Nutrition at the 12th week of pregnancy must be complete and balanced: the baby’s rapidly developing body needs as much nutrients and nutrients as possible. They are found in required quantities in “healthy” foods: meat and fish, dairy and fermented milk products, cereals, vegetables and fruits. Moreover, the method of their preparation occupies an important place: it is better to boil or bake food when cooking (fried food causes heartburn), vegetables and fruits are eaten raw (fiber improves intestinal motility and reduces the likelihood of developing constipation).

A full breakfast is important; it is advisable to always eat a portion of the first meal as a starter, and dinner should be light. It is better to eat, again, more often, but in small portions, avoiding overeating. If some foods suddenly begin to cause aversion in a woman due to pregnancy, you can always find an “alternative” to them: for example, if you do not want and do not accept meat, you can completely replace it with fish. Don't like boiled fish? You can try baking it. Yes, and one more thing: there is no point in torturing yourself and trying to “squeeze” into the stomach a product that the expectant mother simply cannot eat. this moment I didn’t like it, but which, according to all the characteristics, is extremely useful for pregnant women. For example, many women during pregnancy simply cannot look at cottage cheese, even though it seems to bring exceptional benefits to the body of mother and baby. But food eaten forcefully will definitely not be good for future use, so it’s still better not to go against your taste “senses”.

This the last week first trimester, corresponding to the 14th obstetric. It contains a lot of new things. During this period, the mother's toxicosis stops, the fetus begins to make its first still imperceptible movements, and the risk of miscarriage decreases every day. Let's take a closer look at what changes occur during this period in the body of a pregnant woman and her child.

The first months of pregnancy are a difficult time. In the morning, women suffer from nausea, loss of appetite and most experience painful toxicosis. Week 12 is the beginning of the “golden period of pregnancy.” Mommy’s morning sickness and other ailments begin to subside, her health gradually improves, and her drowsiness goes away. The tummy is not particularly noticeable yet, but is already beginning to actively grow.

Normalized and psycho-emotional state pregnant. We can say that the twelfth week is a return to normal life. There is no longer any fear of losing the child and nutrition is improving. It is this time that is remembered as the best during the entire period of waiting for the child. The baby already looks like a child too: he’s not quite proportional yet, but there’s still plenty of time ahead.

Uterus

Continues to grow upward, filling the entire hip area and moving into the abdominal area. Lying down you can already feel it above the pubis. The length of the organ is approximately 12 cm; its width has increased by almost 10 cm. So far, its growth is being stimulated by and. In the future, its walls will become thinner as the child grows. This week the uterus is usually in a slight tone, but this is a normal state if it is not accompanied by uncomfortable symptoms.

Breast

The breasts fill out and increase in size, while still remaining very sensitive. However, the pain may stop during this period. The first discharge resembling colostrum may appear.

Stomach

It becomes rounded, but can still be hidden under loose clothing. If a woman already has children, then the belly will grow faster. At this time, the first stretch marks begin to appear. To prevent their number from increasing like an avalanche in the future, you can start using special creams for stretch marks. In almost all pregnant women, during this period the skin in the middle of the abdomen begins to darken and a brownish stripe appears - a symptom of hyperpigmentation.

Discharge

Discharge in the twelfth week should remain the same. Transparent, yellowish, white discharge with a sour odor, not accompanied by itching, is explained by the activation of epithelial cell renewal. It is still necessary to observe their number, color, and evaluate the smell. They should not be accompanied by nagging pain or other unpleasant sensations.

You should consult a doctor if the discharge becomes profuse, watery or with big amount blood. Heavy discharge may be due to thrush or chlamydia. They will have to be treated, otherwise the infection can harm the fetus. If a woman has erosion, bloody marks may appear after sexual intercourse.

What about the fruit?

Around this time, gynecologists began to call the embryo a fetus.

How is it developing?

All organs by this period have already been formed and are developing further. The development of the embryo is associated with the beginning of the 2nd wave of cytotrophoblast invasion, due to which the uteroplacental blood circulation increases. This leads to an intensive increase in the weight of the fetus and its main organs. The child begins to receive more oxygen and nutrients necessary for intensive growth. In addition to red blood cells, leukocytes begin to appear for the first time in the circulatory system, forming the prototype of the immune system.

The cartilage gradually calcifies and turns into bone. Calcification starts from the middle of the bone and will continue as it grows. The process will be completed only during puberty.

The fingers and toes have finally separated, nails are actively growing, the rudiments of future molars are forming, and signs of hair appear in the eyebrow area. The ribs are formed, and the skeletal system further develops.

The fetal pituitary gland begins to produce most hormones. The brain develops, which by this week begins to resemble the tiny brain of an adult. The simplest reactions have already developed: although the child does not open his eyes yet, he is already reacting to light; touching the wall, he pushes off from it.

The liver is already beginning to produce bile, peristaltic movements begin in the intestines for the first time, and the small intestine can already absorb sugar and glucose. In the kidneys of the embryo, the loop of Henle is activated, which is responsible for filtering urine. Baby drinks amniotic fluid and unnecessary substances are excreted in the urine, while necessary substances are absorbed in the loop tubules. The baby begins to practice breathing by swallowing amniotic fluid - rib cage rises.

The fetus begins active movements and exhibits facial expressions. The child begins to move, may squint, move his fingers, open and close his mouth, and make sucking movements. Mommy will be able to feel the baby’s movements for the first time only after another couple of months.

The genital organs are also differentiated. This week, the male embryo develops a vaginal process - a special protrusion of the peritoneum, which will take part in the process of lowering the testicle into the scrotum. With a successful combination of circumstances, you can already see the sex of the baby on an ultrasound.

