Many couples are now responsible approach to the issue of planning pregnancy, expectant mothers and carefully monitor their condition throughout the childbearing period. About the various nuances of this exciting phase of life, we talked with obstetrician-gynecologist, physician ultrasound diagnosis obstetric clinic «Medok» Natalia Erofeeva .
Most couples today are suitable for pregnancy planning consciously and prepare to conceive a child in advance. When to start and how to plan?
If young women planning their first pregnancy has serious health problems and is regularly visited by doctors, including gynecologists, planning to become pregnant should start in three or four months. First and foremost, of course, you need to come to the doctor obstetrician-gynecologist who will examine, take appropriate smears: smears on the flora on onkotsitologiyu for infections, sexually transmitted infections. You also need to do a pelvic ultrasound, and breast. Complete general medical examinations to verify the condition of the body it is desirable to both men and women. These include complete blood count, blood chemistry, urinalysis, electrocardiogram, chest X-ray, blood for HIV, hepatitis, syphilis. If the parents do not know their blood group and Rh factor, it is necessary to find out. Women still advisable to check the condition of the thyroid gland: to give blood for thyroid
condition of the thyroid gland: to give blood for thyroid hormones, thyroid ultrasound conduct and seem endocrinologist if necessary.
Before planning pregnancy it is necessary to pass the TORCH-complex – blood for antibodies to infections that are potentially dangerous to an unborn baby. It infections such as rubella, cytomegalovirus, toxoplasmosis, herpes virus. You have to know what there is immunity, what woman in her lifetime faced, and what will need to be monitored during pregnancy. If you are not immune to rubella, then you need to get vaccinated, but two or three months after it is necessary to protect themselves.
If a woman has any physical problems, you need to see specialists. It is advisable to visit the dentist, to sanitize the mouth, if necessary, to treat teeth, because carious teeth – is the source of infection during pregnancy.
If a woman has any problems with the spine – scoliosis, low back pain and other diseases, which may be exacerbated during pregnancy it is better to go to a chiropractor, to pass a course of massage.
The spouse must also be tested for infections, sexually transmitted infections, and deliver the semen analysis.
It is necessary for all, regardless of age?
Ideally, yes. If a woman is planning a pregnancy after 35 years, there may be a need for additional surveys.
Planning for the second pregnancy is somehow different from the first?
If a large gap between pregnancies, too, need to undergo the necessary medical examination. But with the second pregnancy it is usually easier and less complex surveys needed than if a woman never became pregnant, and she had a late reproductive age.
It is known that women planning a pregnancy, it is important to maintain the right lifestyle, do not smoke, drink alcohol, engage in sports, and so on. And how important is the image of the life of the Pope?
Healthy lifestyle both women and men affects the very possibility of conception, and the further development of the pregnancy, and the future health of the child. Future dad need to give up bad habits – alcohol, smoking – at least for three to four months before the planned pregnancy. It is useful to engage in sports, but here too it is necessary to know when to stop: excessive exercise can adversely affect sperm quality. Power must be balanced, contain essential vitamins, trace elements. If their power comes not enough, take vitamins separately.
Both men and women need to start taking folic acid three months before the planned pregnancy. For women, it is important in terms of prevention of neural tube defects in the embryo. And for men folic acid is important in spermatogenesis.
To the diet must also man or separately present Zinc – is fish, seafood, as this also affects the quality of sperm. Men desirable or two months before the planned conception, not to visit baths, saunas, because, as you know, the spermatogenesis takes place in the scrotum at a low temperature, respectively, at elevated temperatures, the process may fail.
What if the pregnancy is unplanned? Prospective parents have not had time to give up alcohol, the woman could take some medication, and teeth have not had time to cure …
If a woman or a man in the process of conception or in the first weeks of smoked, drank small amounts of alcohol, or a woman took some medicine, in principle, in the first couple of weeks, this should not adversely affect the fetus. As long as the implantation has not occurred, and the total flow is not, all of these substances must not come to the embryo and somehow disrupt its development.
Of course, the cases are different, and that everything can potentially affect on egg and sperm before conception process. In any case, during pregnancy necessarily need to be screened, which takes place in the 11-13 weeks of pregnancy. Screening identifies possible malformations, chromosomal abnormalities. If high risk, for example, someone in the family suffers from alcoholism or drug addiction, of course, you need to precisely pay attention to it.
