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Pregnancy for first-timers and non-first-timers

You just realized that you are pregnant. Congratulations! But… Now what’s next? Don’t worry, here we leave you a link to the weeks of pregnancy calculator, as well as a list with all the studies that can be performed, their reference values and an infinite number of details that I usually explain in the consultation but in case you forget or if they go to another doctor they will be able to review the information and take control of their pregnancy, because #KnowledgeIsSuccess

Before getting pregnant

As always, the first thing is folic acid, you should take it from the moment you are trying to get pregnant and during the first 3 months, after 3 months you can continue taking it but it is no longer as essential as right at the beginning of pregnancy. What dose? 400 micrograms daily, that is, 0.4 mg, please do not self-medicate and if you are taking several multivitamins, check that when adding the doses of folic acid they do not exceed 1 mg per day. You can go to Creafam at any time during your pregnancy, you do not need to have been infertility patients but usually during the first trimester we carry out 5 consultations, one every 2 weeks.

Week 4 or 5: First consultation

The first consultation is usually in week 4 or 5 when they suspect that they are pregnant and have already confirmed it with a pharmacy pregnancy test or come directly to us for an ultrasound. Remember that ultrasound is completely safe, it does not harm your baby and you can perform each and every consultation.

Do not worry if your doctor does not detect the heartbeat at this time, the really important thing is to ensure that the gestational sac is inside the uterus, if the sac were outside the uterus it would be an ectopic pregnancy and the pregnancy would have to be stopped to protect life of the mother.

And another thing… Almost every day they write to me on YouTube asking me if their baby’s heart rate is okay because in the consultation the doctor told them that he was a little weak, please remember that right now your baby is growing very fast, one week to the next it can double its size and its heart rate can also vary depending on whether the mother has been at rest or, for example, if she had to climb stairs to get to the doctor’s office, if the consultation was before breakfast or after eating. or with all the stress of a heavy afternoon. We cannot be guided by the measurement of a single consultation to say that the heart rate is wrong and the essential thing is that in the first trimester that heart rate gradually accelerates, it will even reach up to 200 beats per minute and that is considered completely normal, that will tell you that the baby’s development is going appropriately.

In that first consultation we are going to check how the mother is doing: Her blood pressure, heart rate, height, weight, if she is taking medications and with all that information we can assess throughout the pregnancy if any of these variables begin to go out of control. control, additionally we give you some recommendations for your diet but right now I am not going to stop at that because we already have 3 videos that talk about prohibited foods, recommended foods and nutrition tips for women with nausea, over 40 years old or athletes who do a lot of exercise.

At the end of the first consultation we give them a container so that when they return they can bring us a urine sample.

Alimentos prohibidos en el embarazo
Nutrientes recomendados o esenciales
Náuseas, deportistas y/o mayores de 40

Week 6: General Urine Exam

The next consultation is in week 6, they must come with a sample of their first urine in the morning. The general urine test is inexpensive, simple, and helps us detect infections, hormonal and nutritional imbalances, and even the risk of preeclampsia. It’s one of the most fabulous exams ever, please do it.

Did you know that urine test protect your pregnancy?

Week 8: Blood count and blood chemistry

From there we go to week 8, already two months pregnant. Time flies very quickly! And we are starting to worry that there is anemia or some other imbalance, so we perform a blood count and blood chemistry.

Here we have the reference values and what it means when one is elevated, however, each woman is unique and these values must be compared with the data we took at the beginning of pregnancy.

Week 12: First trimester screening

12 weeks ultrasound (Sex and Down syndrome) Screening First Trimester of pregnancy

In week 12 we arrive at the study that I consider the most important study of the entire pregnancy, it is the first trimester screening, it is also known as combined screening, duo test, double marker and it can predict up to 90% if your baby has the risk of presenting Down syndrome or some other chromosomal problem… But that’s because to calculate the risk, three things are necessarily required.

  • First: Mother’s blood test.
  • Second: Measure the length of the fetus, its nasal bone and nuchal translucency
  • Third: Carry out the study between weeks 11 and 13.

If it is not performed between weeks 11 and 13, the accuracy of the study drops, it is like doing a flip, it is 50% and if the blood biochemistry is not performed on the mother, then it is an ultrasound of the first trimester, simply take measurements and Measurements must always be taken complete.

You can’t imagine the number of patients who come to see me because they had a “First Trimester Screening” and they were charged in full! But in reality the only thing the doctor did was measure nuchal translucency. And at week 15! … And since it looked very big, he told them that the baby definitely had Down syndrome. And no, the truth is that no, because at week 12 the translucency should be less than 3 mm but as the baby grows, and if they measure it until week 15, it is logical that this space has already grown too much, and as I just said, the results of the blood study and all the measurements have to be entered into a system that calculates the risk accurately.

Please, you have to do all this, otherwise it is useless and it is the most important study of pregnancy.

Week 16: Sex of the baby and sometimes amniocentesis

Now the second trimester begins and we are going to leave a full month for the next consultation. At week 16, there we perform an obstetric control, another general urine test because an infection could appear at any time and only if there is a true suspicion of Down syndrome could we perform an amniocentesis.