What does it look like?

The child looks already fully formed, only slightly disproportionate - the head is much larger than the body. The figure can already be compared to that of an adult. The face has pronounced features and a neck has appeared. The ears are still in their infancy, the nostrils are set wide apart.

Fetal weight and height

During this period, the fetus reaches a size of approximately 9 cm. Weight can reach 19 g. From this period, the gynecologist will more closely monitor the mother’s weight and the dynamics of uterine growth - factors indicating the growth of the child.

Changes in the mother's body

In a woman, the volume of the anterior pituitary gland, the organ responsible for the production of prolactin, increases. This happens so that from the 12th week prolactin accumulates in the body, which is largely responsible for the growth of the mammary glands. In the future, the hormone will promote the onset of lactation.

Brownish spots different shapes begin to appear on the face and neck - this is chloasma or hyperpigmentation of the skin.

Because of higher level estrogen, vascular changes begin to appear:

telangiectasia - dilation of small vessels;
stars;
swellings of a reddish hue with radiating rays (angioma).

They can suddenly appear on the face, neck, arms, and upper chest area. Stars on the palms are called palmar erythema. They will all disappear after childbirth.

Although the fetus begins to move at this time, the mother cannot yet feel them. Some pregnant women say that they feel fetal movements from twelve weeks - however, this is a purely psychological phenomenon.

Attitude to sex

Sex during this period begins to require some restrictions. For example, positions on the stomach are contraindicated for women. Even just lying on your stomach is no longer worth it from this period. However, if a pregnant woman wakes up face down at night, there is nothing particularly terrible about it.

There are no more restrictions on sex during this period if there are no pathological symptoms. You cannot have sex if placenta previa is diagnosed. If discomfort appears after intimacy, it is better to consult a gynecologist. Sex is not recommended for mothers with multiple pregnancies.

hCG

If during the first screening a decrease in the level is detected, this indicates a risk of Edwards syndrome or a pathology of the placenta. Elevated human chorionic gonadotropin may indicate a risk of developing Down syndrome. With twins, hCG may also be elevated. The normal level of hCG in the blood at 12 weeks is 13.4 ng/ml -128.5 ng/ml.

Progesterone

The norm at the twelfth week is from 38.19 nmol/l to 47.41 nmol/l. Low level progesterone levels at this time may indicate:

problems with the placenta;
ongoing chronic inflammatory processes in the female reproductive system;
fetal hypoxia;
ectopic.

A high level may indicate:

developing hydatidiform mole;
presence of corpus luteum cysts;
adrenal gland disease;
multiple pregnancy.

Endometrium

The endometrium is the inner lining layer of the uterus to which the chorion is attached. The thickness of the endometrium plays a big role during pregnancy. During pregnancy, the thickness of the layer also changes and is about 2 cm. The thickness of the endometrium is measured by ultrasound. If the endometrium is thin, the doctor will prescribe medication to help it grow.

Ultrasound, photo of the baby

If a woman has just registered, then the first screening is immediately carried out, including an ultrasound examination. Diagnostic time in the first trimester is limited: from the 1st day to the 6th day.

At the first ultrasound screening:

calculate the length of the embryo, its CTE - coccygeal-parietal size;
assess the size of the head;
look at the symmetry of the brain hemispheres and the presence of structures required for this period;
measure the length of the femur, humerus, as well as the forearm and lower leg;
check the location of the stomach and heart;
measure the size of the heart and abdomen.

Normal ultrasound findings:

CTE - from 51 mm to 59 mm exactly at 12 weeks and from 62 mm to 73 mm - on the last day of the twelve week period;
thickness of the collar zone - from 1.6 mm to 2.5 mm;
nasal bone (an indicator important for diagnosing Down syndrome) - at least 3 mm;
Heart rate - from 150 to 174 beats per minute;
biparietal size - not less than 20 mm.

Based on the results of the 1st trimester ultrasound, they look for markers of chromosomal abnormalities of the fetus and analyze the period at which the baby’s development corresponds. 3D ultrasound can already show the sex of the fetus. If you had a 3D ultrasound, you can ask for a photo of your baby.

If the first screening ultrasound was done earlier, then at the 12th week it is repeated for pregnant women in whom pathology was identified during the first ultrasound examination. The thickness of the nuchal translucency is examined again to identify severe malformations or chromosomal abnormalities. In this case, the question of terminating the pregnancy may arise. In this case, ultrasound examination data must be confirmed by amniocentesis - a biochemical, immunological, genetic and hormonal study of amniotic fluid.

Well-being

During this period, everything should be normal. A pregnant woman becomes less irritable, her state of toxicosis subsides, nausea disappears, the urge to urinate decreases, and her quality of life improves. It is necessary to constantly monitor pressure and temperature. The pressure should be slightly lower, and the temperature should not be higher than 37.5. Your weight may not change during this period, but even if it increases slightly - up to 3.6 kg - then this is normal.

For the first time, an expectant mother may experience the unpleasant phenomenon of heartburn - a burning sensation in the stomach. During pregnancy, the placenta produces large amounts of progesterone, which relaxes the muscular valve between the esophagus and stomach. When a woman lies down, gastric secretions begin to flow into the esophagus, causing irritation.

Chronic diseases not treated before pregnancy can worsen during this period. The load on the liver, kidneys and heart increases. The uterus puts pressure on the intestines and inhibits its peristalsis, which can cause constipation.

You can lead an almost ordinary life - all the main troubles are left behind. A pregnant woman just needs to monitor her diet and follow some recommendations:

avoid taking medications without consulting a gynecologist;
You should not take medicinal herbs without consulting a doctor - some can cause a miscarriage;
walk more in the air, drive moderately active image life;
monitor your weight and avoid overeating;
exclude fast food, soda, food rich in chemicals, spicy, salty, fatty foods from your diet. However, if you crave salty or spicy foods, you don’t need to torture yourself either - spicy foods, for example, reduce heartburn.

