AT antenatal clinic a wide range of laboratory research is carried out:

• clinical analysis of blood, urine, biochemical, hemostasiological (extended hemostasiogram) blood tests;
• studies of biological material from the cervical canal and vagina for flora, atypical cells;
• PCR - diagnosis of sexually transmitted diseases, viral infections;
• bacteriological crops on the flora with the determination of sensitivity to antibiotics;
• blood tests for the determination of specific antibodies of the TORCH complex.

Blood sampling for research is carried out in the treatment room and in the department (without an appointment)

daily except Saturday and Sunday

Blood sampling from a vein for research: RW, HIV, HEPATITIS(Monday - Thursday) from 08:00 to 12:00; from 13:00 to 16:00

(Friday) from 08:00 to 12:00

Blood collection: BIOCHEMISTRY, CLINICAL BLOOD ANALYSIS, BLOOD TYPE, RH-FACTOR, COAGULOGRAM(Monday - Friday) from 08:00 to 12:00

Blood collection: PRENATAL SCREENING (Monday - Wednesday) from 08:00 to 12:00

Urinalysis studies
mon. - Fri. from 08:00 to 10:00

How to Prepare for Research

General rules when preparing for research:

It is recommended to donate blood in the morning, from 8:00 to 11:00, on an empty stomach (at least 8 hours and not more than 14 hours of hunger, drinking water, as usual).
Dinner the day before should be light and early, and the entire previous day (ideally, even 2-3) should refrain from fatty foods until the study.
For 24 hours, any alcohol, thermal procedures (bath and sauna) and physical activity are excluded (it is better to transfer the gym and work in the country).
Do not smoke for at least 1 hour prior to the study.
If you are taking any medications, you should consult with your doctor about the advisability of conducting a study while taking drugs or the possibility of stopping taking drugs before the study, the duration of the withdrawal is determined by the period of removal of the drug from the blood.
It is recommended to rest (better - sit) 10-20 minutes before taking blood samples.
Diet, special requirements: strictly on an empty stomach, after 12-14 hours of fasting, you should donate blood to determine the parameters lipid profile(cholesterol, HDL, LDL, triglycerides, lipoprotein).
Glucose tolerance test is performed in the morning on an empty stomach after at least 12, but not more than 16 hours of fasting.
When donating blood for a hemostasiogram: 30 minutes before the test, drink 1-2 glasses of water.

Collection of urine for general analysis:

On the eve of the test, it is recommended not to eat vegetables and fruits that can change the color of urine (beets, carrots, etc.), not to take diuretics.
Before collecting urine, it is necessary to make a thorough hygienic toilet of the genital organs.
Women are not recommended to take a urine test during menstruation.
For the correct conduct of the study, during the first morning urination, a small amount of urine (the first 1-2 seconds) should be released into the toilet, and then, without interrupting urination, substitute a container for collecting urine, in which it is necessary to collect approximately
50 ml of urine. Urine collection is carried out exclusively in a sterile container (available in the examination room).

Collection of daily urine for biochemical analysis(including DHEA-S, 17-KS):

Urine is collected per day. The first morning portion of urine is removed. All subsequent portions of urine allocated during the day, night and the morning portion of the next day are collected in one container, which is stored in the refrigerator (+4 ... + 8 ° C) during the entire collection time (this is a necessary condition, since when room temperature significantly reduced glucose levels. After completing the collection of urine, accurately measure the contents of the container with a measuring cup, be sure to mix and immediately pour into a small jar (no more than 50 ml). Bring this jar to the maternity hospital for examination. You don't have to bring all the urine. On the referral form, you must indicate the daily volume of urine (diuresis) in milliliters, for example: "Diuresis 1300 ml."

Urine collection for urine culture (with antibiotic susceptibility testing):

Urine collection is carried out exclusively in a sterile container (available in the examination room). Before collecting urine, a hygienic toilet of the genital organs is mandatory.

Research on Nechiporenko:

This study requires particularly careful hygiene. It is necessary to collect urine in the morning, while it is concentrated. Before collecting a urine sample, toilet the genitals. Wash the external genitalia with warm water so that microbes and obsolete cells from their surface do not spoil the picture. Any foreign matter can be misinterpreted. The middle portion of morning urine in the amount of 50 ml is submitted for analysis, the first and last portions are poured into the toilet. Women cannot give urine three days before, during and after menstruation: the discharge that has fallen into it will give an absolutely wrong result.

Girls, I found an article from the magazine "9 months - I was very surprised that some VERY expensive tests (for example, all hormones) can be taken in the LCD for FREE!

Tomorrow I'm going to make an appointment with a gynecologist in the residential complex, I hope to get to the free delivery of everything that is possible ...

How much pregnancy, childbirth and child support cost, future parents calculate in advance, and more than once or twice. True, life later corrects these calculations - and most often upwards. But such a materially expressed aspect as preparation for pregnancy is most often ignored, although conscious parenthood begins precisely from this important stage.

Numerous medical observations have shown that most of the complications that develop during pregnancy can be prevented by proper preparation for it: the identification of possible hidden diseases and their neutralization, appropriate preventive vaccinations ...

