Medical Checkups During Pregnancy

Pregnancy is an exciting phase in a woman’s life coupled with many hormonal changes, psychological and physical upheavals.⁽¹⁾ So, a pregnant woman needs a lot of care under the supervision of gynecologists, in order to prevent complications in her pregnancy. This calls for mandatory pre-natural medical checkups during pregnancy.

Let us understand about the importance of medical checkup during pregnancy. Following are some of the complications that one needs to be aware of during pregnancy. These are the concerns that need immediate medical attention without any delay:-⁽²⁾

• Pain in the abdomen.
• Vaginal bleeding.
• Fever or chills.
• Continuous headache.
• Nausea.
• Persistent vomiting.
• Blurring or dimness of vision.
• Swelling or pain in lower extremities.
• Fluid leakage from the vagina.
• Burning sensation or pain during urination.
• Abnormally fast heartbeat, breathing problem and sweating.

In order to prevent such complications, it is sincerely advised to go for regular medical checkups during your pregnancy

The first three months of the pregnancy are very crucial, as the risk of miscarriage and health problems is very high.⁽³⁾ Some women may be at greater risk due to their age, previous birth history, medical history or medications. These factors further increase the risk of complications in pregnancy. This is when we realize the importance of medical checkups during pregnancy.

While high-risk pregnancies definitely need more frequent checkups, certain unexpected problems too can occur in healthy pregnant women. In order to be aware of the health status and the changes occurring with advancement of pregnancy, regular checkups are needed during pregnancy. Medical checkups during pregnancy play an important role in ensuring good health for the mother and child.

The second and the third trimester in the pregnancy are also extremely important phases of pregnancy when pregnant women may have to get tests done like: blood glucose, blood pressure and several parameters checked. Medical checkups during pregnancy are crucial at this point too.

Here are some of the common tests included in medical checkups during pregnancy:

Regular medical checkup during pregnancy, also called antenatal checkup, mainly involves a thorough physical examination of the mother. The weight and blood pressure of the mother is monitored by the nurse, assistant or the gynecologist himself. The medical history of both parents is required, particularly that of the mother.

Physical examination, especially during the second trimester of pregnancy is done to keep a check on the following medical conditions:

• Blood pressure level.
• Sugar level.
• Protein and glucose level in urine.
• Amount of weight gain.
• Edema.
• Belly size.
• Fetal growth in terms of its height or width.
• Rate of heartbeat for both the mother and the fetus.
• Movement of the fetus.

Lifestyle of the pregnant woman is an important factor to assess the course of the pregnancy; hence it forms an integral part of the medical checkup during pregnancy. Lifestyle assessment of the patient undergoing pregnancy includes assessment of:

• Diet and lifestyle of the mother.
• Prenatal vitamins, supplements or any other medicine use.
• Sleep patterns of the mother.
• Preterm labor symptoms in the mother.
• Preeclampsia symptoms like swelling in the mother.

For some women, based on the possible risks, additional tests may be advised.

Gynecologists may also need to know the overall medical history, family history and details of any ongoing medications. Certain medications or supplements that the mother is already taking might be teratogenic in nature, which need to be altered appropriately. It is necessary to share any unusual complaints or concerns related to your pregnancy to get the right treatment.

Medical checkup and the tests during pregnancy mainly focus on the following:

Heartbeat of the Fetus: During early pregnancy stage, the fetal heartbeat rate is generally faster than the normal heartbeat rate (60 – 100 beats per minute). The usual heart beat range noticed in a developing fetus during the early stages of pregnancy is 120 to 160 beats per minute.⁽⁴⁾ Doppler technology is used to check the heartbeat of the fetus by monitoring sound waves.⁽⁵⁾ The rate of heartbeat can be determined with the help of ultrasound, which is an essential part of medical checkup during pregnancy.

Fundal Height: This examination involves measuring the height of the uterus, from the top of the pelvic bone to that of the uterus (fundus).⁽⁶⁾ The length of the pregnancy and the fundal height are closely related. For example, in the 20th week of your pregnancy, your fundal height should be about 20 centimeters, 2 centimeters more or less. The measurement of the fundal height may not always be accurate; especially for those women who are obese or have fibroids, when the woman is carrying twins or multiples or has excess amniotic fluid. Additional tests may be required, screening of which can be done only with medical checkup during pregnancy.