Scheduled doctor visits

If a pregnant woman has not yet registered, she should do so this week. If a woman is registered, then starting this week, she will have to go to the doctor once every 4 weeks. If you haven’t already, you need to undergo a gynecological examination and examination by a therapist. Consultation with a dentist, endocrinologist, or ENT specialist is also necessary.

Necessary studies and analyzes

If a pregnant woman is just registering, she needs to be tested for HIV, syphilis, blood group and Rh factor, and determine her sugar level.

In the near future you need to submit:

UAC and OAM;
blood for pregnancy hormones - free-B-hCG and PAPP.

A test for placental lactogen may show an increase to 1,550 ng/ml. The coagulogram will show an increase in fibrinogen levels. Analysis of AFP during this period will show its peak amount, which will remain at this level until the 16th week.

The doctor in the residential complex conducts an examination with a mirror on a chair and takes smears for cytology and flora. The presence of STDs is determined - gonorrhea, trichomoniasis, etc.

Diet

The diet does not need any changes or restrictions. The main thing is weight control. To prevent a decrease in hemoglobin levels, it is necessary to increase the amount of iron-containing foods in the diet - liver, veal, beef tongue, buckwheat, apples, pomegranates. To maintain the required amount of calcium, you should increase the amount of dairy products you eat. To reduce the amount of constipation, you should definitely eat soup.

You definitely need to give up heavy foods and fast food, reduce the amount of fatty, fried, flour, and smoked foods.

Lifestyle

In the absence of contraindications, you can continue a moderately active lifestyle. During this period, many expectant mothers give up their usual sports activities - running, fitness and switch to yoga or fitness for pregnant women. Moderate activity is useful for maintaining tone and preparing for childbirth. In addition, trained mothers will be able to recover faster after childbirth.

What's prohibited?

The following should be completely excluded:

drinking alcohol;
smoking;
coffee;
hard physical labor;
X-ray, fluorography and CT;
strength and injury-prone sports;
stressful situations and experiences.

Taking vitamins

If before this time the mother took folic acid, then the time has come for special multivitamin complexes for pregnant women. You can take them on the recommendation of a doctor. Not all women are recommended to take vitamins.

who do not have the opportunity to eat fully;
those who previously suffered from iron deficiency anemia or B12 deficiency anemia, as well as similar conditions;
women whose pregnancy previously ended in miscarriage;
over 35 years old.

The most popular multivitamin complexes are vitamins Elevit, Vitrum Prenatal and Prenatal forte, Alphabet.

Problems

During this period, some problems may arise that need to be paid close attention to.

Stomach ache

Severe sharp pain in the abdomen can be caused by several pathologies: dilatation of the cervix, bladder infection, etc. If it occurs, you should immediately seek advice from your treating gynecologist.

Abdominal pain close to the sides and moving into the lumbar may indicate stretching of the muscles on which the load increases. These are harmless painful sensations.

Lower back pain

If your lower back hurts, but there are no other symptoms, it is better to change your lifestyle: rest more often, work on your feet less, choose more comfortable shoes. If the work involves standing on your feet for a long time, it is better to take a vacation at your own expense. This is usually how the increased load on the back muscles manifests itself.

Bleeding

Bleeding at any stage requires consultation with a doctor, because it can be a sign of very dangerous complications: miscarriage, ectopic, etc. Bleeding accompanied by cramping or nagging pain in the lower abdomen is especially dangerous.

Temperature

A temperature of up to 37.5 is considered normal if it is not accompanied by an increase in ESR and leukocyte levels, which indicates the presence of an inflammatory process. With more high temperature you need to consult a doctor. You should stop taking most antipyretics at week 12; only paracetamol is harmless to the fetus and the woman. Rubbing with water and vinegar will help reduce the heat.

Toxicosis

Toxicosis already passes at this stage. For some, it ends abruptly in one day, for others, every day the unpleasant sensations appear less and less. However, for some it may continue.

If toxicosis does not subside, this may indicate:

about the individual characteristics of the body;
multiple pregnancy;
incorrect deadline;
presence of the body's reaction to medications taken;
gastrointestinal disorder.

Nausea

Nausea may be a symptom that accompanies early toxicosis and should stop at most by 14-16 weeks. If it is accompanied by diarrhea, this may be a sign of an intestinal infection; in this case, consulting a doctor should be urgent. Systemic digestive disorders can be the result of a malfunction of the gastrointestinal tract, liver and spleen. Taking progesterone and other medications can lead to such consequences. Also, nausea at this stage is sometimes a sign of a deficiency of microelements - for example, magnesium.

Cold

Any illnesses will no longer have such serious consequences as during the previous period. Colds are best treated with bed rest and folk remedies, avoiding taking antibiotics. Under no circumstances should a pregnant woman carry the disease on her feet: it can lead to placental insufficiency and cause fetal hypoxia.

You can treat yourself with plenty of warm drinks - rosehip decoction, herbal teas, berry fruit drinks. Honey in small quantities will be useful. A traditional remedy for colds is warm milk with Borjomi. A mixture with marshmallow, Doctor MOM lozenges, Gedelix will help with cough. Do everything only according to the doctor’s recommendations!

Antibiotics

All the baby’s organs have already formed; the woman can take antibiotics if indicated. A doctor can prescribe antibiotic therapy in the presence of intestinal infections, inflammatory diseases of the genitourinary tract, pneumonia, etc. The doctor must prescribe an antibiotic and dosage, taking into account the disease. The course is to drink it completely so that pathological microorganisms do not become resistant to antibiotics.