We have touched on this topic many times in the magazine, so the purpose of this article is not to convince future parents to take family planning seriously (you probably know about it yourself), but to calculate how much this peace of mind can cost you. It’s worth reassuring readers right away: almost all examinations and analyzes can be done at a state clinic. Naturally, the service there will be somewhat different from a commercial clinic. And everyone decides for himself how determined this circumstance will be for him.

If you have addressed the issue of pregnancy planning to the district antenatal clinic, then for a start you will receive a referral to such banal studies as general analysis blood, urine, blood test for AIDS, syphilis, hepatitis, Rh factor, blood group and biochemical blood test. If any pathology is suspected, the doctor in the clinic gives a referral to other free tests. The simple desire of the patient in the absence of complaints is not enough to get a referral for a comprehensive free examination.

So let's count the costs.

Expert advice

Naturally, to find out how healthy you are, and in which case, specialist doctors can correct or completely eliminate existing problems, from a visit to which it is worth starting the planning stage.

If a visit to a gynecologist and a therapist is not in doubt, then it is worth making a reservation about other specialists. Visiting an endocrinologist, surgeon, etc. necessary according to the testimony of a therapist or in cases where future parents know in advance about the presence of certain diseases.

Sanitation of the oral cavity, carried out by a dentist, will eliminate dangerous sources of infection and help prevent the destruction and loss of teeth during pregnancy due to a lack of calcium in the body.

In commercial clinics, an appointment with a gynecologist, therapist, endocrinologist costs from 500 rubles, treatment at the dentist - depending on the condition of your oral cavity - from 1000 rubles.

You can use the services of a doctor in the district antenatal clinic (gynecologist) and a polyclinic (therapist, endocrinologist, etc.) - it's free. You won’t be able to save a lot on a dentist, even in a district clinic, since there is a possibility that during treatment you will have to pay for certain materials.

Analyzes

Objective research - analyzes and ultrasound can confirm or refute the opinion of specialists. Keep in mind that if an infection is detected, then after treatment, the analysis will need to be repeated.

What tests should be done?

A blood test to determine the blood type and Rh factor in both spouses.

If a woman has a positive Rh factor, there is no problem. But if the future mother has a negative Rh factor and if she has the first blood group, and the father has a different one, an analysis for antibodies to the Rh factor or ABO antibodies is necessary. These antibodies may have formed in a woman during previous pregnancies.

The cost of this analysis in a commercial clinic is from 160 rubles, the cost of an analysis for antibodies is also from 160 rubles.

The same tests can be taken free of charge at the antenatal clinic or the district polyclinic, having previously taken a referral from a gynecologist or therapist.

Blood test for antibodies to rubella, toxoplasma, herpes, CMV, chlamydia, etc. The presence of IgG antibodies means infection with certain bacteria or viruses even before pregnancy. The presence of IgM means an acute stage of an infectious disease. In any case, treatment is necessary, after which the analysis must be repeated.

The cost of this comprehensive analysis in a commercial clinic is from 1500 rubles.

In the state polyclinic, the analysis can be done free of charge.

Tests for infections: a normal smear, a smear for sexually transmitted infections - in both spouses.

The cost of this comprehensive analysis is from 1000 rubles.

A smear from the cervix for cytological examination (Pipel biopsy). This analysis is necessary for every woman to exclude malignant diseases of the cervix.

The cost of this comprehensive analysis is from 850 rubles.

It can be done free of charge at the state clinic.

Blood test for hormones (LH, FSH, estradiol, prolactin, TSH, free T4, 17-hydroxyprogesterone, DHEA-S, cortisol, testosterone, progesterone). This analysis is prescribed by an obstetrician-gynecologist for irregular menstrual cycles, complaints of oily skin, excessive hair growth, overweight or underweight, menstrual disorders (soreness, profusion, scarcity).

The cost of this analysis is 300 rubles. for each hormone.

In the state polyclinic, this analysis is free.

Hemostasiogram, coagulogram. These tests reveal the features of blood coagulation.

The cost of analysis in a commercial clinic is an average of 700 rubles.

Determination of lupus anticoagulant, antibodies to chorionic gonadotropin, antibodies to phospholipids. The analysis helps to identify the presence of early miscarriage factors.

The cost of each of these tests in a commercial clinic is from 700 rubles.

In a state polyclinic by appointment of a doctor (in the presence of previous miscarriages) - free of charge.

General clinical blood test (hemoglobin, erythrocytes, leukocytes, platelets, ESR, color index, leukocyte formula).

The cost of this analysis in a commercial clinic is from 300 rubles.

In the state clinic - free of charge.

General urine analysis.

The cost of this analysis in a commercial clinic is from 200 rubles.

In the state clinic - free of charge.

General analysis of the ejaculate, or spermogram (for the husband). Sperm analysis.

The cost in a commercial clinic is from 500 rubles.

In a state clinic, such an analysis is done in the direction for free.

Functional diagnostics

Colposcopy is a method that allows you to see with the naked eye the nature of the pathological processes of the vagina and the vaginal part of the cervix. The study is carried out using a colposcope - a microscope equipped with a strong light source. Its optical system allows you to examine the mucous membrane at a magnification of up to 30 times.

