nilay-karaca-pregnancy-management

Factors such as changes in the body, hormones released due to pregnancy, the growth of the uterus, and diets differentiate the symptoms of pregnancy on a weekly and monthly basis. The first signs of pregnancy are the increase in estrogen and progesterone hormones. With the increase in the body level of these hormones; At the same time, more tenderness and enlargement of the breasts are observed in the breasts, which are also menstrual symptoms. However, these should not be considered as a definite sign of pregnancy and a pregnancy test should be done to be sure. Although the symptoms that indicate pregnancy are not very obvious in the first weeks, the hormonal changes created by pregnancy begin to manifest themselves in the body quickly.


I’M PLANNING A PREGNANCY, WHAT SHOULD I DO?

It is beneficial for women who are planning a pregnancy to adopt a healthy lifestyle before pregnancy. Women planning pregnancy can be divided into two groups. Women with a known chronic disease prior to pregnancy and who are perfectly healthy. It is recommended that women with heart disease, kidney disease, asthma, epilepsy and similar chronic diseases before pregnancy stay in close contact with their doctors and become pregnant during a period when their diseases are under control. In healthy women, the following points should be considered before pregnancy: Smoking should be stopped or reduced to less than 5 per day.

In order to start the pregnancy with the ideal weight, women who are overweight should lose weight under the control of a doctor. It is important in terms of reducing gestational blood pressure (preeclampsia) and gestational diabetes.

Rubella test, Hepatitis B screening and blood count before pregnancy are beneficial. Vaccination is recommended for women who have never been or have not been vaccinated against rubella infection.

Women who have a family history of Mediterranean anemia, sickle cell anemia, cystic fibrosis and similar hereditary diseases or who are carriers for these diseases should be evaluated together with their spouses and receive genetic counseling.

It is recommended that women who are planning pregnancy use 400 micrograms of folic acid daily to prevent anomalies in their babies called neural tube defects that develop due to incomplete closure of the spine. In women who have carried such a baby in previous pregnancies, the daily dose of folic acid should be 4 grams.


I’M PREGNANT, WHAT SHOULD I DO?

First of all, congratulations. Get ready for one of the most beautiful and exciting experiences of your life. Pregnancy is a physiological event and will not negatively affect your life unless there is an important reason. When should the first inspection be? The first examination should be done at 6 weeks of pregnancy. Baby and heartbeats may not be seen in previous examinations. Gestational age is calculated from the last menstruation. What is inconvenient to do? Smoking and drinking alcohol are contraindicated during pregnancy. Kafein içeren çay, kahve ve kolalı içeceklerden ise az miktarda tüketilmelidir.

What can I do? 

There is no harm in doing or using the following during pregnancy.
Having sexual intercourse-Until the last 3 weeks of pregnancy
Doing sports-except horse riding and scuba diving
Swimming in the sea and pool
Sunbathing, use a sunscreen with a protective factor of at least 30
Using computer
Using a mobile phone
Using a microwave oven
Passing through security gates
Driving a car (it is useful to take a break every 2 hours)
Traveling by plane (A doctor’s report is required after the 26th week of pregnancy.)
Using plug-in insecticide

What should my diet be like in early pregnancy? Eating healthy is enough. There is no need to increase calories during this period. Avoid foods that make you fat (oily, fried, pastries, sweets, fast food). They do not contain any useful items for your baby anyway. If you do not want to eat due to nausea and vomiting, do not force yourself. There is no harm in losing weight during this period.

Should I take vitamins and iron? If your doctor has not given you folic acid before, it is better to start now. You can also use multivitamins. Iron pills are necessary for women who have started pregnancy without blood or who have decreased blood after 26 weeks.


HOW SHOULD THE BIRTH BE?

Mothers, who receive the news of pregnancy, start to think about how the baby will give birth as well as the healthy development of the baby from the very beginning of the process. Although the mode of delivery is not completely clear in the first weeks according to the anatomy of both the baby and the mother, it will be possible for families and mothers to choose between different birth types in the following weeks. Apart from normal birth, different techniques have been developed over time in order to minimize the labor pains that mothers will feel and to have an easier birth. The most preferred among these birth types are cesarean and water birth methods.