Alcohol

Alcohol should be completely avoided throughout pregnancy. No one can say what dose of alcohol in a particular mother will have a detrimental effect on the fetus. For example, scientists have found that a pregnant woman's daily intake of 30 grams. alcohol is associated with the risk of developing fetal alcohol syndrome in the baby. However, fetal alcohol syndrome is also observed in children whose mothers consumed 3-5 grams. alcohol

The danger of alcohol for a baby depends on the characteristics of the body, its reaction to alcohol, condition, the nature of the diet, the genotype of the fetus, etc. Of course, nothing will happen from one glass of dry wine during the entire pregnancy, but you definitely shouldn’t be zealous in this matter.

Miscarriage

A high risk of miscarriage can be observed from the 1st to the 12th week of pregnancy. Starting this week, the likelihood of an unfavorable outcome decreases.

If a miscarriage does occur, the woman should be alert to the following symptoms:

bleeding;
severe nagging pain and spasms in the lower abdomen or pulling sensations in the lower back.

Possible dangers and complications

Some women may experience uterine hypertonicity, which may be manifested by the following symptoms:

a feeling of hardness of the uterus, its stone state;
heaviness and tension in the lower abdomen;
cramping pain in the lumbar or pubic area.

This condition can be provoked by excessive physical activity, stress, or sexual intercourse. This condition is confirmed by ultrasound. Antispasmodics, hormonal medications, and magnesium-containing medications will help you cope. Complications of hypertonicity include the possibility of miscarriage at any stage, fetal hypoxia and placental abruption.

Another danger that can await a woman at this stage is the detection of a frozen pregnancy. Fetal death can occur both in and out, but it will be revealed later. This most often occurs before the age of 13 weeks. A frozen pregnancy can be detected by ultrasound.

There are some symptoms that suggest this pathology:

bloody issues;
cramping pain in the lower abdomen;
abrupt cessation of toxicosis;
basal temperature decreases;
hCG decreases.

If a woman ignores these signs and does not consult a doctor, then intoxication begins: nausea, vomiting, fever up to 39 degrees, weakness and pallor.

12 weeks is deadline, which may reveal ectopic pregnancy. As a rule, a rupture of the fallopian tube has already occurred. The woman feels a sharp pain in the abdomen, lightheadedness, and may lose consciousness. Dizziness begins, decreasing slightly while lying down. If such symptoms appear, it is necessary to urgently call ambulance. The doctor will detect symptoms of internal bleeding: decreased blood pressure, pallor. If you are late in calling an ambulance, the woman may be at risk of death.

Placental abruption is a pathology that can also lead to miscarriage. By 12 weeks the placenta reaches its maturity. If detachment has begun, it is primarily manifested by bleeding, abdominal pain, and tension in the uterus. The woman is usually hospitalized or put on bed rest. The pathology is treated with antispasmodics, drugs that relax the uterus, hemostatic agents, and antianemic drugs. Correct and timely treatment allows you to maintain the further normal course of pregnancy.

Often, during the first ultrasound of a pregnant woman, uterine fibroids are detected. Small - as a rule, only needs observation. If a woman carries her pregnancy to 12 weeks, the risk of miscarriage decreases. It usually does not grow during pregnancy. However, large fibroids can have an impact on the growing fetus as it takes up space in the uterus - the baby may develop a deformed skull or torticollis, and the baby may develop a low birth weight. Often an indication for caesarean section, during which it is excised.

A hydatidiform mole or trophoblastic tumor of pregnancy may appear before. The disease is an increase in chorionic villi. Visually, this is manifested by the fact that the uterus looks much larger than it should be. The skid can be complete or partial. This pathology is determined by ultrasound.

A woman should be wary of:

bleeding;
in 30% of cases - vomiting;
in 30% of cases - hypertension.

In case of pathology, the fetus cannot be saved; curettage is performed with histology. For several months after curettage, the woman monitors hCG. 80% of women recover without consequences, 20% of women whose hCG does not decrease are referred to an oncologist for treatment.

Video

At normal course pregnancy is a time to breathe easy, smile, get an ultrasound photo of the baby and prepare for the upcoming addition to the family.

Women often complain that they have to take too many tests and visit antenatal clinics very often. In fact, modern medicine has come a long way, so now the list of required studies is very small.

In this article, we offer an expanded list of studies, which includes both mandatory and additional tests that can be prescribed to a pregnant woman.

Tests at 4-7 weeks of pregnancy

You are just beginning to suspect that you are pregnant. Therefore, most likely, you will take all tests in the first month of pregnancy on your own initiative. Now your main task is timely, competent diagnosis. This will help you:

Home urine test.

It can be done literally on the second day of missed menstruation. However, in such a tiny period of time, its result can be either false positive or false negative. This is due to the still very low level of pregnancy hormone.

Although experts say that if a modern test with two stripes shows one brighter and the second barely noticeable strip, an important event has arrived! Already with repeated examination, literally in a few days, the second stripe will become brighter.

Ideally, it should be carried out using a vaginal sensor, in which case you will receive the most complete information about the size and condition of the embryo, the number of fetuses (in case of multiple pregnancies). Compared to abdominal (through the abdominal wall) ultrasound examination, the vaginal sensor allows you to install even the most minimum term pregnancy. Ultrasound diagnostics can also exclude ectopic pregnancy.

Biochemical blood test to determine the amount of pregnancy hormone - human chorionic gonadotropin.

An analysis that allows you to determine the onset of pregnancy even at the very minimum stage.