The cost of this study in a commercial clinic is 300 rubles.

In the state clinic - free of charge.

Ultrasound of the pelvic organs should be done to a woman 1 or 2-3 times in the presence of pathology during the menstrual cycle. Estimated general state pelvic organs, the presence of a corpus luteum and transformation of the endometrium, indicating that ovulation has occurred. The cost of each ultrasound in a commercial clinic is from 300 rubles.

In the state polyclinic, the study is free of charge.

Vaccinations

Rubella vaccine. If the results of the analysis revealed that the expectant mother does not have antibodies to rubella, it is necessary to be vaccinated and protected for another 3 months after it, because the rubella vaccine is live, and this time is necessary to develop immunity. In case of an accidental vaccination in the early stages of pregnancy, it is not necessary to interrupt it - the vaccine strain is safe for the fetus. It is also safe for a pregnant woman without immunity to communicate with newly vaccinated people (including children), in contrast to really ill people.

The cost of this vaccination in a commercial clinic is from 300 rubles.

In the state polyclinic, vaccination is done free of charge.

Diphtheria vaccination. It is carried out from the age of 26 1 time every 10 years for all adults in the family.

The cost of this vaccination in a commercial clinic is 450 rubles.

In the state clinic - free of charge.

Hepatitis B vaccine.

The cost of vaccination in a commercial clinic is from 500 rubles. depending on the manufacturer of the vaccine.

In a state clinic, vaccination costs from 100 rubles. — depending on the cost of the vaccine.

Directions for free vaccinations are given by the local therapist.

vitamins

Special multivitamins for women who are preparing to become a mother cost from 150 rubles. per package (100 tablets). It is recommended to start taking them six months before the planned pregnancy. For multivitamins for a husband, you will have to pay from 70 rubles; These are the usual complex multivitamins.

If you do not take multivitamins, folic acid for both will cost about 60 rubles. for two. When taken continuously for at least 6 months before conception, it dramatically reduces the incidence of fetal malformations.

Other

To determine the day of ovulation and, accordingly, favorable days for conception, they draw up the so-called basal temperature chart, for which at the same time, without getting out of bed, the temperature in the rectum is measured with a mercury thermometer for 5 minutes.

The cost of a thermometer is from 80 rubles. depending on the manufacturer.

Thus, preparation for pregnancy will cost about 11,000 rubles. However, if you prefer free medicine, then you will have to pay a minimum for vitamins and a thermometer - about 500 r

The main functions of the antenatal clinic are as follows:

• registers pregnant women;
• organizes the necessary and sufficiently complete medical examination of pregnant women - by an obstetrician-gynecologist, therapist;
• during the entire period of pregnancy, regularly monitors the state of health of a woman; if necessary, conducts sanitation of foci of chronic infection - for example, palatine tonsils in chronic tonsillitis, nose and paranasal sinuses in chronic rhinitis and sinusitis, carious teeth, etc.; in cases where the consultation cannot provide the necessary assistance on its own, it organizes the assistance of specialists from other medical institutions;
• if necessary, the doctor of the antenatal clinic prescribes treatment and monitors the results of this treatment;
• the doctor of the antenatal clinic also monitors the working capacity of a woman during pregnancy; if a pregnant woman works in a production that may pose a danger to her health, the doctor of the antenatal clinic issues to this woman a certificate of a recommendatory nature on the need for a temporary transfer of this woman to another job - easier;
• at a gestational age of thirty weeks, the antenatal clinic provides the pregnant woman with prenatal leave;
• antenatal clinic organizes regular home visits for pregnant women; a woman is systematically visited by a patronage nurse (specially trained), a midwife, and somewhat less frequently by a doctor; the purpose of regular home visits is to monitor the state of health of a pregnant woman, monitor the woman’s compliance with the doctor’s recommendations, familiarize herself with the conditions of her life, sanitary and educational work, and give the necessary recommendations; if a woman has any questions, the medical worker provides comprehensive answers; in the event of certain complications during pregnancy (for example, toxicosis), the doctor of the antenatal clinic will immediately organize necessary treatment; if the doctor sees that outpatient treatment is not enough, he sends the woman to the hospital for treatment;
• women's consultation constantly carries out sanitary and educational work; In addition to the sanitary and educational work that is carried out with pregnant women individually at home, work is also organized at a higher quality level: lectures are given to expectant mothers, printed materials are distributed among pregnant women (brochures, magazines, books, posters, etc.). ), mothers' schools can be organized in which classes are held in hygiene, rational nutrition, caring for a newborn baby, etc .; meetings with a psychologist are regularly organized; clarifies the laws that protect the rights of pregnant women;
• issued a referral to the hospital.

Visiting a women's clinic

Currently, specialized obstetric and gynecological care in the polyclinic network is carried out in the antenatal clinic. Among the primary tasks of the antenatal clinic is the monitoring of pregnant women. Over the years, specialists have developed clear methods for examining pregnant women, plans for the prevention of complications, as well as methods for their treatment. If a pregnant woman fulfills all the doctor's prescriptions, then many diseases and complications, as well as undesirable consequences, can be prevented.