Now there is a non-invasive prenatal test PANORAMA, which has been held for nine weeks of pregnancy. A woman takes a blood sample from her blood stands fetal DNA that reveals various chromosomal abnormalities of the fetus. And you can determine the sex of the child, since the nine weeks of pregnancy. The downside is that this screening is not cheap, and the results have to wait a couple of weeks, since it is held in America. But this test very often used because it is considered a safe, precise, efficient. The percentage of false positive results in his far less than conventional screening, which is currently carried out in droves.
As for dental treatment, but now there is a safe pain relief methods that can be applied to pregnant women. In the first trimester, when the foundations of the system and all organs of the baby, of course, have to be careful. A second or third trimester, it is safe. However, if there is some kind of an emergency, you need to be treated immediately. If, say, a pregnant toothache, it is necessary to go to the dentist. It is necessary to inform the doctor about her pregnancy, respectively, in this case will be applied anesthetics without epinephrine.
How do you feel about the fact that many women postpone pregnancy “for later”?
Now, of course, such a rhythm of life that many women postpone their first pregnancy. Late age of first pregnancy, we considered the age after 35 years in America – after 37.
Of course, our bodies are not getting younger, accumulate various chronic somatic diseases. And pregnancy age 20 lighter flows and carries most of the pregnant than in 40 years, because the body is still young, hardy, there are so many different diseases.
The woman, after 35-40 years may experience problems with conception. Most of them tend to be solvable, may simply need more time to pregnancy, and will need to undergo a more detailed examination.
Many women in this age becomes difficult psychologically. If they do throughout the year you can not get pregnant, it becomes a fixed idea. It is important to every woman relax and try not to focus on this issue. Many of these couples to conceive a child get well when they go on vacation, relax, relax.
The problem is that the follicular reserve is exhausted – ovarian reserve. Woman born with a certain number of follicles and during their lifetime, with each ovulatory cycle, the number of follicles decreases. In late reproductive age ovulate each cycle is not that, of course, reduces the chances of getting pregnant. If under 35 year can be 1-2 anovulatory cycles in which no ovulation, after 35 years of such cycles can be 5, 6, and year.
And we must bear in mind the genetic predisposition: if a woman knows that her mother had an early menopause, there is a high likelihood that she may come early menopause. In this case, proceed with the pregnancy, one probably should not, but it’s worth checking the follicular reserve.
What is the optimal interval between pregnancies, from the point of view of medicine?
It is believed that the optimal interval between birth and the next pregnancy is about 1.5-2 years. If the previous generations have ended quickly, and has a scar on the uterus after cesarean section, then, of course, it is not necessary to reduce these terms, 2 years – this is the best option.
If a woman is breastfeeding is long, the body needs to recover. For complete recovery takes about 9 months after the end of breastfeeding.
When a pregnant woman needs to first go to the doctor? Immediately, when there were two test strips, or before the first screening can not go anywhere?
If a woman’s menstruation is late, she did urine pregnancy test and it was positive, it is a chance to go to the doctor. Firstly, you need to find out what this pregnancy – uterine or ectopic. If it turns out that pregnancy uterine, you need to understand, develop it or not. To do this, you need to donate blood for hCG, it is better to do it every 48 hours, since the normal pregnancy hCG after 48 hours should be doubled. So we can estimate that the pregnancy is developing normally. Still it is necessary to conduct ultrasound when the doctor sees the embryo with a heartbeat in the uterus, then there is no doubt is left that this uterine pregnancy, and it is developing.
On the eighth week of a pregnant woman goes all the necessary range of tests and examinations, starting from 11 weeks of losing the first screening. Further observed once a month after 30 weeks – once every two weeks, and 36 weeks after this may be once a week. The frequency of visits to the doctor strictly individual, on the testimony of the reception can be administered more frequently. On average in normal pregnancy women can visit a gynecologist 10-12 times.
What is the reason for the unscheduled trip to the doctor?
Severe pain, bleeding in any trimester of pregnancy – this is definitely a reason to see a doctor. If pregnant in the first trimester are concerned a strong toxicosis, not only nausea, and vomiting more than 5-6 times a day, then you need to think about and infusion therapy, and hospitalization.
If in the third trimester suspected at leakage of amniotic fluid, it is also an occasion to see a doctor. Or if the child began to move somehow strange – too active or too little, or a woman does not feel perturbations baby – all this is also an occasion to refer. Emerging problems with pressure, swelling – can be a lot of different options.