An obstetrician-gynecologist will monitor your health throughout your pregnancy. But sometimes a woman needs to visit related specialists. If there are indications, an examination is carried out by a dentist, otolaryngologist, endocrinologist, geneticist and ophthalmologist.

A visit by a pregnant woman to a local physician is mandatory to obtain an extract from the outpatient card.

Tests to be taken before 12 weeks of pregnancy

Usually, a woman receives a list of directions for all studies necessary by this time from her supervising obstetrician-gynecologist. These include:

Urine tests:

General urine analysis. Determines the presence of protein, indicating problems in the kidneys.
Bacterial culture of urine. It is carried out to identify asymptomatic bacteriuria.

Blood tests:

General blood test to determine platelet count and hematocrit, iron level.
A more detailed examination to determine iron content is necessary if the hemoglobin level in a general blood test is less than 110 g/l. Low levels may indicate iron deficiency anemia in the pregnant woman.

Before 12 weeks of pregnancy a pregnant woman is not required.
Determination of group and Rh factor;
Blood test for the presence of antibodies for Rh negative blood factor;

If Rh is positive, there is no need to worry; if it is negative, the woman needs additional monitoring for the appearance of antibodies in the blood. These antibodies cross the placenta and attack the fetus, causing hemolytic disease.

4. Detection of syphilis infection - blood on RW;

If the reaction is positive, the woman is offered treatment or termination of pregnancy, the presence of syphilis causes irreparable harm to the fetus.

5. Test for HIV infection (AIDS);

This is done to determine whether a woman is a carrier of the virus. Since the mother’s immune system, while protecting the fetus, struggles with all its might to fight any viruses, sometimes the results of the first test, unfortunately, can be both false-positive and false-negative, so it is necessary to take an HIV test twice - at the beginning and at end of pregnancy. If the test result is positive, a re-examination is not prescribed.

6. Test for the presence of HBsAg.

7. First mandatory ultrasound screening

At up to 12 weeks, one of the most important ultrasound screenings is carried out. It is carried out between 11 weeks + 1 day and 13 weeks + 6 days simultaneously with a double biochemical test, free and RAPP A. Such a serious study should not be neglected, the fact is that at this period markers of congenital and chromosomal pathologies are detected.

The following 2 blood tests are given only when indicated:

Biochemical blood test. Gives a detailed description of the composition of the blood, shows the amount of calcium, iron, bilirubin, proteins, cholesterol and other elements in the blood.
Blood test for coagulation, coagulogram (hemostasiogram).

This study is necessary in order to assess the risk of bleeding, and in case of complications, cope with large blood loss during pregnancy and childbirth.

Shows whether the child is in danger placental insufficiency, and for a woman - obstetric bleeding and its complications.

Also, during the registration period, up to 12 weeks, the doctor conducts a vaginal examination and a speculum examination, which includes:

Cytology smear;
Flora smear.

It is carried out according to indications: if the pregnant woman has complaints or the doctor has reason to believe that there is a violation.

In addition to identifying possible infectious diseases (gonorrhea, trichomoniasis), the analysis allows us to qualitatively determine the nature of the microflora of the vagina, cervical canal and urethra. An examination must also be carried out in order to prevent inflammatory diseases of the female genital area and for diagnostic purposes in the presence of complaints.

Examination in mirrors and colposcopy (examination of the cervix under a microscope with the application of diagnostic samples) help to exclude the presence of erosion.

If this study is ignored, the risk of infection of the baby in utero or during passage through the birth canal increases.

Blood test for STDs. An additional study, which is carried out if, after receiving the results of a vaginal smear, a more extensive examination is required to identify infectious pathogens.

If the doctor deems it necessary, additional blood tests may be prescribed for hormones, specific infections and hereditary diseases.

The tests discussed below are no longer mandatory. Moreover, if their results turn out to be positive, it will be almost impossible to influence the course of pregnancy and its outcome.

Taking into account the fact that in most cases a referral for these studies is issued only “to be on the safe side,” a decision was made at the state level to refuse to conduct such tests due to the tedious wait for the results, as well as the expectant mother’s worries about the fact that There is nothing wrong with her child, causing serious harm to the psychological health of a pregnant woman.

Blood test for the presence of rubella antibodies. If you have already had rubella and the test result confirms the presence of antibodies, you do not need to take the test again.
Blood test for TORCH infections: toxoplasmosis, herpes and cytomegalovirus.

The long list listed above does not at all mean that tests will be taken multiple times; during this period, you only give urine, blood from a finger and from a vein once. Based on the samples taken, a complete diagnosis is carried out. If you want to save time, choose laboratories that provide a full range of tests.

Sometimes specialists perform early amniocentesis at 8-14 weeks. This study may be recommended to a woman (but not always) if:

she is over 35 years old;
close relatives have genetic or hereditary diseases;
Ultrasound identified genetic disorders in fetal development;
the fetus experiences intrauterine hypoxia;
there is a Rh conflict;
there is a suspicion of intrauterine infection of the fetus.

Tests from 13 to 17 weeks of pregnancy

Apart from the traditional urine test, which is mandatory for every visit to the doctor, there is no need to take anything else during this period.

The only exception is the first mandatory one, if it was not done within 12 weeks.

If your pregnancy is problematic, specialists may recommend a series of tests to determine levels of various hormones. It is impossible to bring these studies to a common denominator and set clear deadlines for conducting each of them. This is due to the individual characteristics of all expectant mothers.

Also, after 15 weeks, late amniocentesis may be prescribed.

Tests at 18-23 weeks of pregnancy

General urine test or rapid protein detection test.