With the introduction of birth certificates, a woman has every right to choose in which antenatal clinic she will be observed. She can also choose a doctor of her choice when visiting a antenatal clinic at her place of residence. But, in addition to the antenatal clinic, a woman can apply to private clinic which specializes in monitoring pregnant women. It's no secret that private clinics create more comfortable conditions for a pregnant woman. In such clinics, an individual approach is used to each woman, the specialist spends as much time on examination and examination as the situation requires. As a rule, there are no queues and all research is carried out in one place. The only disadvantage of private clinics is the high service charge. The main criteria in choosing a antenatal clinic or other specialized medical institution there should be the availability of qualified doctors of various specialties, the availability of a variety of modern examinations, as well as the use of modern methods of treatment.

The choice of an obstetrician-gynecologist is an important task facing a pregnant woman. Indeed, monitoring the physical condition of the future mother, the course of pregnancy and the development of the unborn child will depend on the experience of the specialist, the level of knowledge and qualifications. The best option for cooperation between the patient and the doctor will be the observation of a woman during pregnancy and after the birth of a child by the same specialist. The doctor should become an assistant and authority for a woman, a person whom the expectant mother can trust. A woman is advised to get to know the doctor in advance, talk about the methods of his work, understand how experienced and educated he is. Many doctors are now widely using new techniques and modern technologies. Other doctors, cooperating with future parents, leave the right to solve problems for parents or, conversely, exercise strict control. Most specialists seek to find the best way to monitor the natural course of pregnancy. A pregnant woman should immediately agree on an important condition during the observation - the opportunity to consult with a doctor on any day (day off or holiday) and time of day (day or night). The ability to quickly resolve an issue or problem, get advice will help a woman feel more confident and calm during pregnancy. The sooner a woman decides on a specialist who will observe her during pregnancy, the sooner their cooperation will begin. The effectiveness of all activities carried out by the doctor is the highest if they are carried out in the early stages and regularly throughout the entire period of pregnancy.

It is important for a woman to understand that she should start monitoring in the antenatal clinic as early as possible in order to be able to identify deviations in the course of pregnancy and in the development of the fetus at an early period.

When pregnancy is established, a woman should visit the first antenatal clinic before the 12th week of pregnancy. This is the period when the doctor determines if pregnancy is possible. If the pregnancy proceeds normally, without complications, then on average a woman should come to see a doctor 14 times. After the first visit, the doctor appoints the woman the next examination in 7-10 days.

Until the 28th week of pregnancy, a woman is recommended to attend a antenatal clinic once a month. From the 28th to the 36th week, a woman should come to the doctor 2 times a month, and in the further period before childbirth - 1 time per week. In exceptional cases, the number of visits to an obstetrician-gynecologist may be changed according to indications. If a pregnant woman has any chronic diseases, concomitant diseases or complications occur during pregnancy, then the number of visits and the number of studies and analyzes may be more.

At the first visit of a pregnant woman, the doctor will be interested in the following points: previous diseases (both in childhood and in the mature period before pregnancy), the course of the menstrual cycle (when menstruation began, what are the duration, etc.), hereditary diseases(hypertension, diabetes mellitus, tuberculosis, the presence of multiple pregnancies in the family, oncological diseases).

Among the transferred diseases, the doctor should pay attention to Special attention rubella, cytomegalovirus infection, toxoplasmosis, cardiovascular diseases, endocrine diseases, Availability chronic tonsillitis. The doctor will also ask the woman about allergic reactions medicines and certain foods, whether you have had blood transfusions or surgeries, your blood type and Rh status, and bad habits (such as smoking, drinking alcohol or drugs). Along with questions about the health of a pregnant woman, the doctor will also be interested in the age and past diseases of the husband, his blood type and Rh affiliation and his bad habits, as well as whether there are occupational hazards.

If a woman had previous pregnancies, then the doctor is obliged to find out their number, course features, complications, whether there were miscarriages, abortions, the condition of the newborn child.

At each visit to the consultation, a pregnant woman is required to undergo a series of tests and studies, according to the results of which the doctor will be able to judge the course of pregnancy and the development of the unborn child. At each visit, the doctor will definitely take a measurement blood pressure, weigh the woman, measure the circumference of the abdomen, and in the future, the doctor will have to listen to the baby's heartbeat (starting from the 15th week of pregnancy). At each examination, the doctor is recommended to examine the wrist joints, lower legs and ankle joints for swelling. Examination of the legs will help to identify initial signs varicose veins.

