Pregnancy Monitoring – Prenatal Screening

After confirming an early pregnancy, which can be done through a beta-hCG measurement accompanied by an ultrasound examination, a series of blood tests and other medical evaluations should be conducted.

1.      First Visit to the Clinic (first trimester)

During the first visit, weight, blood pressure, and pulse are checked, and a detailed medical history (personal, family, gynecological, and obstetric) is taken. The following tests are then performed:

Blood Tests

• Complete Blood Count (CBC): Checks hematocrit, hemoglobin, platelets, and white blood cells.
• Blood Type – Rhesus Factor and Coombs Test (Direct & Indirect): It is crucial to determine blood type (O, A, B, AB) and Rhesus factor (positive or negative) for pregnancy progression. If the woman is Rhesus-negative, the partner is also tested. If the partner is Rhesus-positive, the woman undergoes indirect Coombs testing throughout the pregnancy.
• Hemoglobin Electrophoresis: Detects if the woman is a carrier of beta-thalassemia (thalassemia trait). If positive, the partner must also be tested.
• Sickle Cell Test: Determines if the woman is a carrier of sickle cell anemia. If positive, the partner must also be tested.

Biochemical Tests

• Fasting Blood Sugar, Iron, Ferritin, Uric Acid
• Thyroid Hormones: TSH, FT3, FT4, Anti-TG, Anti-TPO
• Liver Function Tests: SGOT, SGPT, γ-GT, ALP
• Kidney Function Tests: Urea, Creatinine, Sodium, Potassium
• Vitamin D3

Infectious Disease Screening

• Syphilis (VDRL)
• Hepatitis B (HBsAg)
• Hepatitis C
• HIV
• Rubella (German Measles) Screening: IgG antibody (indicates past infection) and IgM antibody (indicates recent infection).
• Toxoplasmosis Screening: IgG and IgM antibodies.
• Cytomegalovirus (CMV) Screening: IgG and IgM antibodies.

Urine Tests

• Urine Culture: Checks for possible urinary tract infection.
• Urinalysis: Screens for infection, hematuria, proteinuria, etc.

Additional Tests

• Pap Smear Test (if not recently done).
• Vaginal Fluid Culture.
• Cystic Fibrosis Gene Mutation Screening (most common mutation: ΔF).
• Hearing Loss Gene Mutation Screening (35delG).
• Spinal Muscular Atrophy (SMA) Gene Mutation Screening.
• Thrombophilia Genetic Screening.
• Cardiological Examination.

Following these, a Nuchal Translucency Ultrasound is performed.

Invasive Diagnostic Tests

Invasive tests are conducted based on indications from the Nuchal Translucency Scan and Non-Invasive Prenatal Testing (NIPT). Specifically:

• Chorionic Villus Sampling (CVS): Conducted between the 10th and 15th weeks of pregnancy to diagnose chromosomal abnormalities like Down Syndrome.
• Amniocentesis: Conducted between the 15th and 20th weeks of pregnancy for the same purpose.

2.     Second Trimester (Weeks 13-28)

Every 6 weeks, the following tests are performed:

• Complete Blood Count (CBC)
• Urinalysis
• Fasting Blood Sugar
• TSH
• Vitamin D
• Toxoplasmosis Screening (IgG and IgM antibodies)
• CMV Screening (IgG and IgM antibodies)
• Rubella Screening (IgG and IgM antibodies)

Glucose Tolerance Test (26th-28th Week)

After the Level 2 Ultrasound (Anatomy Scan), the Glucose Tolerance Test (GTT) is conducted between the 26th and 28th weeks. This test requires fasting, and the patient drinks 75g of glucose dissolved in water. Blood samples are taken:

1. Before drinking the glucose
2. 1 hour after consumption
3. 2 hours after consumption

Desired blood sugar values:

• Fasting: >60 mg/dl and <96 mg/dl
• 1 hour after glucose: <180 mg/dl
• 2 hours after glucose: <153 mg/dl

3. Third Trimester (Weeks 29-40)

• Growth Ultrasound – Doppler Scan
• At 36 weeks: Vaginal fluid culture for Group B Streptococcus (GBS) to prevent infection, especially for vaginal birth.

If complications arise or the pregnancy is classified as high-risk, the frequency and type of tests are individualized.

Summary of Prenatal Visits

First Visit (5th – 8th Week)

• Blood & Urine Tests
• Genetic Screening for Cystic Fibrosis, SMA, and Thrombophilia
• Ultrasound to confirm pregnancy age and fetal heartbeat

Second Visit (11th – 13th Week)

• Urinalysis
• Start prenatal supplements
• Nuchal Translucency Ultrasound

Third Visit (16th – 18th Week)

• CBC, Urinalysis, Blood Sugar, Toxoplasmosis, Rubella, CMV (IgG, IgM), Vitamin D, TSH

Fourth Visit (20th – 23rd Week)

• Level 2 Ultrasound – Doppler of Uterine Arteries – Cervical Length Check
• CBC, Urinalysis, Blood Sugar, Toxoplasmosis, Rubella, CMV (IgG, IgM), Vitamin D, TSH

Fifth Visit (26th – 28th Week)

• Fetal Growth Ultrasound
• Glucose Tolerance Test (75g glucose at 0’, 60’, 120’ minutes)
• CBC, Urinalysis, Blood Sugar, Toxoplasmosis, Rubella, CMV (IgG, IgM), Vitamin D, TSH

Sixth Visit (30th – 32nd Week)

• Doppler Ultrasound – Fetal Growth Assessment

Seventh Visit (34th Week)

• CBC, Urinalysis, Blood Sugar, Toxoplasmosis, Rubella, CMV (IgG, IgM), Vitamin D, TSH

Eighth Visit (36th Week)

• Fetal Growth Ultrasound
• Vaginal Culture for Group B Streptococcus (GBS)
• Non-Stress Test (NST)

Ninth Visit (37th Week)

• Fetal Growth Ultrasound
• Non-Stress Test (NST)
• Urinalysis

Tenth Visit (38th Week)

• Fetal Growth Ultrasound
• Non-Stress Test (NST)
• Urinalysis

Eleventh Visit (39th Week)

• Fetal Growth Ultrasound
• Non-Stress Test (NST)
• Urinalysis

This prenatal monitoring plan ensures a comprehensive health assessment for all pregnancies. In cases of complications or high-risk pregnancies, the tests are customized accordingly.