By this stage of pregnancy, the genitourinary system is subject to double pressure. The fact is that the hormone that promotes pregnancy (progesterone) causes dilation of the ureters and renal pelvis. At the same time, the growing uterus puts pressure on the bladder and again, the ureters, making it difficult for urine to flow out. Such conditions contribute to the development of infection in the renal pelvis.

If the presence of bacteria in the urine is not detected in time, the pregnant woman begins to develop a serious illness that causes complications in the last months of pregnancy and childbirth. You can suspect the appearance of bacteriuria - bacterial infection of the genitourinary system, as well as kidney disease based on the following signs:

painful urination;
dull pain in the lower back on both sides of the spine;
weakness;
temperature increase.

To confirm or refute the diagnosis of bacteriuria, it is necessary to undergo a urine culture (bacterial culture). It is mandatory before 12 weeks of pregnancy, and according to indications - at any time. Its result is assessed no earlier than a week later and shows what kind of infection is attacking the genitourinary system.

If a kidney disorder is suspected, doctors sometimes recommend urine tests according to Zemnitsky or Nechiporenko.

General and biochemical blood tests. It is given only if there is a suspicion of the development of anemia in pregnant women.

In addition to the main indicators, this analysis shows the level of hemoglobin. If you track your tests over time, you may notice significant changes in your indicators by this time. The number of leukocytes may increase, ESR (erythrocyte sedimentation rate) accelerates, the volume of blood plasma increases compared to the mass of red blood cells - the blood thins.

If hemoglobin levels are below normal (below 110 g/l), we can talk about the development of anemia. Under no circumstances should the disease be allowed to develop; the weakness and shortness of breath that accompany an anemic pregnant woman cause serious harm to the baby - he suffers from a lack of oxygen.

To prevent this from happening, you need to start taking iron supplements; keep in mind, they can cause constipation, so make sure your diet contains foods high in fiber, fresh vegetables and fruits. You can also get iron from foods such as beef liver, buckwheat porridge, pomegranate, apples, peanuts, and tomato juice.

If the expectant mother has endocrine disorders, especially those associated with signs of adrenal cortex dysfunction, additional tests may be prescribed to determine hormone levels.

Blood test for HIV infection (week 22-23);
2 mandatory ultrasound screening. It is carried out during pregnancy from 18 weeks to 20 weeks and 6 days (structural abnormalities of the fetus are determined).
It's also ideal to spend biochemical screening The second trimester of pregnancy, consisting of the following studies: hCG, alpha-fetoprotein (AFP), free estriol, together with the results of ultrasound, the risk of chromosomal abnormalities of the fetus is assessed. It is carried out between 16 and 18 weeks of pregnancy.

Tests at 24-29 weeks of pregnancy

At this time, directions are issued for the following tests:

General urine test or rapid protein detection test;
Complete blood test to determine the number of platelets (it should be taken at 29 weeks);
Blood test for syphilis RW (at 29 weeks);
Blood test for the presence of antibodies for Rh negative blood factor (at 28 weeks with uncomplicated pregnancy);
Two hours. Now it is prescribed to all pregnant women.

Even with a normal pregnancy, this analysis is mandatory.

It is given twice if the woman is at risk:

she is obese
she had gestational diabetes in previous pregnancies,
there are close relatives in the family who are diabetics,
previous pregnancies ended in the birth of a child weighing over 4 kg,
in a previous birth, the fetus was stillborn.

According to indications, the following is additionally prescribed:

Individual hormone tests if a woman is at risk.
Coagullogram.

Tests to be taken after 30 weeks of pregnancy

Starting from the 30th week of pregnancy, you will visit the doctor every 2 weeks, respectively. At the 8th month you will take a general urine test at least once every 14 days; at the 9th month the doctor may ask you to do this even more often - once a week.

Of the mandatory tests that the expectant mother needs to undergo at this time, only a general urine test, or a rapid test for protein detection.

Tests at 38-40 weeks of pregnancy

Once every 7-10 days, a traditional urine test is performed, which allows you to monitor the appearance of protein in the urine.

Additionally, the following studies are prescribed:

Vaginal smear - given if a woman has complaints about the condition of the genital area.
Immunological analysis for antibody content. It is carried out only if indicated if the mother has a negative blood type.

Ultrasound - as prescribed by a doctor.

Now the concept of third ultrasound screening has been abolished, however, this diagnosis is very important. For example, it is necessary to monitor the baby’s development, determine its size, weight, position in the womb, or require recommendations regarding the management of future births.

Doppler testing - carried out according to indications together with ultrasound, examines the blood flow of the placenta.
Cardiotocography (CTG) - only when indicated.

Registers the fetal heart rate, its motor activity and uterine tone. It can be prescribed according to indications earlier, from 30 weeks. Or, for example, at 34 and 38 weeks of pregnancy, if systematic monitoring of the fetus is necessary.

How to donate blood correctly?

blood from a vein is donated on an empty stomach (you cannot drink tea, coffee, yogurt, etc.);
the most informative time, in terms of the quality of results, for taking tests is between 7-9 a.m.;
when preparing for biochemical analysis, avoid eating meat products in the evening;
before taking a general blood test, do not eat fatty foods;
blood counts are affected by the production of adrenaline, so before taking tests, try to calm down and not be nervous;
If you feel dizzy at the sight of a syringe, or at the moment of blood sampling, ask the nurse to prepare ammonia.

How to take a urine test correctly?

a couple of days before collecting the analysis, exclude from your diet vegetables and fruits that can change the color of urine (beets, carrots, etc.)
do not take diuretics the day before;
use sterile (boiled or purchased at a pharmacy) dishes;
collect a portion of the first morning urine;
thoroughly wash the perineum with intimate gel and rinse it with water until completely removed;
close the vaginal opening with a cotton swab;
flush the first few milliliters of urine down the toilet and do not collect it in a jar;
if you take two tests at once, for example, general and bacterial culture, prepare separate dishes for each;
the urine portion should not be less than 30 ml.