In general, a woman may experience a range of different sensations. But if it is something different from the normal, physiological pregnancy, then it’s certainly a reason to see a doctor.
Many women at the beginning of pregnancy, progesterone is prescribed drugs. In some cases, it is justified?
There are many women who have pregnancy occurred in patients receiving some progesterone drugs. In this case, of course, they continue to take progesterone drugs with a gradual reduction in dosage to 16 weeks of pregnancy.
Progesterone is a hormone of pregnancy. It was originally produced by the corpus luteum, followed by the placenta. If it produces enough to sustain pregnancy, this may lead to danger of miscarriage and abortion.
How does the doctor determines it? If he sees hypertonicity on ultrasound or when viewed, it is an occasion to appoint progesterone?
Diagnosis “uterine hypertonus” as such in the international classification of diseases there. Uterus – a muscular body, it tends to shrink. Therefore, if a pregnant slack feels pain of short duration, such as a long walk, but these disappear after resting pain, then, as a rule, it does not require any treatment. Physiologically, the uterus is so arranged that it can be reduced.
If the doctor for an ultrasound sees some local tone of the uterus (it could be a reaction to the uterine probe), but a pregnant woman no pain and other complaints, then, as a rule, it is not necessary to treat.
But if a woman has strong pulling pain in the abdomen, lower back, long, do not pass after a rest, it is a chance for the purpose of progesterone preparations, various antispasmodics, in order to remove the uterus hypertonus.
It is interesting that in America and Europe, a slightly different approach to the management of pregnancy. In the first trimester, 12 weeks pregnant, no drugs, the pregnancy, not appointed. In this regard, domestic practice is different.
What is Rh-conflict? If a woman has Rh negative, you need to do before or during pregnancy?
Probability Rhesus conflict may occur in women with Rh-negative blood, if a spouse, respectively, positive Rh. If the child has a positive Rh, during pregnancy Rh red blood cells with Rh-positive baby into the blood of Rh-negative mother and is in her blood the formation of antibodies to the Rh factor (friendly to her, but cause destruction of red blood cells of the child). But as a rule, the first normal pregnancy rhesus minimal risk.
In this case, women need to donate blood at the anti-Rhesus antibodies once a month. Then, at 28 weeks for the prevention of Rh-conflict entered Rh immunoglobulin. If born Rh positive baby, the mother re-entered Rh immunoglobulin for the prevention of Rh-conflict in subsequent pregnancies.
There is a conflict on the blood group. If a pregnant woman first blood and the baby’s father, another group of blood, blood group conflict may arise. But it’s even more rare situation than Rh-conflict. An increase in titer of antibody in the blood group of pregnant women we can talk about the development of the conflict on the blood group between mother and child. In this case, it is shown conducting a more thorough prenatal care in a specialized medical institution. Unfortunately, specific prevention of conflict on the blood group does not exist.
Than it is fraught?
And Rhesus-conflict, conflict and blood group can lead to hemolytic disease of the fetus and newborn. The collapse of the fetal red blood cells as a result of the impact of the relevant antibody results in damage to the liver, kidney, fetal brain, the development of hemolytic disease of the fetus and newborn.
Women with first blood, it is necessary to hand over any analyzes?
It is desirable, of course, monitor the titer of antibody group. Another thing is that it is not carried out for all pregnant women without exception. But if a woman has a history of miscarriages, stillbirths, of course, behind this track.
How should I eat during pregnancy? What kind of foods should be avoided?
During pregnancy and breastfeeding diet should be more balanced. We need to eat meat and fish. All food must necessarily take the necessary heat treatment for the prevention of infections, including parasites, toxoplasmosis, listeriosis, which are potentially dangerous for the child. It is desirable that the heat treatment was carried out in a sparing mode: cook food steamed, stew, etc.
Bad fried, spicy, too oily food. It is important to monitor the consumption of fats and carbohydrates, to prevent excessive weight gain. It is necessary to abandon the canned products.
In the first trimester of pregnancy may not limit itself to the salt, especially in toxicosis, but in the second and third trimester, better food nedosalivat because excess salt and action of progesterone leads to fluid retention in the body, and this, in turn, provokes swelling and weight gain.
Of course, it is necessary to eat more fruits and vegetables. If vitamins are lacking in food consumption, it is necessary to take extra vitamins. In the first trimester folic acid is usually nothing special is required. In the second or third trimester, it may be different multivitamin complexes. Typically, they are not permanently assigned and in a cyclic mode, if necessary. In the summer, if well nourished pregnant, eat lots of fruits and vegetables, you can stop taking multivitamin complexes. In autumn, winter, spring cyclically worth doing it.
