20 May 2019 Author : Pedro Oliveira And because all pregnancies are different, pregnancy is a unique moment in a woman's life so her monitoring and follow-up are key. Why should pregnancy be monitored? It has been demonstrated in recent decades that access to specialised health care in pregnancy, from planning to delivery and post-partum care, drastically reduces maternal, foetal and child morbidity and mortality. Recent factors include: Demographic changes; The low birth rate; Women having fewer and fewer children and at more advanced ages. In this scenario, achieving better health outcomes and gains during pregnancy is only possible if the pregnancy is subject to intervention that should: Start at a pre-conception appointment; Finish at a puerperium consultation. Pre-conception appointment All women of childbearing age should be informed about the importance of the first weeks of pregnancy so they can make choices about their reproductive future. It is therefore recommended that when a woman or a couple wishes to become pregnant, they should undergo a special evaluation at a pre-conception appointment before interrupting the contraceptive method they are using. The aim of this appointment is to: Assess the mother’s health; Perform pre-conception screening; Start vitamin supplements; Make important recommendations. The evaluation warns the woman and couple of the possible risk of the pregnancy. This risk, which may change during pregnancy, should be re-evaluated at all visits. The schedule of appointments, examinations and interventions should be adapted to the degree of risk of each pregnancy. This works as follows: In a low-risk pregnancy, appointments are usually monthly; High-risk pregnant women, depending on the specificities of their problems, may require more frequent appointments and interventions, and should be followed up by teams that target existing risk factors. What risk factors should be considered? Some pregnant women are at risk from the start of pregnancy if they have chronic diseases such as: High blood pressure; Diabetes; Heart disease; Epilepsy; Thyroid disease. Previous premature birth or unsuccessful pregnancy should be taken into consideration as risk factors. Also situations can occur in a normal pregnancy that transform it into a high-risk pregnancy, for example: High blood pressure; Gestational diabetes; Pregnancy cholestasis; Changes in foetal growth and / or amniotic fluid. Aims of pregnancy monitoring Evaluation of the mother and baby’s wellbeing and results of diagnostic tests; Early detection of situations that may divert pregnancy from its normal course; Identification of risk factors and promotion of health education; Preparation for childbirth and parenting; Information on parental rights and duties. Pregnancy stages The determination of gestational age is one of the most important aspects of pregnancy and is based on the date of the last menstrual period. The age may be revised and possibly corrected with ultrasound data from the first trimester. Prenatal consultations At prenatal consultations, information will be recorded in the Pregnancy Health Report and relevant information will be shared with the pregnant mother, such as: Healthy eating, safe and suitable food during pregnancy; Regular physical activity and its importance throughout pregnancy; Sexual health and sexuality during pregnancy; Warning signs and discomfort during pregnancy; Optimisation or change of lifestyle during pregnancy. Schedule of prenatal visits 1st consultation: ideally up to 12 weeks; Up to 30 weeks: appointment every four to six weeks; From 30 to 36 weeks: appointment every two to three weeks; After 36 weeks: appointment every one to two weeks. Lab tests The lab tests requested in prenatal consultations are designed to screen for, prevent or treat possible threats to maternal, foetal or perinatal health. Purpose of the ultrasound scans Ultrasounds are used to confirm: Foetal viability; Correct dating of pregnancy; Complement screening for foetal malformations; Evaluate foetal development and wellbeing; The foetus’s weight. When should ultrasound be done? 1st trimester: between 11 and 13 weeks; 2nd trimester: between 20 and 22 weeks; 3rd trimester: between 30 and 32 weeks. Prenatal classes Prenatal appointments and classes preparing for childbirth and parenting are very important in informing and preparing the pregnant mother, couple and family. Confidence is developed and skills are promoted for a better experience of pregnancy, childbirth and the transition to parenthood. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