As you can see, now expectant mothers are not at all required to take a blood test monthly, but at the 9th month - weekly, as was the case just a few years ago. Among the permanent ones subject to constant monitoring are only urine tests. They do not require mandatory control of TORCH infection.

But keep in mind that depending on what other questions the specialists have regarding your health, additional studies may be needed, which the doctor will prescribe on an individual basis. You should not avoid medical supervision, since the life of your child now depends on your well-being.

If the pregnancy proceeds without complications and the mother feels well, then she will be able to look at her baby for the first time during the first screening at approximately 12 weeks of pregnancy. We will talk about what a screening study is at this stage in this article.

What it is?

There are three pregnancy screenings. The Ministry of Health recommended that the very first be carried out at a period of -13 weeks; the 12th week is considered optimal. Then screening tests are carried out in the second and third trimesters (16-24 weeks and 30-36 weeks).

The examination, which is carried out at the very beginning of the process of bearing a baby, includes Ultrasound, and biochemical blood test for the content of the hormone hCG and protein PAPP-A. Based on a number of characteristic markers that are detected in the ultrasound diagnostic room, as well as on the concentration of hormones and proteins in the pregnant woman’s tests, a preliminary calculation is made of the risk of a given woman having a baby with incurable and fatal genetic pathologies.

This stage of prenatal diagnosis allows us to identify women who are most likely to give birth to a toddler with Down syndrome, Turner and Cornelia de Lange syndromes, Patau syndrome, Edwards syndrome, severe neural tube defects, as well as other developmental anomalies that do not leave the slightest chance of cure and a normal life.

Previously, screening was carried out only for those pregnant women who belong to the risk group - women who are already 35 years old and older, who became pregnant from blood relative, those who have previously given birth to children with genetic problems or women who have relatives with hereditary diseases on their side or their husband’s side. If the expectant mother took medications that are prohibited during early pregnancy, she was also prescribed a screening test.

Now this diagnosis is prescribed to all representatives of the fair sex in an “interesting situation” without exception. Of course, a woman can, for personal reasons, refuse screening, but doing this is not entirely reasonable, because the examination itself does not oblige anyone to anything.

It should be noted that Based on the results of screening during pregnancy at 12 weeks, no one will make any diagnoses. This is not the purpose of the screening study. A woman will only have to calculate her individual risks of giving birth to a sick baby, and whether they are healthy can be determined by other methods that will be recommended by an obstetrician and a geneticist if the risks turn out to be high.

The first screening is considered the most important and informative. It is carried out free of charge in a consultation at the place of residence, directions for a blood test and a coupon to the ultrasound room are issued by the doctor with whom the woman is registered for pregnancy.

Procedure and preparation

When undergoing a perinatal examination in the first trimester, it is very important to follow a strict procedure. Ultrasound diagnostics and blood donation from a vein are planned for one day so that the time interval between these two actions is minimal.

Usually, they first undergo an examination in the ultrasound room, and then, with a completed form, go to the treatment room to donate blood. However, in some consultations the order is reversed. In any case, both examinations are completed strictly in one day.

To ensure that the test results are not influenced by negative factors, which include biochemical changes in the blood, accumulation of gases in the intestines, it is recommended that Prepare thoroughly for diagnosis. For two days you should go on a short diet - do not eat fatty and very sweet foods, fried and smoked foods, and six hours before the blood test you should not eat at all. A blood test is taken on an empty stomach.

Before the ultrasound, you should take Smecta or Espumisan a couple of hours to get rid of intestinal gases, which are faithful companions of pregnancy, since they can put pressure on the pelvic organs and the ultrasound results may be inaccurate.

Ultrasound at 12 weeks is performed with a transvaginal sensor; the second method is through the abdomen, until it gives a clear picture and idea of what is happening inside the uterus.

On the appointed day, the woman comes to her obstetrician-gynecologist's office, is weighed, has her height measured and fills out a detailed questionnaire. The more data it contains, the more accurately the risks will be calculated. The questionnaire includes information about previous pregnancies, miscarriages, abortions, the woman’s age and weight, information about her bad habits(smoking, alcohol), information about the husband and the health status of close relatives.

Then there will be an ultrasound, and then blood donation. The general results will be entered into a single form; a special program will “compare” the genetic portrait of the pregnant woman along with her tests with the “portraits” of women with a high risk of giving birth to a sick baby. As a result, an individual calculation will be issued.

Ultrasonography

In the ultrasound room, the doctor will examine the baby, determine whether everything is fine with him, where he is located in the uterine cavity, and also check the baby for the presence of markers that indicate a high probability of having a child with genetic syndromes. At week 12, the expectant mother will be able to see her baby, listen to his little heart beat, and also see the movements of the fetus, which she does not yet physically feel.

The doctor will definitely indicate in the protocol for the first trimester screening study: how many fetuses are visualized in the uterine cavity, Do they show signs of vital activity? They will also describe the main dimensions, which will make it possible to clarify the timing of the “interesting situation” and find out how the baby’s development proceeds.

The normal development indicators at 12 weeks are as follows:

Fetal head circumference (HC) is 58-84 mm, most often 71 mm.

The coccygeal-parietal size (CPR) is 51-59 mm, most often 55 mm.

Bipariental head size (BPR) is 18-24 mm, most often 21 mm.

Heart rate (HR) – 140-170 beats per minute.

Motor activity is present.