Pregnant women who smoke, use alcoholic beverages and drugs are under special supervision of a doctor. Gynecologists and therapists should give such women compelling arguments about the need to give up bad habits not only during pregnancy, but also in the postpartum period, during breastfeeding. If a pregnant woman uses alcohol and drugs, she is referred to a psychiatrist-narcologist for a consultation. The course of pregnancy and the development of the unborn child in such a pregnant woman will be monitored jointly by an obstetrician-gynecologist and a psychiatrist-narcologist. A psychiatrist-narcologist decides on the appointment of special treatment methods for a pregnant woman to prevent the occurrence of complications during pregnancy, as well as to reduce the adverse effects of alcohol and drugs on the body.
At the first visit to the consultation, the doctor determines the type of physique, the body weight before pregnancy is specified. Women who are overweight or underweight should call the doctor's close attention. Carrying out a mandatory weighing of a pregnant woman at each visit to the antenatal clinic, the doctor controls the condition of the expectant mother. If a woman is not gaining enough weight or there is an excessive increase in body weight, then this may indicate the development of complications.

Experts have found that a pregnant woman from the 32nd week should gain weight no more than 400 g per week and 2 kg per month. During the entire pregnancy, weight gain should not exceed 10-12 kg. It is considered normal if a pregnant woman has lost a small amount of weight due to morning sickness and vomiting.

At the first examination, the gestational age is established or specified and the estimated date of delivery is calculated. If necessary, the gestational age is determined, taking into account the result of an ultrasound examination.

To obligatory medical examinations many women are treated differently.

Some pregnant women are frightened by a large number of studies, other women are worried for any reason and require testing more often than usual.

At the first appointment, the obstetrician-gynecologist, as a rule, issues referrals for a number of mandatory tests: a general clinical blood test, a blood test to determine hormones, a blood test for blood group and Rh factor, a general urine test, a smear from the vagina. The results of these tests will help the doctor determine the course of pregnancy (whether the pregnancy will be normal or complications are likely).

During pregnancy, a general clinical blood test is taken several times. With repeated blood tests, it is possible to determine the disease in time and conduct specialized treatment. According to the general blood test, the doctor can judge the presence or absence of anemia and other blood diseases in a pregnant woman that can lead to a violation of the formation of the fetus. A general blood test is taken at the first visit to the doctor and during pregnancy 3 more times, and according to indications, the number of tests can be increased. At the first visit, and then according to indications, fasting blood sugar is determined. This analysis will reveal the risk of developing diabetes in a pregnant woman. Three times during pregnancy - at the first visit, at 30 weeks and 36 weeks of pregnancy - the blood is examined for the presence or absence of sexually transmitted infections: Wasserman reaction, blood for AIDS. If a pregnant woman has a positive test result, then she and her husband are sent for specialized treatment to a venereal dispensary. It is mandatory for all women to determine the blood type and Rh factor. If the expectant mother has Rh-negative blood, then it is necessary to check the blood for Rh-affiliation with the father of the child. If the expectant mother has Rh-negative blood, and the future father has Rh-positive blood, and in such a situation the child has inherited the father's blood (according to the Rh factor), then a Rh conflict may develop between the mother and the baby. In the body of the expectant mother, antibodies begin to form against a foreign Rh-positive protein, which is located in the child's red blood cells. Being in the blood of a pregnant woman, these antibodies do not harm her. But, passing through the placenta into the blood of the unborn baby, they destroy the baby's red blood cells. With an Rhesus conflict, there is a danger that the unborn baby may be born dead, premature birth may occur, or the child will have a blood disease at birth. If a Rh conflict is possible, the blood of a pregnant woman is examined several times during pregnancy (every 2 weeks) and the presence and amount of antibodies to fetal erythrocytes are determined in it. The frequency of delivery of this analysis is as follows: until the 32nd week of pregnancy, blood for antibodies is given once a month, then from the 32nd week to the 34th, the study is carried out 2 times a month, and in the prenatal period - 1 time per week. If a pregnant woman has Rh-negative blood, and the unborn child has inherited her blood, then the Rh conflict does not develop.

There are several blood tests, the results of which can suggest that the unborn child has a genetic abnormality in development. This study is called a "triple test". To do this, between the 14th and 16th weeks of pregnancy, blood is taken to determine the amount of α-fetoprotein (ACE) in it, chorionic gonadotropin(CG) and unconjugated estriol (NE). If the content of α-fetoprotein is increased in the blood of a woman, then this can be regarded as a violation of the formation of an unborn child. nervous system, namely impaired development or absence of the brain, dropsy of the brain, impaired development spinal cord. If the amount of this substance is reduced, then this may be the first sign of the development of Down's disease. A blood test for ACE will help identify diseases of the kidneys, liver, intestines (obstruction). But it should be borne in mind that an increase in the amount of α-fetoprotein may indicate twins or an incorrect calculation of the gestational age. It is believed that the "triple test" is optional. But if the age of a pregnant woman is over 35 years old, there are relatives with hereditary (genetic) diseases in the pedigree, if the woman herself or her husband are carriers of chromosomal diseases and if the previous child has Down syndrome or has congenital disease, then this analysis will be necessary. These analyzes are taken 2 times with an interval of 1-2 weeks during the period from the 14th to the 20th week of pregnancy. A pregnant woman should be aware that when deciphering the analysis for α-fetoprotein, errors may occur - this is a disadvantage this study. Currently, statistics have established that for every 1000 such analyzes there are 40 cases with unreliable data. Therefore, a woman who has received a positive test for AFP should not immediately become discouraged. In this case, it must be sent for re-analysis. If the repeated analysis of the “triple test” also determines a positive result, then the doctor will recommend a puncture of the fetal bladder. This study does not apply to mandatory examinations during pregnancy. In this analysis, a study of amniotic fluid is carried out, as a result of which it is possible to determine whether the child has genetic diseases or diseases of the nervous system. through the front wall abdominal cavity under local anesthesia and under ultrasound control, a special needle is inserted into the uterus and a certain amount of amniotic fluid (about 30 ml) containing fetal cells is taken into the syringe. To determine the chromosomal changes in the unborn child, these cells are examined. As a result of this analysis and study of the composition amniotic fluid and the cells in it, a specialist can detect approximately 40 types of abnormalities in the development of an unborn child. When carrying out a puncture of the fetal bladder, there is a risk of hurting the fetus, placenta, infecting amniotic fluid and this procedure can lead to miscarriage. Therefore, such a study is carried out only by a qualified doctor and in a specialized medical clinic. According to statistics, during this examination, from 0.3% to 3% of complications occur (average 1%), so the doctor must warn the pregnant woman about this. If the pregnancy is proceeding normally, the puncture of the fetal bladder is not performed.

