Pregnancy follow-up

What is it about ?

A good follow-up of the pregnancy:

• contributes to the safe birth of a healthy child;
• limits the risks for the mother;
• allows the mother to live her pregnancy safely and in the greatest possible comfort;
• guarantees rapid handling of any problems.

The details of the follow-up depend on your preferences and those of your partner, as well as any regional recommendations for care and follow-up. Professional follow-up makes perfect sense, as has been demonstrated on numerous occasions. This patient guide focuses on the follow-up of a normal pregnancy, without major problems requiring the follow-up of a specialist.

Pregnancy monitoring is preferably well structured. The ONE pregnancy logbook is a practical tool for this. This notebook contains information for future parents and the medical records of healthcare professionals, thus promoting communication between parents and professionals. It also contains all the certificates necessary to obtain social benefits for the parents and for the child. Sharing information between caregivers and parents is essential for a successful pregnancy.

The main objectives of pregnancy monitoring are:

• early detection and limitation of potential risks to mother and child;
• monitoring of maternal and child health;
• early detection and treatment of possible pregnancy-related problems;
• facilitating the transition from pregnancy to labor and delivery .

How is pregnancy diagnosed?

The urine test is reliable enough to show pregnancy. If the test is positive, you are pregnant. The result should not be confirmed by a blood test.

Who can monitor your pregnancy?

In Belgium, pregnancy monitoring can be provided by a general practitioner, a midwife and / or a gynecologist. This guide mainly deals with the follow-up of a normal pregnancy, by a general practitioner or a midwife.

If you are pregnant, a file will be created in your name. The modalities of monitoring your pregnancy depend on the possibilities and your personal preferences. The checks planned for a first pregnancy are generally a little more numerous than for a second.

What are the stages of pregnancy monitoring?

A normal pregnancy is a pregnancy with a single fetus (single pregnancy) and lasts between 37 and 42 weeks (40 weeks on average). The general practitioner or midwife sees you regularly to assess the elements to be taken into account to analyze the risks. A number of follow-up appointments are scheduled, which may vary slightly depending on the situation.

First date

The first appointment will preferably be split over two consultations, because it talks about many points such as:

• the finding of pregnancy;
• reviewing any preventive measures (folic acid, vaccinations, risk of infection, diet, etc.);
• the creation of a file containing the medical history ( see below );
• measurement of starting weight and height;
• blood pressure measurement;
• the detection of risks which could lead to an abnormal course of the pregnancy;
• a blood test ;
• a presentation of screening tests.

Creation of the pregnancy file

The following items are noted in the pregnancy record:

• Your medical history:
  • You will be asked if you have certain ailments or diseases (eg epilepsy , diabetes , etc.) or if you have to take certain medications chronically. Based on your medical history, your general practitioner or midwife will determine whether your pregnancy requires specialized monitoring.
  • You will be asked if you have had any infectious diseases (eg toxoplasmosis ), as this may be important for your child’s health.
  • Stricter pregnancy monitoring is required in women under 16 or over 40.
• Your gynecological history:
  • Certain infections, diseases of the uterus,… can complicate the normal course of a pregnancy.
• Your vaccination status:
  • At the start of your pregnancy, we will check whether you are immune to certain infectious diseases (eg toxoplasmosis ).
  • Some vaccines need to be given during pregnancy, such as the pertussis vaccine and the flu shot during flu season .
• Ultrasound results:
  • An ultrasound helps monitor the baby’s development. Each organ system is examined in a targeted manner. The growth rate of the fetus is also measured.
  • During a normal pregnancy, three ultrasounds (reimbursed) are necessary.

Screening tests

Certain diseases are screened in order to detect abnormalities early ( see also “follow-up appointment” ). Screening tests are used to detect:

• the presence of protein in the urine and high blood pressure (hypertension) (for early diagnosis of toxemia of pregnancy (preeclampsia));
• a diabetes (gestational) (glucose test (test glucose tolerance by oral route (OGTT)));
• the presence in the blood of antibodies to certain infectious diseases:
  • rubella ;
  • HIV ;
  • syphilis ;
  • hepatitis B ;
  • toxoplasmosis ;
  • cytomegalovirus (CMV) (in some cases);
  • chickenpox (in some cases).
• Group B streptococcal infection: this screening is done using a small smear from the vagina and anus. If the bacteria are found there, the baby may have problems after birth;
• the presence of genetic abnormalities in the baby, eg by means of noninvasive prenatal screening (DPNI) from the 10 ^th week of pregnancy. The baby’s DNA is analyzed through the mother’s blood. The main objective of the test is to detect trisomies 13, 18 and 21 ( Down syndrome ).

If an anomaly is noted, you will be referred in a targeted manner or put under certain treatments.