In addition, the doctor determines the two most important markers for diagnosing genetic pathologies - the thickness of the collar space and the presence of nasal bones in the baby. The fact is that in children with severe developmental defects, the cervical fold is enlarged due to subcutaneous fluid (edema), and the nose is flattened. He will be able to examine the remaining facial bones only after one and a half to two calendar months.

TVP (thickness of the nuchal translucency) at 12 weeks in the absence of pathologies does not go beyond the range of 0.7-2.5 mm. If the baby exceeds this parameter slightly, the expectant mother may be advised to undergo an ultrasound again in a week. If TVP significantly exceeds the upper limits of normal, additional examination will be required; the risks of giving birth to a sick baby increase. We are talking about an excess of 3.0 mm and above.

Nasal bones can be much more difficult to discern; they are not always visualized at 12 weeks; the fetus may have its back to the doctor’s sensor and stubbornly refuse to turn around and let its nose be measured. If this was possible, normal values for the length of the nasal bones at this stage are considered to be values that do not fall within the range of 2.0-4.2 mm.

If the doctor indicated that at 12 weeks these bones are not visualized or their size is less than 2 mm, a program that calculates risks will increase the individual likelihood of giving birth to a child with Down, Turner, Patau syndrome.

In fact, the baby may just have a small, miniature nose, which is still difficult to capture in numerical value, especially on an old ultrasound scanner with low image clarity.

Theoretically, at 12 weeks you can already try to determine the sex of the child, because the external genitalia are formed, and if the baby is conveniently positioned and open to the eye of the diagnostician, they may well be noticed. However, you should not expect guarantees from the doctor that the birth will be a boy or a girl. The gender at this time can only be named tentatively (the probability of an accurate hit is approximately 75-80%). The doctor will more accurately assess the baby’s sexual characteristics at the next ultrasound, after 16-17 weeks of pregnancy.

Additionally, an ultrasound scan at the end of the first trimester evaluates the probable threats of miscarriage - thickened uterine walls may indicate the presence of hypertonicity, as well as the condition of the cervix, fallopian tubes, and cervical canal.

Blood chemistry

In an analysis of the venous blood of a pregnant woman, a laboratory technician identifies the amount of hCG hormone and plasma protein PAPP-A contained in it. Because only two blood components are assessed, the first screening test is called a "double test." The results of this study, unlike ultrasound data, which a woman is given immediately after undergoing it, will have to wait from several days to several weeks - this depends on how long the line is lined up for the study in an accredited medical genetic laboratory.

One can only guess what numbers will be as a result of the analyzes, since individual laboratories use their own standards in calculations. To simplify decoding, it is customary to talk about the norm of PAPP-A and hCG in MoM - a value that is a multiple of the median. During a healthy pregnancy, when both the baby and the mother are doing well, both values “fit” within the range of 0.5 to 2.0 MoM.

Fluctuations from this range up or down give rise to a lot of anxiety in pregnant women and There are many possible reasons:

Increased hCG.“Too much” in this indicator can be a sign of Down syndrome in a baby, as well as a sign that a woman is carrying more than one child. 2 fruits together give a practical double increase in the hormone norm. Elevated hCG may occur in a woman who suffers from excess weight, edema, toxicosis, diabetes and hypertension.

Decreased hCG. An insufficient level of this hormone, which is unique to pregnant women, is characteristic of the development of Edwards syndrome, and can also indicate the likelihood of a miscarriage or a delay in the development of the baby.

Decrease in PAPP-A. A decrease in plasma protein in a sample sometimes indicates the development of conditions such as Down, Patau, Edwards, and Turner syndromes. Also, an insufficient amount of this substance often indicates the baby’s malnutrition, which means that the baby is deficient in the nutrients and vitamins it needs for normal development.

Increase of PAPP-A. An increase in protein in a sample does not have much diagnostic value in terms of calculating the possible risk of chromosomal disorders. This indicator may be higher than normal in case of twins or triplets, as well as with a tendency to a large fetus.

How are risks calculated?

The results of tests and ultrasound, as well as all available information about the state of health of the pregnant woman and her age, are loaded into a special program. Thus, the calculation of individual risk is carried out by a machine, but the result is double-checked by a person - a geneticist.

Based on a combination of factors, individual the risk may look like a ratio of 1:450 or 1:1300 for each disease. In Russia, a risk of 1:100 is considered high. Threshold risk– 1: 101 – 1: 350. Thus, if a pregnant woman’s probability of having a baby with Down syndrome is calculated to be 1: 850, this means that one in 850 children of women with identical health indicators, age and other criteria will be born sick. The remaining 849 will be born healthy. It's low risk and nothing to worry about.

Women for whom screening diagnostics at 12 weeks show a high risk for a particular genetic disease are recommended to undergo additional diagnostics, since screening itself cannot be considered the basis for making a final verdict, it's not that accurate. You can take a non-invasive DNA test. Such an analysis costs several tens of thousands of rubles and is performed exclusively in medical genetic centers and clinics.

If the analysis confirms suspicions, you will still have to go for an invasive test.

Amniocentesis or chorionic villus biopsy can be offered immediately, without wasting time and money on examining the baby’s blood cells isolated from the mother’s blood, as is done with a non-invasive DNA test. However, both biopsy and amniocentesis involve penetration into the membranes to collect material for analysis. The procedure is carried out under ultrasound control only by experienced doctors, but the risk of fetal infection, rupture of water, and termination of pregnancy still remains.

Agree or disagree to undergo an invasive examination when high risks- a personal matter for every woman; no one can force her to do this. Analysis accuracy is 99.9%. If the disappointing assumptions are confirmed, the woman is given a referral to terminate the pregnancy for medical reasons. Whether to interrupt it or not should also be decided only by the woman herself and her family.