Among all the tests that a pregnant woman will have, the most common in terms of frequency will be a general urine test. Pregnant women should take urine tests at each visit to the antenatal clinic. This is due to the fact that during pregnancy, the kidneys work with great effort, as they have to remove the waste substances of the pregnant woman and the unborn child. A pregnant woman should be alerted by a change in the color of urine (but it should be remembered that if beets or cherries were present in the diet, the color of the urine will be reddish) and transparency, since cloudy urine may indicate the presence of infection, salts or kidney stones. In urine tests, the doctor pays attention to the presence and amount of protein and sugar. If the protein is determined in the urine even in minimal amounts, then this indicates a violation of the kidneys, since the protein in the general urine test should not be determined. A pregnant woman who has protein in her urine must be taken under control, and if necessary, sent for inpatient examination and treatment, since the presence of protein in the urine is usually accompanied by edema in the expectant mother and an increase in blood pressure. Also, in the general analysis of urine, sugar should not be determined. When it appears, the doctor may suspect the presence of diabetes in a woman. The detection of sugar in the urine may also indicate prolonged starvation.

To detect hidden swelling, the doctor may prescribe a urinalysis called a Zimnitsky test. A pregnant woman collects urine in 8 jars during the day (day and night). When evaluating the results of this analysis, the amount of fluid drunk, the amount of urine excreted day and night, and their ratio are taken into account.

Mandatory examinations include a smear on the flora. The smear is taken from the mucous membrane of the cervix, vagina and ureter. A smear analysis will help in identifying inflammatory processes (with an increase in the number of leukocytes), some infections (bacterial vaginosis, candidiasis). A smear for flora during pregnancy is prescribed three times - at the first visit, at 30 and 36 weeks of pregnancy. If there are medical indications, then the gynecologist may prescribe this analysis more often.

An additional examination is prescribed if a pregnant woman has the following symptoms: itching and burning of the external genital organs, in the vagina, a change in the color and smell of vaginal discharge. These phenomena may indicate the presence inflammatory process. Control of the vaginal microflora is necessary, as it affects the organization of the intestinal microflora and skin child during the birth process.
At each visit to the antenatal clinic, the doctor will carry out a control weighing of the pregnant woman at least once a month in the first half of pregnancy, and in the second half of pregnancy - every two weeks.

Along with the control weighing, the doctor will measure the pressure at each visit to the pregnant woman. Normal pressure is 120/70 mm Hg. Art. If there is a rise in pressure to 140/90 mm Hg. Art., then a pregnant woman should immediately consult a doctor, since high blood pressure may be the first manifestation of preeclampsia.

To eliminate the anxiety factor when visiting a antenatal clinic, a woman is recommended to measure the pressure several times in a calm home environment. All pressure measurements together with analyzes are recorded in the exchange card.

Among all the analyzes and examinations carried out, the most effective for collecting information about the development of the child is an ultrasound examination. During this examination, the device's sensor emits and receives ultrasonic waves reflected from organs and tissues, which are then reformed by the computer on the screen in the form of a two-dimensional image. The duration of the procedure is from 10-15 minutes. The advantage of this method over the rest is that it is easy to perform, completely safe for the woman and for the unborn child. A pregnant woman does not need to specially prepare, it can be carried out repeatedly, which allows you to monitor the development of the baby. The first ultrasound examination is prescribed by a doctor at 10-12 weeks of pregnancy. During this period, the specialist assesses whether the pregnancy is developing correctly, whether there is an ectopic pregnancy, determines the true gestational age, reveals whether the pregnancy is multiple or one fetus, and can diagnose the presence of tumors of the uterus or ovaries. At this stage, it is possible to recognize the formation of various serious defects in the child. The formation of heart disease can be recognized during this period.

The second ultrasound examination is necessarily prescribed by the doctor at the gestational age from the 19th to the 21st week. At this time, the unborn child has almost completely formed organs and systems, so an ultrasound examination will help to identify their structure and even determine whether they work normally or not.