Normal Birth

Normal birth, which has been used for centuries, is also called natural birth. In this birth, which is carried out without medication, painkillers and any medical intervention, it is seen that the first contractions in the uterus begin. As a result of the contractions, the vaginal delivery of the baby occurs between the 37th and 42nd weeks of pregnancy.

Normal birth takes place in three stages. In the first stage, contractions are seen in the uterus. These contractions, which come every 10 to 15 minutes, can last for about 14-16 hours. At this stage, the cervix is expected to open 8-10 cm. As time passes, the intensity of contractions increases, and the minute interval in which the contractions are felt may decrease to 2-3 minutes. The second stage is the stage when the baby is born. While this stage may end in a short time as the baby’s vaginal exit with the mother’s pushing and straining movements, this stage may last for several hours in some cases. In the last stage, which is the third stage, the placenta separates from the uterus.

There are many advantages of normal delivery, which is preferred by most women who are confident about childbirth and believe that they can cope with the pain, except for some exceptional cases that require a cesarean section. First of all, women who start to experience the feeling of motherhood with the news of pregnancy want to experience the birth experience from the beginning to the end. Mothers who do not experience drowsiness due to the absence of medication have the chance to establish a tight bond with the baby from the moment of birth in the wakeful state.

More endorphins are secreted in the bodies of women who have given birth naturally than women who are given painkillers during childbirth. This allows mothers to return to their normal lives more quickly. At the same time, it is seen that women who give birth normally have less pain complaints after delivery than those who give birth with other methods such as cesarean section.

Cesarean Birth

Cesarean delivery is one of the birth methods used in cases where normal birth is risky. This method is considered as a surgical intervention since an incision is made in the mother’s womb and uterus during cesarean section performed by applying spinal, epidural or general anesthesia to the expectant mother. Cesarean delivery is generally preferred in cases where it is not possible to complete a normal delivery safely.

When a situation that threatens the mother or the baby is detected, cesarean delivery should be applied considering the risks brought by the medical intervention. Among these risky situations, there are situations such as the baby not being in the ideal position for birth, the baby being larger than the ideal size, the premature separation of the placenta, the low heartbeat of the baby, and the first pregnancy after the age of 35. The fact that the psychology of the expectant mother is not strong enough to handle normal birth or labor pains can be counted among the reasons why cesarean delivery is preferred.

Cesarean section has become the most preferred mode of delivery after normal delivery, especially in Turkey. According to the birth data of 2017, 53 out of every 100 children are born by cesarean section. However, the Ministry of Health and many other experts state that cesarean delivery should be preferred only in exceptional cases where normal delivery is not possible. Not only in our country, but also in many countries, women are encouraged to have normal birth. For example, in the statement made by the American Society of Gynecology and Obstetrics (ACOG) in 2008, it was stated that an optional cesarean delivery before the 39th week is not an accepted situation.

Expectant mothers do not suffer as much pain and pain in cesarean birth as in normal birth. However, the disadvantages of cesarean delivery are much more than normal birth. First of all, since anesthesia is required in cesarean delivery, the mother feels numbness in her body and therefore cannot experience the feeling of normal delivery. Since the abdominal layers are opened one by one with an incision, the recovery period of the mother after delivery is longer than in normal delivery. This may both prolong the hospital stay and adversely affect the mother’s close contact with the baby. In addition, since cesarean delivery is a surgical intervention, risks that can be experienced in every surgery are also present in this surgery. Another advantage of normal birth is that the baby can expel the fluid in the lungs more easily in normal birth. Since this process may take longer in cesarean delivery, the baby may experience temporary breathing problems.

In cases where there is a situation that threatens the health of the mother and baby, cesarean delivery turns into a life-saving operation. However, in cases that do not require emergency intervention, not only the mother’s but also the doctor’s opinion should be sought on this issue. If the conditions are not suitable for normal delivery, cesarean section should be preferred and detailed information about the process should be obtained.