Edema: Swelling in the hands, legs, ankles, feet and face is normal during pregnancy.⁽⁷⁾ It is caused due to retention of fluids.^(7,8) This condition is called edema, which increases during the third trimester phase. Although some edema is common, it is important to keep a watch on abnormal swelling during the pregnancy, as it may indicate problems like gestational diabetes, blood clot or preeclampsia.^(7,8) In such cases, immediate medical aid is necessary.

Blood Pressure: Many women experience low blood pressure during pregnancy. However, for some, there is a risk of high blood pressure. Monitoring blood pressure, as a part of medical checkup during pregnancy is important, as there is an increased risk of other problems like preeclampsia or gestational hypertension. These are potentially harmful conditions, as they can affect the health of the mother and child and increase the risk of premature birth.⁽⁹⁾

Weight: In medical checkup during pregnancy, noting the weight is one of the most important parameters. Weight gain of the mother during second trimester depends on the pre-pregnancy body weight, number of fetuses and the amount of weight already gained during pregnancy.⁽¹⁰⁾ In some cases, pregnant women gain excess weight, not because of diet or overeating, but because of the increased retention of water in the body. However, the extra water content is lost after delivery. On the flip side, some pregnant women don’t gain enough body weight, which may be due to inadequate growth of the fetus or nutritional deficiencies. They may be advised supplements to support the nutritional requirement of the fetus and the mother.

Urine Examination: Pregnant woman’s urine is often tested for the presence of sugar, glucose, protein or any micro-organism. Increased amount of protein in urine of the pregnant woman might be a cause for preeclampsia.⁽¹¹⁾ Gestational diabetes can be detected by the presence of glucose in urine.⁽¹²⁾ Other possibilities like urinary tract infection or causes of pain or burning sensations while urinating can also be diagnosed with urine test.

Ultrasound: Ultrasound is an important test done as a part of the medical checkup during pregnancy, to confirm pregnancy and thereafter to monitor fetal development and maternal health.^{(13, 14)} Ultrasound is an essential part of medical checkup during pregnancy. A lot of women don’t need to have an ultrasound test until the second trimester. Ultrasound performed between the 13th and 27th week of pregnancy, is usually done to check the anatomy of the fetus, the placenta and the condition of the amniotic fluid. Any abnormal growth or complications can be detected with the help of ultrasound.^{(15, 16)}

Triple Screen Test: All pregnant women should take a triple screen test, especially during the second trimester.⁽¹⁷⁾ This test is also called ‘AFP Plus’ or ‘Multiple Marker Screening’. In this test the mother’s blood is tested for the following hormones:-

• HCG: A hormone that is produced in the placenta.
• Estriol: A form of estrogen produced by the fetus and the placenta.
• AFP: A form of protein produced by the fetus.

Triple Screen Test in pregnancy examines the levels of these hormones and this test is generally performed between the 15th and 22nd week of the pregnancy. Fetal abnormalities like Trisomy 18 syndrome, spina bifida and Down syndrome can be detected with the help of this test.

Cell-Free Fetal DNA Test: This test in pregnancy helps in assessing the risk of chromosomal disorder in the developing fetus.⁽¹⁸⁾ Women who have a high risk of trisomy are recommended to undergo this test. Cell-free DNA test examines the genetic material that is released by the placenta. It can be detected by taking a sample of mother’s blood. Neural-tube defects can be detected with the help of this Cell-free DNA test.

Amniocentesis: This test provides a definite diagnosis for any complications with the pregnancy.⁽¹⁹⁾ A sample of the amniotic fluid is extracted and examined for genetic or chromosomal abnormalities. Amniocentesis is an invasive procedure, but completely safe.

Other Tests done in Pregnancy: Some of the tests recommended for pregnant women, if appropriate include:

• Platelet and blood count tests.
• RPR, a Rapid Plasma Reagin test.

Tests to look for sexually transmitted infections, vaginal infections and bacterial infections.

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