The third planned ultrasound examination is performed at the 30th week of pregnancy. At this stage of the study, you can determine the position of the baby, how fast he grows and what his condition is, whether he has enough nutrients and oxygen, the sex of the unborn child is determined. But if the baby is cross-legged or has its back to the sensor, then it will be difficult for the specialist to recognize who is developing - a boy or a girl. In addition to the child, a study of the work of the placenta, quantity, color, transparency, the presence of pathological impurities in the amniotic fluid is carried out.

The fourth mandatory ultrasound examination is performed at a period of 37-39 weeks of pregnancy. In this study, the specialist specifies the fetal presentation (cephalic or gluteal), the length and weight of the child, the location of the umbilical cord, the functioning of the placenta, blood flow in the vessels of the child and uterus. If the blood flow is insufficient, then the doctor recommends cardiotocography. Using this method, you can assess the tone and strength of uterine contractility, the motor ability of the unborn child. If the child's condition causes concern or blood flow is reduced, then a pregnant woman is recommended specialized treatment to improve blood circulation and supply enough oxygen. Also, after 1-2 weeks, additional ultrasound examinations with dopplerometry are prescribed. All this will further help the obstetrician in the correct conduct of the birth process.

There is a transvaginal ultrasound examination, which is performed in early pregnancy. Using this method, you can recognize an ectopic pregnancy, establish the possibility of a miscarriage. In this study, a special sensor is located directly in the vagina and does not provoke bleeding or miscarriage.

At each examination of a pregnant woman, the gynecologist feels the abdomen, which helps him to determine the size and position of the uterine fundus, which allows him to monitor the growth of the unborn child. In the last weeks of pregnancy, probing the abdomen will help the doctor determine how the baby is located and whether his head has sunk into the small pelvis.

After the 20th or 30th week of pregnancy, at the next visit to the antenatal clinic, the doctor gives the woman an exchange card in her hands. This document records the features of the course of pregnancy, all the results of tests and examinations that the pregnant woman undergoes during the observation period, all examination data and diagnoses of medical specialists. In the absence of this card, the woman in labor is sent to a specialized maternity hospital.

So, during pregnancy, a woman undergoes the following tests and studies.

1st month of pregnancy: general urine analysis; clinical analysis of urine for sugar, protein, bacteria; general blood analysis; blood test for hepatitis, AIDS, syphilis, trichomoniasis, chlamydia; a blood test to determine the group and Rh factor, a smear from the vagina for flora; analysis of feces for the content of eggs of worms; bacteriological analysis of feces. Of the surveys, an examination of the external genital organs, determining the size of the pelvis, measuring blood pressure, measuring height and weight are carried out. A pregnant woman is given an electrocardiogram.

2nd month of pregnancy: clinical analysis of urine for protein and sugar content; examination of the wrist joints, shins and ankles for the presence of edema, to determine varicose veins; determining the weight of a pregnant woman; measurement of blood pressure.

3rd month of pregnancy: urine test to determine the presence of sugar and protein; measuring the weight of a pregnant woman; mandatory control of blood pressure; according to indications during this period, the doctor prescribes a puncture of the fetal bladder;

4th month of pregnancy: determination of a woman's weight, measurement of blood pressure, examination of the woman's arms and legs to detect edema, examination of the lower legs to determine varicose veins, examination of the abdomen to determine the size of the uterus. During this period, the doctor listens to the fetal heartbeat. A woman is assigned a urine test to determine the amount of sugar and protein.

5th month of pregnancy: ultrasound examination, which will help to identify congenital changes in the development of the fetus, a general urine test, a blood test to detect hepatitis, syphilis, AIDS. On examination, the size of the uterus is revealed, blood pressure is monitored, the weight of the woman is measured, and an examination is required to detect edema.

6th and 7th months of pregnancy: clinical urinalysis, urinalysis for the detection of protein and sugar content, weight and blood pressure control. During the examination, the fetal heartbeat is heard, the size of the uterus is determined.

8th month of pregnancy: a repeated blood test for syphilis, hepatitis, HIV infection, a smear on the flora from the vagina to identify diseases that are sexually transmitted, general and clinical urine tests. Routine studies are carried out - examining the abdomen and determining the size of the uterus, the location of the child, listening to his heartbeat, measuring the weight of the expectant mother, monitoring blood pressure.

9th month of pregnancy: studies are prescribed, which are carried out at the 8th month of pregnancy, and an ultrasound examination is added.

Last month: final blood and urine tests.

At present, the approach to managing pregnancy has changed in obstetric science, in particular, monitoring a pregnant woman. If earlier this role was assigned to only one obstetrician-gynecologist, now the expectant mother is being examined by a therapist and doctors of narrow specialties, such as a geneticist, cardiologist, ophthalmologist, otolaryngologist, endocrinologist. These specialists will be able to competently evaluate complaints, identify negative changes in a woman's body and carry out the necessary prevention to prevent the development of complications in a pregnant woman and unborn child. If necessary, each specialist will be able to choose modern method treatment that will not affect the intrauterine development of the child.