NUTRITION IN PREGNANCY

Small but frequent feeding in the first months

First of all, it is recommended that the expectant mother take a folic acid supplement 3 months before pregnancy and for the first 3 months of pregnancy. Following this, it is recommended that the expectant mother should eat oil-free, odorless, non-spicy and salty foods due to the nausea and odor sensitivity she may experience.

Such snacks will be useful in suppressing the nausea that can be seen in this process. Consumption of fish, eggs, red meat, milk and dairy products is also important as in the nutrition of a normal individual. However, if the expectant mother is sensitive to these products, she does not need to force herself to consume. Because in the first 3 months, the baby is not affected positively or negatively by the mother’s nutrition. In other words, during the first 3 months of pregnancy, the expectant mother can eat as she wishes.

This period does not require any special effort, only processed foods with a long shelf life such as sausage, salami, ready-made fruit juices, etc., should be avoided. If heartburn is excessive, soda can be drunk.

Pay attention to nutrition after 3 months

From the 3rd month of pregnancy, the hormones begin to regulate, and the expectant mother enters a more comfortable process both physically and psychologically. 3. Nutrition during pregnancy is of great importance for the development of the baby and the health of the expectant mother. Starting from this period of pregnancy, the daily energy intake should be increased to 2200 calories. In other words, the level of nutrition should be increased and 3 snacks should be made in addition to 3 main meals. Healthy foods such as fruit, milk and yogurt can be consumed at meals that will both balance blood sugar and suppress the feeling of hunger.

Consumption of milk and dairy products is very important.

Nutrition during pregnancy requires a daily routine. At least 1 glass of milk, a bowl of yogurt and cheese should be consumed every day. Since egg is a very rich food in terms of protein, it should be added to the nutrition ritual at least 3 days a week. Since protein and calcium intake during pregnancy is of great importance for the development of the baby, milk and dairy products and eggs are among the foods that should be consumed in abundance.

Not without red meat

Many processes such as the growth of the baby in the mother’s womb, the formation of the nervous system, the development of the muscles, and the regulation of enzymes and hormones are on track with the protein source. Since red meat is considered as the most important protein source, it should be on the nutrition list at least 2 days a week.

In addition to being a source of red meat protein; It is also very rich in terms of oil, water, phosphorus, sodium, magnesium, calcium, zinc, iron and copper minerals and vitamins belonging to group B. However, in meat consumption, care should be taken to ensure that the meat is well cooked. Undercooked meat is not recommended during pregnancy as it can lead to bacterial growth in the large intestines. (Very well-cooked meats should be consumed in terms of anthrax.)

Fish consumption should not be neglected during pregnancy

Fish, which is rich in omega 3 and 6 fatty acids and protein, is very important for the baby’s brain and eye development. However, the high amount of mercury found in some fish species can be dangerous for the baby. For this reason, while the consumption of large fish such as sea bass, sea bream and salmon, not more than 350 grams per week, is positively important; Consumption of fish with high zinc value such as mussels, oysters, swordfish, shark, sushi and mackerel is considered harmful.

Make a habit of eating the Mediterranean style

Vegetable dishes with olive oil should be consumed at dinner, both in terms of vitamin source and in terms of intestines.

Don’t forget the nuts

Add foods such as walnuts, almonds, dried figs and dried apricots, which are rich in omega fatty acids, to the diet list several times a day. These foods, which will also help balance your sweet needs, will keep you away from high-calorie and unhealthy foods such as sweets, cakes, pastries and chocolate during your pregnancy.

Don’t forget to drink 3 liters of fluid a day

First of all, water consumption is of great importance during pregnancy. Although water consumption is very important for every individual, this need increases even more during pregnancy. Water consumption reduces uterine contractions, reduces the possibility of urinary tract infection, prevents constipation and edema of the body, and prevents complaints such as heartburn and nausea. Although drinking plain water is the most beneficial, fluid needs can be supported with foods such as clear tea, milk, ayran, soup and mineral water to complete 3 liters a day. During pregnancy, acidic and carbonated drinks should be avoided during the feeding process.

