It is a structured system of consultations that evaluates the normal progression of pregnancy and discovers early through the clinic, the laboratory and sonography the appearance of maternal and/or fetal problems that could arise (5-20% of cases); for this to be possible, the Obstetrician must have solid knowledge of the physiological changes of pregnancy in order to detect conditions that deviate from normality.

Preconception control begins before pregnancy, is the most advanced form of reproductive planning. Here you can download the Prenatal Medications in PDF format during your pregnancy.

Who should follow a Prenatal Control?

All pregnant women without distinction.

Why are there so many queries?

The number of consultations is closely linked to the changes of pregnancy, the needs of each period and the particular evolution in each of them. Many international organizations have established that the ideal number of consultations should be 13 visits divided into smaller and smaller intervals that are in accordance with the natural evolution of pregnancy and the moments when complications begin to appear. It is accepted that visits are made as follows:

• Monthly consultations until week 28.
• Consultations every 2 weeks until the 36th week.
• Weekly consultations from week 37 until delivery or cesarean.

Under conditions of low risk, and reliable patients, a more flexible scheme and with fewer consultations can be used, but this is subject to the physician’s criterion in agreement with their patient.

What is the most important object of Prenatal Control?

Prevent, Guide, Eliminate Risk Factors, Discover Problems and Treat Adverse Conditions.

Although pregnancy is a natural process, it is far from perfect and unfortunately there are complications in some of them. So, the purpose of prenatal care is to detect those anomalous pregnancies that could endanger the life of the mother and / or her baby. If this control did not exist we would see a great profusion of complications that otherwise could have been avoided.

Does it really make any difference to comply with Prenatal Control?

Yes. Certainly the risk of illness and death of the mother and her baby is diminished, in medical words this is: decrease of the Morbi-Maternal-Fetal Mortality.

What would happen if I do not want to be controlled?

You would expose yourself to unnecessary risks and above all things you could incur an act of supreme selfishness with a helpless baby that depends on you. Remember: pregnancy is natural rather than perfect, in fact, pregnancy is a dangerous period for the health of women.

Sometimes I think the consultations are very superficial and I do not even see their value, am I right?

No. Some consultations may seem unnecessary but fortunately this is because you are in the presence of a normal pregnancy. If there is a significant complication, you would see that the consultations would be more frequent, more thorough and more complex.

It has been shown that Prenatal Control is justified because its cost is less than its benefits: it is much more economical (in monetary, psychological, personal and family terms) than prevention of the treatment of complications that may arise.

I give you an example: urinary infection without symptoms is frequent in pregnancy and its treatment is very simple, but if the diagnosis is not made in time serious complications can occur that can lead the mother to be hospitalized, generate a premature birth and as a consequence obtain a premature baby who in turn will also be hospitalized in Neonatal Intensive Therapy for prematurity (without guarantees of survival or free of physical or neurological sequelae). And to think that all this could have been prevented …!

Should my husband attend the Controls?

As far as possible it is suggested that your partner attend the Controls so that you get involved in your pregnancy, know your doctor and follow the evolution of your baby. In this sense, I hope that you will attend at least 2 consultations and that you will be present in at least one ecosonographic study. The fact that you can not attend all your evaluations should not be a reason for friction in the couple, we must remember that labor and economic pressures sometimes do not allow it

How often should I become Ecosonograms (Echoes)?

This depends a lot on your doctor’s judgment. The frequency ranges from one to two Echoes throughout the pregnancy to an Echo in each consultation. In my particular case I practice sonography in all the controls but there are two studies of great importance: the Eco Eenético of First Trimester and the study of Third Quarter Risks, with them and the continuous evaluation I fulfill the objectives of maternal-fetal surveillance: (1 Anatomical location, gestational age of pregnancy and number of embryos or fetuses; (2) screening for congenital anomalies and Chromosomal diseases; (3) anatomical complement, circulatory status and 3D evaluation (three-dimensional, optional); (4-5) growth and antepartum fetal health tests.

Laboratory exams are expensive. Should I practice them?

The cost is justified because there are silent conditions such as anemia, pregnancy diabetes and infections that can be detected and treated effectively. The most expensive exams are those of the first consultation, then some less expensive ones are practiced according to the stage of your pregnancy: Chromosomal Risk and Neural Tube Disease screening, Gestational Diabetes screening, genital culture and final routine.

Is gynecological examination necessary during Prenatal Control?

Typically a gynecological examination is performed at the time of the First Consultation (Cytology and Uterine Neck Culture), during week 35-36 (only to take a sample for genital culture) and finally after week 38 to evaluate the condition of the neck uterine (these are the famous “touches” that determine the evolution of the cervix, the descent of your baby and the clinical characteristics of your pelvis).

What conditions can be detected during the Prenatal check?