A mandatory specialist who must examine a pregnant woman is a therapist. For the entire period of pregnancy, the expectant mother is obliged to visit this doctor three times. At the first examination, the doctor will try to find out if the woman has any concomitant diseases. internal organs and whether these diseases will affect the favorable course of pregnancy. Also, the doctor may raise the question of terminating the pregnancy for medical indications. The second visit to the general practitioner occurs in the second trimester between the 13th and 24th weeks of pregnancy. At this stage, the therapist must determine if the woman has those diseases that may appear during pregnancy (for example, anemia, beriberi) or join the course of pregnancy - neurocirculatory dystonia, kidney disease, infectious diseases, diseases of the circulatory system and many others. Having identified a disease in a pregnant woman, the therapist gives her a referral to the appropriate specialist or sends her to a hospital for examination and treatment. The third examination of a pregnant woman by a therapist occurs in the third trimester, starting from the 25th week of pregnancy and before the onset of labor. At this stage, the therapist needs to determine if the woman needs special examination, treatment and delivery in a specialized maternity hospital. Along with this, the therapist sets the timing of referral to the hospital. Inpatient examination and treatment is needed for women whose pregnancy proceeds with deviations and complications, as well as women with existing concomitant diseases that lead to a deterioration in the condition of the expectant mother. If pregnant women are somatically healthy, but need operative delivery or they expect complications during childbirth, they are sent to a specialized hospital before delivery. The general practitioner together with the gynecologist has the right to write a certificate to the woman about her pregnancy and the need to transfer the expectant mother to light work.

A pregnant woman who has relatives with chromosomal diseases or congenital pathology should receive a genetics consultation, if the woman and her husband are blood relatives or have genetic diseases, if the woman is over 30 years old (there is a high risk of having a child with Down syndrome). A geneticist will help determine the problem that may appear 'about the time of pregnancy. Consulting this specialist will help future parents whose previous child was born with a congenital defect or chromosomal disease.

A pregnant woman should definitely consult an endocrinologist. Statistics show that the normal function of the thyroid gland has a beneficial effect on the development of the unborn child. An endocrinologist during examination detects the level of thyroid hormones in a future mother so that in case of a change hormonal background prescribe appropriate treatment and prevent complications. Thyroid diseases are the most common diseases of the endocrinological system. A woman who has a thyroid disease must definitely undergo a follow-up examination with an endocrinologist. If the thyroid function is impaired, in particular with a decrease in hormone production, the risk of spontaneous miscarriages and stillbirths increases. Undoubtedly, a woman suffering diabetes should be seen by an endocrinologist. During pregnancy, such a woman needs to be attentive to her health and follow all the recommendations and requirements of an endocrinologist.

A pregnant woman suffering from diseases of the heart and blood vessels must necessarily undergo a consultation with a cardiologist and be observed by him repeatedly during pregnancy (however, like women who were not observed by a cardiologist before pregnancy). Cardiologist during examination and examination (electrocardiography, ultrasound examination, x-ray examination of organs chest) will be able to judge the state of the circulatory organs and the work of the cardiovascular system as a whole. With heart disease in a future mother with increased stress during pregnancy, heart failure may develop. To avoid this, women with deficiency mitral valve, birth defects heart, repeated consultations and examinations by a cardiologist are necessary for the pregnancy to go smoothly. The cardiologist, together with the pregnant woman, determines the plan and terms of observation, conducts more frequent measurements of blood pressure and controls the weight of the woman and the growth of the unborn child, develops an individual daily routine with the obligatory daytime sleep and sufficient (up to 10 hours) night sleep.

Among the specialists who should advise the pregnant woman is a nephrologist. Examination by this doctor is especially necessary for expectant mothers who have chronic kidney disease. The normal course of pregnancy can be affected by urinary tract infection and the development, together with kidney disease, of arterial hypertension. In kidney diseases such as polycystic, urolithiasis, chronic pyelonephritis with normal kidney function, double kidney, horseshoe kidney, the pregnancy itself and its outcome can be favorable. But if acute pyelonephritis develops during pregnancy, then the risk of premature birth very high. Statistics have proven the impact of acute pyelonephritis in pregnant women on the increase in mortality among newborns. If a woman suffers urolithiasis, she is at increased risk of developing a urinary tract infection and may experience episodes of renal colic. Due to the fact that the ureters dilate during pregnancy, stones that are in the kidneys can pass through the dilated ureters and be excreted in the urine. Pregnancy does not harm and does not negatively affect the body of a woman who has kidney stones. However, there are a number of nephrological diseases in which the prognosis of pregnancy may be unfavorable. These include: glomerulonephritis, chronic pyelonephritis, in which the functioning of the kidneys is impaired, the condition after a kidney transplant. Studies have found that if there are kidney diseases that disrupt their work, but there is no increase in blood pressure, then the woman's pregnancy will proceed more favorably than in cases where the kidneys work normally, but there is an increase in blood pressure.

In the first trimester (up to the 12th week of pregnancy), the expectant mother should consult an ophthalmologist. The oculist during examination should identify or exclude the presence of myopia, hyperopia, any changes in the fundus.