Eliminate cigarettes and alcohol from your life

Cigarette consumption reduces the transportation of substances such as blood, oxygen and nutrients that your baby needs to the baby. This doubles the risk of miscarriage during pregnancy. Alcohol consumption, on the other hand, affects the development of the brain negatively and harms the development, function and life span of nerve cells.

In addition, alcohol consumption during pregnancy can cause premature death in bone and cartilage cells. For this reason, alcohol and cigarette consumption is one of the most important issues that expectant mothers should pay attention to during the nutrition process during pregnancy.

Don’t miss sports in your life

Nutrition during pregnancy does not necessarily mean unlimited eating. Regular exercise combined with a quality and balanced diet allows both a comfortable pregnancy process and a healthy and easy delivery. During pregnancy, you can go for a walk at least 2 days a week, swim or take advantage of sports such as yoga and pilates special for pregnant women. Exercises involving weights, dangerous activities such as cycling and skating should be avoided.


PREGNANCY SCREENING TESTS

The purpose of screening tests (double, triple, quadruple test); whether the chance of giving birth to a baby with chromosomal anomaly increases or not. For this reason, before starting the applications with the expectant mother, the reliability of the screening tests should be discussed in detail. It should be noted that no screening test will catch all babies with chromosomal abnormalities. Another point is that screening tests will not show any structural anomalies (disability) in the baby. Although screening tests do not have a direct side effect on pregnancy, interventional intervention (amniocentesis, CVS) may have to be performed due to the results and may lead to complications such as loss of pregnancy (result of interventional intervention). may be low). For this reason, since performing unnecessary and many screening tests may cause false results and unnecessary interventions as a result, a single screening test and a detailed (detailed-advanced ultrasound) ultrasound in the following week will be beneficial for the maximum detection of chromosomal anomalies.

First Trimester Screening Test – Double Combined Test (double Test):

While the baby in the mother’s womb is lying in the side position, the transparent area behind the nape can be seen between the 11th and 14th days of pregnancy. A double combined test is performed by measuring HCG + PAPP-A from the blood sample taken from the mother (by adding age and gestational week parameters). This screening test is currently the most successful test in detecting babies with chromosomal anomalies (eg, Down syndrome) and is recommended for all expectant mothers regardless of age. With the double combined test, approximately 90 out of 100 babies born with Down syndrome can be detected. If your Down syndrome risk is more than 1/270 or only NT (nape thickness measurement) is more than 3mm as a result of the double combined test, CVS (chorionic villus sampling) is performed within the current week (between 11-14 weeks) (with FISH method in one day if necessary). ) you can learn 100% of your baby’s chromosome structure. If you have had this test and you are going to have a detailed ultrasound (detailed-advanced ultrasound) in the later stages of pregnancy, you do not need to have another biochemical screening test.

Triple Test:

Triple testing is usually done between 16-18th weeks of pregnancy. This test; It gives information about the risk of your baby having Down syndrome and Trisomy 18 by looking at HCG, E3 and AFP from the blood taken from the mother and combining these values with the mother’s age and the baby’s week. This test is a screening test and it is impossible for the triple test to predict all possible babies with Down syndrome. Today, this test has lost its effectiveness due to its weak power to detect a baby with Down syndrome. If amniocentesis is applied to mothers who are at risk as a result of this test, only 60-65 babies out of 100 who can be born with Down syndrome (Mongol baby) can be caught.

Quad Test:

Quadruple test is the calculation obtained by measuring the HCG + AFP + E3 + Inhibin-A levels from the blood taken from the expectant mother and combining these values with parameters such as gestational week and maternal age.

This test, like the triple test, is frequently applied between 16-18th weeks and its power to detect babies with Down syndrome is 75-80%. Although this rate is a more successful screening test than the triple test, the quadruple test is not preferred because it is performed later than the double combined test and because it has a weaker ability to detect Down syndrome compared to the double combined test. However, if you missed the double combined test between 11-14 weeks, it would be appropriate to have the quad test instead of the triple test as a screening test for chromosomal abnormalities.

