Tests and treatments recommended during pregnancy
Before pregnancy if possible, otherwise at the first consultation:
– If no history, consult a specialist nurse for genetic disease screening (סקר גנטי).
– If there is a known history of a genetic disease in the couple or family, consult a geneticist (יעוץ גנטי).
– If taking medication, consult a teratology physician – Cervical screening smear (PAP) or HPV PCR screening Test. To be done if more than 3 years old.
– Folic acid intake (400 micrograms to 5 mg daily); if possible, start 2 months before pregnancy onset.
– Vitamin B12 check, and supplementation especially in vegetarian patients.
– Flu Vaccination Board (שפעת), September to January.
– Consultation with an obstetrician gynecologist to assess the possibility of a high-risk pregnancy.
During pregnancy:
Between 4 and 11 weeks of amenorrhea, and in any case, during the first consultation:
– Check patient and spouse’s medical history and family history.
– Check obstetric and gynecological history.
– Provide an update on drug and other allergies.
– Clinical examination.
– Weight/height ratio. Body Mass Index (BMI)
– Prescribing Baseline: Blood Count (CBC), fasting blood glucose. Serology rubella, toxoplasmosis, cytomegalovirus, varicella, syphilis, hepatitis B and C, blood group and irregular agglutinins (indirect coombs). HIV serology.
– Echography of pregnancy dating and verification of embryonic vitality.
– In case of multiple pregnancy, check for the presence of one or more separate or separate egg sacs.
Between 11 and 13+5 weeks of amenorrhea:
– Fetal Neck Ultrasound (שקיפות עורפית)
– First trimester Trisomy 21 blood screening (PAPP-A, free B HCG). To be done promptly after ultrasound.
– Possibility of free fetal DNA testing for Down syndrome and other fetal genetic abnormalities (NIPT)
Between 14 and 16 weeks of amenorrhea:
– Early morphological ultrasound (סקירת מערכות מוקדמת). – Genetic counselling for fetal abnormalities on ultrasound. (יעוץ גנטי).
– Iron intake with folic acid begins.
– Taking vitamin D.
– Cytomegalovirus serology control in early pregnancy
Between 16 and 18 weeks of amenorrhea:
– Trisomy 21 triple screening test (חלבון עוברי – תבחין משולש)
– The integrated test includes the neck thickness associated with the first and second Down syndrome screening blood test.
Between 17 and 20 weeks of amenorrhea:
– In case of abnormalities in the integrated test result, genetic counselling to discuss the indication of amniocentesis (בדיקת מי שפיר).
Between 20 and 24 weeks of amenorrhea:
– Second morphological ultrasound (סקירת מערכות מאוחרת).
– Genetic counselling for fetal abnormalities on ultrasound. (יעוץ גנטי).
Between 24 and 27 weeks of amenorrhea:
– Screening for gestational diabetes: Load test at 50 g glucose or in certain indications, load test at 100 g glucose (העמסת סוכר).
– Blood Count (CBC).
– Cytomegalovirus serology check in case of negativity in early pregnancy.
– Administrative registration for maternity.
Between 28 and 30 weeks of amenorrhea:
– Injection of anti-D immunoglobulins in case of Rhesus negative Blood Group. Make an indirect coombs blood test beforehand.
– Pertussis vaccination reminder (שעלת) no later than 36 weeks.
After 30 weeks:
– Possible enrollment in preparation for childbirth and breastfeeding. Between 32 and 35 weeks of amenorrhea:
– Ultrasound of the third trimester to assess the weight and position of the fetus, the amount of amniotic fluid, the location of the insertion of the placenta and control the fetal morphology.
Between 34 and 38 weeks of amenorrhea:
– Laboratory tests: Blood count (CBC), Urine tests, Vaginal and rectal sampling to eliminate the presence of streptococcus B (GBS).
Between 40 weeks and 42 weeks of amenorrhea:
– Fetal monitoring and ultrasound twice a week.
– Indication in some cases of medically induced childbirth.
Between 6 and 8 weeks after delivery:
– Visit to the gynecologist.
– Presentation, if necessary, of the different contraceptive options.
N.B.:
1- Definitions:
– Amenorrhea weeks: The number of weeks since the first day of the last period.
– Date of pregnancy onset: date of fertilization, usually 14 days after the first day of last menstrual period
– In case of irregular cycles or imprecise terms, the onset of pregnancy is evaluated by an early ultrasound and a date of final theoretical menstruation is fixed by subtracting 14 days from the evaluated date of fertilization.
2- It is advisable to make a visit per month with control of blood pressure, weight and analysis of urine for abnormalities (infection, albumin).
3- This table is for information purposes only. In the end, only the gynecologist doctor is entitled to decide on the necessary examinations for each patient according to the clinical context.
Dr Marc Sion ZERAH, Gynecologist-Obstetrician, Attached to Hadassah Ein Kerem Hospital, Jerusalem
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