Follow-up appointments and routine exams

In the case of a normal pregnancy, the first appointment is followed by 9 routine appointments, each with its own schedule:

• Around 12 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • blood test for possible screening tests ( see above );
  • urinalysis for bacteria ;
  • control of fetal heart sounds;
  • 1 ^re ultrasound .
• Around 16 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • urinalysis for bacteria (if not done at 12 weeks);
  • control of fetal heart sounds;
  • estimate of the size of the uterus.
• Around 20 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • control of fetal heart sounds;
  • estimation of the size of the uterus;
  • 2 ^e ultrasound , with detailed examination of each organ system (heart, kidneys, brain, …) of the fetus.
• Around 24-28 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • fetal control (movements, growth, heart sounds);
  • estimation of the size of the uterus;
  • blood test;
  • glucose test (OGTT) for screening for diabetes (gestational);
  • administration of pertussis vaccine .
• Around 30-32 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • fetal control (movements, growth, heart sounds);
  • estimation of the size of the uterus;
  • 3 ^e ultrasound to monitor any growth abnormalities and fetal position.
• Around 34 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • fetal control (movements, growth, heart sounds, position).
• Around 36 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • fetal control (movements, growth, heart sounds, position);
  • estimation of the size of the uterus;
  • screening for group B streptococci ( see above ).
• Around 38 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • fetal control (movements, growth, heart sounds, position).
• Around 41 weeks:
  • blood pressure and weight control;
  • detection of protein in urine using a urine dipstick;
  • control of the (well-being of the) baby (movements, growth, heart sounds, position);
  • preparation and planning for childbirth .

>> Download our flowchart containing practical information on all follow-up appointments during pregnancy.

What can you do ?

Choice of healthcare provider

The mother and the child have every interest in benefiting from a good follow-up. If you think you are pregnant, take a pregnancy test as soon as possible. If the urine test is positive, it is important that you quickly choose a healthcare provider (midwife, general practitioner and / or gynecologist). Remember that your GP, too, has the necessary experience to monitor your pregnancy. Whichever healthcare provider you choose, they will support and guide you through the various treatment options. The ONE pregnancy diary contains a lot of valuable information and is therefore a practical working tool.

Folic acid

A folic acid supplement is recommended as soon as you are pregnant. Folic acid is an essential vitamin for the development of the nervous system of the child. A folic acid supplement is recommended as soon as you have a desire for pregnancy. It is best to start it 2 months before you get pregnant and take it during the first 12 weeks of pregnancy. For a normal pregnancy, the dose is 0.4mg per day.

Self-care during pregnancy

When you are pregnant, it is very important to take care of yourself as best as you can:

• Eat healthy and get enough exercise. You will find, in the ONE pregnancy diary, the foods that are best to avoid during pregnancy. You are going to gain weight anyway. Ask or seek concrete advice that will help you manage your weight.
• Listen to yourself and listen to your body. Your mental health is also very important. Pay attention to the signals your body sends you when something goes wrong, and discuss your concerns with your GP and / or midwife.
• Consult a doctor:
  • if you notice your baby moving less or not moving after 28 weeks of pregnancy;
  • if you have headaches, vision problems and stomach aches at the same time .
• Do not smoke , drink alcohol, or use cannabis or other drugs during pregnancy. If you are dependent on a specific product, talk to your doctor and / or midwife.
• The sauna is not recommended during pregnancy.
• Sex is not a problem; no risk has been demonstrated for the baby.
• The usefulness of systematic intake of iron or other vitamins is not proven. Only vitamin D may be of interest in some cases. Your midwife or general practitioner can give you more information about this.
• In the car, use your seat belt correctly: above and below the stomach, never across it.
• In the event of a long-haul flight, wear varicose vein stockings (compression stockings) to reduce the risk of thrombosis .

Pregnancy and labor

The best time to announce your pregnancy to your employer depends on individual factors. Sometimes the work involves risks for both mother and child, especially when it is heavy work or if you are in contact with chemicals. If you work in the care sector or if you are around a lot of people, you can run some risks. Talk to your doctor and / or midwife and, if necessary, contact the occupational doctor.

Prenatal care and information

• Look for group antenatal care sessions, pregnancy and breastfeeding information sessions ,… near you. There is no shortage of initiatives, they are often organized by maternity hospitals and / or midwives. Take advantage, you will meet other expectant mothers in your area and you will certainly get something out of it.
• In any case, discuss your questions and doubts about the pregnancy, birth and follow-up with your healthcare provider. Make sure you understand the information provided to you.
• Apart from the medical aspects, there are other things that can complicate your pregnancy. If you find it difficult to seek help due to socio-economic problems, because you are a single mother, because you did not want this pregnancy or for any other reason, contact a Medico-Social Worker. (TMS) of ONE. He will provide you with the necessary support.

Complaints during pregnancy

There are a lot of pregnancy-related complaints that you can deal with on your own:

• Nausea and vomiting : Usually goes away on their own after 16-20 weeks of pregnancy. If nothing relieves you (for example eating a cracker before getting up), you can take medicine after asking your doctor for advice.
• Reflux : watch your diet. You can possibly take medication. Ask your doctor for advice.
• Constipation : Eat foods high in fiber, drink plenty of water, and get enough exercise. If this is not enough, ask your doctor for advice.
• Hemorrhoids : Adapt your diet to keep your stools soft. Avoid constipation .
• Calf cramps : try stretching regularly.
• Varicose veins : frequent during pregnancy. Wearing varicose veins (compression stockings) can provide relief.
• Back pain : keep moving (e.g. swimming), perform specific back exercises and get a massage if necessary.
• Pelvic instability: develops as pregnancy progresses and affects about 1 in 2 pregnant women. It is characterized by severe pain in the pelvis, which may radiate to the legs and tailbone. Your doctor can prescribe specific physiotherapy sessions for you.
• Tingling in the hands ( carpal tunnel syndrome ): The swelling of the tissues puts pressure on the nerve , causing the complaints. If you have it during your pregnancy, wait and see if the complaints persist after childbirth .

Source

• www.ebpnet.be

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