NIPT test:

It is the screening of genetic diseases in the fetus on the blood sample taken only from the mother without any interventional intervention. From the first weeks of pregnancy, some fetal cells enter the mother’s bloodstream and are present in the mother’s blood during pregnancy. With this test, some microdeletion syndromes can be detected along with the most common chromosomal abnormalities (Down syndrome, Patau syndrome, Edwards syndrome) during pregnancy.

What Are the Advantages and Disadvantages of the NIPT Test?

Although it allows to detect serious chromosomal anomalies encountered during pregnancy and can reach delivery at a very early stage, it has a much higher reliability rate than double and triple screening tests performed in routine pregnancy follow-ups. There is no possibility of procedural complications and miscarriage as no interventional intervention is required.

A low-risk NIPT test does not mean that the baby will be completely genetically healthy, as the test only examines certain DNA regions. Although it has an accuracy rate of over 98% in terms of the chromosomes and genetic diseases examined, the NIPT test is a screening test, not a diagnostic test. Therefore, if the result is risky, it must be supported by an interventional prenatal test.

When And How Is The NIPT Test Done?

In order for the test to be applicable, a certain amount of fetal DNA obtained from maternal blood must be present. For this reason, it is recommended to be done from the 10th week of pregnancy. There is a high risk of not getting results in previous tests. Taking 10 cc of blood into special tubes produced for the test is sufficient for the study. However, in some special cases (if sufficient fetal DNA cannot be obtained, the test may be repeated or canceled.

 

A NORMAL OR CESAREAN BIRTH?

Why is normal birth the priority?

It is the type of birth that should be preferred unless otherwise required by the doctor. From the quick healing of the stitches to the immediate formation of the mother-baby bond with breastfeeding, the advantages it provides for both the mother and the baby are undeniable. 37. The birth that starts between the 30th and 42nd weeks without any intervention is a normal birth. If the necessity of the intervention is not based on a valid reason, every expectant mother should prefer this birth. Because in this delivery, all the risks and negativities such as infection and bleeding are much lower. After a normal delivery, you can have more enjoyable moments with rapid recovery and minimum pain.

What are the challenges of cesarean delivery?

Increasing fear and anxiety towards the end of pregnancy may push the expectant mother to a cesarean delivery. Cesarean section should never be the first choice as it poses higher risks for postpartum recovery and subsequent births. You are likely to experience nausea, vomiting, and problems with delayed regulation of your bowels immediately after birth. Cesarean delivery also increases many risks; in the short term, blood clotting, emergency uterine surgery, stroke, etc. In the long run, it can cause many problems, from an increase in pelvic pain to an ectopic pregnancy in future pregnancies. A cesarean delivery should only be performed when deemed necessary by your doctor. Since cesarean delivery requires surgery, anesthesia is in question. This anesthesia can be applied to the whole body as general anesthesia or just below the waist as epidural anesthesia.

How does an easy birth happen?

Your doctor is definitely the person who can help you in the easiest way to pass the moment of birth that you have been waiting impatiently for months. In addition, being ready to be a mother will help you give birth psychologically. It is very important to pay attention to your diet and water consumption throughout your pregnancy. Pregnancy courses, exercises, meditation and pregnant pilates you will attend for a healthy birth will also facilitate your birth.

Do birth stitches cause pain?

In both birth types, incisions and stitches are normal. In normal births with episiotomy, this incision is about 3 – 4 cm, and the complete healing of the stitches takes 1 – 2 weeks, just like other incision stitches. It is normal to have pain after stitches. During the healing process, the pain will also decrease. Since the incision made with local anesthesia is sutured with the effect of the same anesthesia, it is not even possible to feel pain. The body absorbs the normal birth suture and it disappears on its own, there is no question of removing the suture. The suture mark does not create an uncomfortable appearance even at first, and it almost disappears over time.