Pregnant and lactating need to take iodine preparations. The minimum daily requirement for iodine – 200 micrograms per day. This is necessary for the thyroid gland pregnant woman, and child. In pregnant women, who do not pay enough attention and do not take iodine preparations may have thyroid problems after childbirth and breastfeeding. This is important, given that we all live in iodine deficiency area.
You do not share the opinion that vitamins “raskarmlivayut” baby in the womb, and the children get very large?
Yes, indeed, vitamins may contribute to the birth of a large baby. But if not permanently assign vitamins, and if necessary, in a cyclic mode, then, as a rule, this does not occur.
How do you feel about coffee? Is it possible to drink pregnant?
Of course, the coffee can be pregnant, there are no strict contraindications. Especially if a woman has a low pressure, which is often in the first trimester. Then it may well drink a cup of coffee a day, and it will not cause any harm to the child.
And alcohol? No, no, or sometimes it is possible?
Personally, I am planning during pregnancy and during the pregnancy itself alcohol and smoking is strictly prohibited. Of course, if a woman drinks for the entire pregnancy a total glass of dry red wine, most of all, it is no effect on the baby will not. But it is better not to do it, because all that pregnant drink, and alcohol including – gets into the blood to the baby.
People who abuse alcohol and nicotine before conception and during pregnancy, children are born with chromosomal abnormalities, low birth weight, with a variety of neurological disorders, which at birth are themselves did not show, but with the growth, the child’s development may occur.
Most women after pregnancy dramatically change the way of life, because it is very afraid of harm to the child. If the pregnancy is normal, a woman can lead the same lifestyle as before pregnancy? Engage in sports, travel, have an intimate relationship? Or is it necessary to reduce the activity?
Pregnancy – is, of course, is not a disease, but a natural physiological condition of the female organism. Therefore, if the pregnancy proceeds normally, there are no medical contraindications, the woman may well continue to maintain the same lifestyle to which she was accustomed. And intimate relationship here is not contraindicated, provided that there is no problem – the threat of miscarriage, placenta previa, and the like.
Sport is not prohibited. A pregnant woman is even advisable to lead an active lifestyle. This contributes to an easier pregnancy and prepare the body for childbirth. If a woman is engaged in some extreme sports and martial arts, from this, of course, you will need to be abandoned. In the measure is necessary. Some heavy physical exertion, sudden movements – this is, of course, is undesirable. A gymnastics for pregnant women, yoga, swimming, dancing – it’s fine, and only for good.
Is it possible to travel depends on the woman’s state of health and how her pregnancy proceeds. If everything is in order and there are no medical contraindications, it is quite possible. However, we must bear in mind that the long flight (6-8 hours or more) increases the risk of threatened abortion. Of course, the risk is small, but think it is worth.
If a woman going on a trip, especially in the later stages, it is required to have a first aid kit and and exchange card. You can take on the road with antispasmodics, and take appropriate medication before the trip.
A cosmetic procedure permitted?
A pregnant woman, of course, want to feel beautiful and be well-groomed. Haircut, hair coloring, manicure, pedicure – all this is possible, there are no contraindications. If a woman wants to go to the beautician to do some cleansing, moisturizing for skin treatments, it is also possible.
Undesirable hardware cosmetology, body wraps, massages, affecting the abdomen, cellulite massage, as well as general massage, which can cause pain. Generally massage during pregnancy is possible, but it should be a quiet, relaxing massage. Tattoo and body piercing, of course, undesirable.
How best to prepare for childbirth?
Now there are a lot of different courses for pregnant women, which tell that a woman is waiting for during pregnancy and childbirth, how to behave during labor give exercises, including breathing. I believe that pregnant women should attend this course, but you need to wisely apply to their choice. Such courses should be at some health facility and conducted by physicians or specialists who understand this. This should not be at the level of traditional medicine.
Pregnant should understand that it will happen in labor and how she should behave in this period. If the planned partnerships childbirth, and the spouse is also important to understand how he should behave, how to help his wife to move this process easier.
Also important is the psychological mood of the pregnant woman. If it is calm and configured on labor, not as a source of pain, as well as the process of birth of a new life, the more likely labor will be well.
I wish you all an easy pregnancy and childbirth!
Interview Alain Khmilevskaya