In an amniocentesis we insert a needle through the mother’s abdominal wall to extract a little amniotic fluid. This fluid contains the baby’s cells that naturally come off the baby’s body and are floating inside the tummy. These cells are sent genetic study and can give us 100% certainty as to whether or not a syndrome exists. And if you like, you can also know the sex of your baby.

Although by week 15 it is very likely that we, through the ultrasound study, will know 100% if it is a boy or a girl.

Amniocentesis (Removal of amniotic fluid) for Cystic Hygroma

Week 20: Morphological study

Morphological Study of 3 triplet twins with anomaly in the Umbilical Cord

From week 20 we can perform the morphological study, in general it takes us from 30 minutes to a full hour because measurements are taken of all the bones, we check that all the organs are present and functioning well, that there is no cleft lip, that their eyes and pupils can be seen clearly, complete fingers, well-differentiated brain, we can even check the little heart, although later there will be a study completely focused on your baby’s heart.

Week 24: Obstetric control

We do the last consultation of the second trimester until week 24, in this we are not going to do any special study for the baby, it is simply to continue monitoring the mother and the development of her baby.

Week 26: Sugar Test (O'Sullivan)

We have already reached the third trimester, in week 26 the essential thing is to make sure that we do not have gestational diabetes, since during pregnancy, even if you have never had diabetes or problems controlling sugar, all women are prone to having gestational diabetes.

And I get asked a lot if diabetes affects your baby, the truth is that it does. All that extra sugar will go to your baby, it will make the baby chubbier than normal, which will greatly increase the probability of having to have a cesarean section. All that sugar they received during pregnancy, they need it at birth. So what’s up? They cause hypoglycemia, a baby born to a diabetic mother during her life has a higher risk of developing diabetes, so yes, it does affect her baby.

Now, it’s not just about the baby. A mother with diabetes can also suffer from hyperglycemia and which can end in a diabetic coma, she could also develop blood pressure so high that it can cause damage to her eyes, hearing or even a stroke.

In Mexico, 15% of all deaths that exist are due to diabetes. In week 26 you have to take a sugar test no matter what, there is no other way, remember 15%!

What does preeclampsia feel like? and signs of other complications

Week 28: Fetal echocardiography

A heart at 28 weeks (Fetal Echocardiography) Ultrasounds of the third trimester of pregnancy

As soon as we reach week 28, we recommend performing fetal echocardiography, this is the last specialized ultrasound that is performed on the baby and of course, we once again thoroughly review all of the baby’s organs, measurements and bones, but the most important thing is to ensure that the heart is well formed: Every atrium, every ventricle, every valve, every blood vessel that that little heart has. That the heart has a good position within your chest, that it has an adequate size for your baby’s chest, that there is no reflux of blood, that there are no communications between the ventricles, that all your atria and ventricles are of proportionate sizes .

If we detect a serious problem, we could not operate at this time, but we could prepare to have a cardiologist at the time of birth.

Week 32: General Urine Exam

If everything goes well in the fetal echocardiography, we usually wait another month for the next consultation and at week 32 we perform another general urine test, along with monitoring the mother’s health.

Week 34: Fetal monitoring

As I told you at the beginning of the video, now, starting from week 34, it will be essential to record fetal monitoring. We have to ensure that your heart rate is between 120 and 160 beats per minute, you must measure a little more than 34 cm and weigh a little more than 2 kg.

If the baby is too small, it could be that he or she begins to have a growth restriction. This usually happens when there are twins, triplets, or when there is a problem with the umbilical cord or poor nutrition.

Week 36: Pre-birth studies

From week 36, that is, 8 months, the baby is ready to be born and could arrive at any time. Then, we take blood samples from the mother to assess its coagulation and rule out anemia, everything necessary to reduce the risk. bleeding during or after childbirth. We are going to check if the baby has already turned upside down and that the umbilical cord has not become tangled.

Weeks 37 onwards: Ready for delivery?

Now the consultations would have to be done every week. I recommend watching our videos on the signs of labor and if you notice any signs, contact your doctor immediately. Don’t worry if your baby moves a lot or you feel like he or she moves little, it is normal for these variations to exist, your baby is not sad or upset or angry with you. The real alarm signal is if you suddenly notice that she hasn’t moved at all all day or all night. If you notice that, go to the hospital and have fetal monitoring performed.

Am I in labor? Symptoms, myths and false alarms (Signs before giving birth)

Were you looking for recommendations For each trimester?

Explaining all the studies and recommendations in a single 12-minute video is practically impossible, which is why we also have 3 videos that explain the recommendations and studies for each quarter in greater detail.

First trimester of pregnancy
Second trimester of pregnancy (Advice and studies)
Third trimester of pregnancy (Care and humanized birth)

Sorry for making a video that is so technical and focused on studies, but I think it is very important that you understand the usefulness and reason for everything that we specialists in Maternal Fetal Care do. I hope that now you no longer feel like new moms and dads, but like prepared moms and dads!

Dr. Carlos Monsalve
Dr. Carlos Monsalve
Specialist in gynecology and obstetrics

Perinatology, invasive techniques and obstetric ultrasound.
Hospital Universitario La Fe, Valencia, España.

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