Since cesarean delivery requires a surgical procedure, a cesarean section is applied during the operation. It may take 4-6 weeks for the stitched to heal. Pain is felt more intensely, especially at the two end points of the sutures. Edema and swelling are considered normal in the first times of stitching. Pain and burning after delivery last longer than normal delivery. The numbness and numbness around the incision may occur later than the healing of the stitches. If the stitches are not the type that dissolves on their own, the stitches should be removed 5 days after the birth. If it is a self-melting suture, it cannot be removed.


MULTIPLE PREGNANCY

How does a twin pregnancy occur?

Twin pregnancies are the most common type of multiple pregnancies. Multiple pregnancies are observed in approximately 2-3% of all pregnancies. While some of the twin pregnancies occur spontaneously, some of them occur due to assisted reproductive techniques (vaccination, pills that facilitate ovulation, in vitro fertilization). Factors such as increase in maternal age and family history of multiple pregnancy increase the frequency of multiple pregnancy.

When is twin pregnancy determined and when is it certain?

Twin pregnancies can be detected as soon as the gestational sac can be observed after menstrual delay. Today, one of the most important purposes of ultrasonography performed in the first 14 weeks of pregnancy is to determine the number of gestational sacs. A diagnosis of multiple pregnancy can be made by seeing the gestational sac or sacs in the ultrasonography after an average of 7 weeks according to the last menstrual period, and after the 3rd week after the menstrual delay.

What is the effect of IVF method in twin pregnancy?

As the number of embryos transferred in IVF method increases, multiple pregnancies such as twin and triplet pregnancies are encountered more frequently.

What are the symptoms of twin pregnancy?

Nausea, sensitivity to smell and vomiting, which are encountered in the first 3 months of pregnancy, may be more intense in twin pregnancies. Apart from this, it does not cause any different complaints compared to single pregnancies.

How should expectant mothers of twins be fed?

In twin pregnancies, the mother’s needs for trace elements such as iron, folic acid, and calcium increase. Daily protein intake and calorie intake should be higher than in singleton pregnancies. For example, daily protein intake should be 1.5 g per kg of body weight, 300 kcal should be added to the daily calorie requirement for each baby.

What are the differences between identical twins and fraternal twins?

In twin pregnancies, the distinction between monozygotic and fraternal twins may not always be easy. It matters whether each baby has a separate placenta (partner) or whether they share a single placenta, rather than whether they are single or fraternal. If we look at it from that perspective, the problems that twin pregnancies with a single placenta may encounter during pregnancy are much different than the others. Among these problems, the growing difference in their growth, twin-to-twin blood transfusion, loss of one of the twin partners, cord-related problems in twins with a single sac, and amniotic fluid differences are the first ones that come to mind.

What are the risks of twin pregnancy compared to singleton pregnancy?

Miscarriage in twin pregnancies compared to single pregnancies, death of one of the twins at 20 weeks in the womb, premature birth, growth retardation, congenital anomalies, placenta previa, problems caused by prematurity due to preterm birth; maternal hypertension, gestational diabetes, anemia, urinary tract infections, vaginal bleeding, respiratory distress caused by increased amniotic fluid, and an increase in the frequency of cesarean delivery are more common.

What kind of treatment and precautions are applied in the face of possible risks in twin pregnancy?

Among twin pregnancies, monochorionic twins, that is, pregnancies with a single placenta and in which the twin partners share that placenta, must be followed up with a perinatology specialist or her guidance. These pregnancies should be followed more frequently, and when problems such as twin-to-twin blood transfusion are encountered, treatment options such as treatment in the womb (laser or cord coagulation) should be applied in reference centers experienced in this field. Apart from that, follow-up is similar to single pregnancies in fraternal twins and those with two separate placentas from identical twins. In both groups, one should be alert to the signs of preterm birth. As in single pregnancies, although there is no already established screening (cervical length measurement by ultrasonography) and drug treatment options, case-specific action can be taken. Measures should be taken against the health problems faced by the mother, especially iron and folic acid support against anemia (anemia) should be given importance.

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