• Asymptomatic bacteriuria (Urinary infection without symptoms, the previous example)
• Genital infections associated with abortion or infection of the Newborn
• Congenital Abnormalities (Cardiac Abnormalities, Hydrocephalus)
• Hereditary Diseases and Genetic Syndromes
• Congenital infections (such as fetal rubella)
• Chromosomal Diseases (Down Syndrome)
• Multiple Pregnancies (Twin Pregnancy)
• Premature Labor Threat
• Placental Problems (Previous Placenta, Premature Detachment)
• Hypertensive Diseases of Pregnancy
• Fetal Growth Disorders (Intrauterine Growth Delay)
• Pregnancy Diabetes
• Incompatibility of Blood Group (Rh incompatible disease)

What is a strict Prenatal Control?

This is the type of Prenatal Control that should be given to a patient with a High Risk Pregnancy. It includes a greater frequency of evaluations, a close surveillance plan and usually involves the intervention of other medical or surgical specialties. Logically, the expenses are important but this is where the true justification of the cost-benefit relationship is observed.

Why is Prenatal Multiple Pregnancy Control more strict?

This is not an adequate condition for the human being. The presence of 2 or more babies, the presence of a large placental mass, uterine overdistension and more pronounced physiological changes increase the risks already existing in a single pregnancy, they double up to six times the risk of complications associated with pregnancy: Preterm Labor, Preeclampsia , Diabetes, Placenta Previa, etc.

A typical sequence

First date

• Clinical history and general physical examination
• Sampling for cytology and triple cervical culture (Chlamydia, Ureaplasma and Mycoplasma), germs associated with early pregnancy loss and late complications.
• Transvaginal echocosography: diagnosis of pregnancy, location, number of embryos, embryo vitality and determination of gestational age.
• Classification of obstetric risk.
• Determination of the probable date of delivery or cesarean according to the case.
• Request for laboratory exams and delivery of instructions.

We hope it is as early as possible, however I try to ensure that this first consultation takes place between weeks 6 and 9 so that the ecosonographic study is already able to provide concrete data on pregnancy: before 5 weeks it is very little what can be evaluated.

Second date

The reservoir for the First Trimester Genetic Echo, the most important study of early pregnancy for the detection of problems associated with chromosomal disease, genetic syndromes and early detection of congenital anomalies. It is done between weeks 11 and 13.6, preferably 11-12 weeks. It has a sensitivity greater than 90% to detect certain conditions of great maternal-fetal importance.

At La Trinidad Medical Teaching Center, we have the Combined First Trimester Test, a study similar to the genetic echo to which biochemical markers are added to determine the risk of frequent chromosomal problems. An echo-sonographic fetal study is performed and a blood sample is taken from the mother. A quantitative result of risk is obtained for the patient in a few days

Third appointment

This appointment coincides approximately with week 16, at which time we can accurately determine the definitive fetal sex and detail other structures that can not be evaluated in the genetic echo

The need to perform the second-trimester fetal risk assessment study ( Maternal Serial Markers or Marking Triplet ) is discussed: this test has become increasingly unpopular due to its low sensitivity, however it remains the standard for the determination of fetal risk for trisomies 21, 18 and 13 and spina bifida for women under 35 years of age. If you have already done the Combined Test, you do not need to do it. Likewise, based on the results of the Genetic Echo, the patient could decide not to do it either.

The need to practice amniocentesis in the next 2-3 weeks is discussed if: there is a formal indication, there are altered markers in the Genetic Eco, the Combined Test suggests risk, the Marker triple suggests risk or simply because the patient wishes it.

Week 24-28: It is indicated to perform the test to rule out Gestational Diabetes . The test is called Glucose Overload 50 and it involves the measurement of fasting blood glucose and a second measurement exactly one hour after taking a drink containing 50 grams of glucose. Normal values: lower than 95 for fasting glycemia and less than 140 at 60 minutes after glucose intake. If this test is abnormal, a Glucose Oral Tolerance Curve of 2 or 3 hours and 75 or 100 grams of glucose should be performed. Ultrasound of Risks of the Third Trimester : I practice a vaginal study to rule out risk of preterm and abdominal delivery to detect risk of pre-eclampsia

Weeks 25-29 : moment of the Three-dimensional Echo . I will refer you to another specialist, after 12 years I have decided not to practice it personally for reasons that I explain to my patients in the consultation.

Week 28 : if the patient is Rh (-) not sensitized, with an Rh (+) partner the placement of the Rh antiglobulin (Rhogam) is indicated. 1 intramuscular ampoule

Week 34 : for many patients, their prenatal rest begins this moment. Reports are issued

Week 35 : the final laboratory routine is requested, the genital sample is taken to detect local colonization by Group B Streptococcus , reports and budgets are issued for the administrative management of the baby’s birth

Week 38 : time to practice the first genital touch to determine the possibilities of birth, if possible, the membranes of the cervix are separated to stimulate the onset of labor in those patients who have no contraindication to vaginal delivery. During this week I practice the cesareans of those patients who have a formal indication. If there are doubts about the possibility of vaginal delivery, a radiopelvimetry should be performed

Weeks 39-40 : in this period they must give birth to waiting patients. Before reaching week 40, a decision is made for the appropriate termination of the pregnancy, either by induction of labor or cesarean section. In particular, I never go beyond week 40.