Registration with a gynecologist in the first weeks of pregnancy

The most common question for a woman in this position is: "When should I register for pregnancy and what do I need to do for this?". Registration with a gynecologist in the first weeks of pregnancy is usually carried out 2-4 weeks after the first missed period and the fact of pregnancy (positive pregnancy test or hCG test). In this case, the obstetric period will be 6-8 weeks. To register, you need to contact the antenatal clinic, which is located in the district clinic at the place of registration.

In this case, you need to have your passport and preferably a medical card with you. What should you do if you do not live at your registered address? There are two ways to register at your place of residence. The first is to go to the antenatal clinic at your registered address and get a referral to the local clinic, writing an application. The second is to go to the antenatal clinic at your place of residence, write an application and pay a fee for out-of-towners. At the antenatal clinic, you will be assigned to a gynecologist who will monitor the course of your pregnancy until delivery. If you are not satisfied with your gynecologist for any reason, you can change him or her to another, having previously written an application.

So, you have come to your gynecologist who will be observing you. What next? And then you will face a huge number of questions, manipulations, referrals for tests and examinations, strange incomprehensible words, recommendations and advice, which we will discuss in detail below.

At the first appointment and registration in the first weeks of pregnancy, the gynecologist fills out a special card for the pregnant woman (exchange card), which will record all scheduled appointments, test results, additional examinations, factors aggravating pregnancy, etc. The entire appointment can be divided into five stages:

1. Collection of anamnesis;
2. Measurement of physiological data;
3. Gynecological examination;
4. Issuing referrals for tests and additional examinations;
5. Recommendations.

[ 1 ]

Collection of anamnesis when registering with a gynecologist in the first weeks of pregnancy

At this stage, the gynecologist questions and records data in the pregnant woman's exchange card about: existing pregnancies, methods of delivery, miscarriages, abortions, the patient's general health, past illnesses, surgeries, the presence of acute and chronic diseases in the pregnant woman and her relatives, bad habits, place of work, type of work, living conditions and social status of the family. All this information will help to give specific recommendations and build an individual pregnancy management plan in order to maximally preserve the health of the mother and child.

Measuring physiological data when registering with a gynecologist in the first weeks of pregnancy

At this stage, the gynecologist measures:

• weight and height of the pregnant woman (to control weight gain during pregnancy). It is believed that a normal gain over 9 months is about 12 kg. But this number is quite relative. Each organism is individual. Weight gain in the first weeks of pregnancy is approximately 2 kg. But if a woman has toxicosis, then weight loss is also possible.
• the size of the pregnant woman's pelvis (to assess the possibility of spontaneous delivery). Usually, the size of the pelvis is measured using a special instrument similar to large tweezers - a pelvimeter. The pelvic size indicators are indicated by Latin names: Distantia spinarum, Distantia cristarum, Distantia trochanterica and Conjugata externa. Accordingly, normal pelvic size indicators are: 25-26 cm / 28-29 cm / 31-32 cm / 20-21 cm. The difference between the first three indicators is also taken into account; it should be 3 cm.
• the height of the standing fundus of the uterus of a pregnant woman (to assess the normal enlargement of the uterus). This parameter is measured in a lying position and, usually, in the first weeks of pregnancy it is 8-9 cm. An increased value may indicate multiple pregnancy, incorrect gestational age and polyhydramnios. A decreased value may indicate a delay in fetal development or incorrect gestational age.
• abdominal circumference (to assess the positive dynamics of fetal growth). The abdominal circumference size is also used in later stages of pregnancy to determine the approximate weight of the fetus.
• blood pressure (to exclude hypertension). Most often, pregnant women experience low blood pressure and rapid pulse in the first weeks of pregnancy. If the patient feels normal with such indicators, then this is not considered a pathology. But high blood pressure is very dangerous. Hypertension can lead to a condition called preeclampsia, which can cause placental abruption, bleeding, and even intrauterine death of the fetus.

Gynecological examination when registering with a gynecologist in the first weeks of pregnancy

When registering with a gynecologist in the first weeks of pregnancy, a gynecological examination on the chair is mandatory. During this procedure, the gynecologist examines the walls of the vagina, the cervix and takes a smear for flora. The smear can determine the presence of certain infections (trichomoniasis, thrush, gonorrhea) and, if present, prescribe treatment in a timely manner. There is a myth that a gynecological examination on the chair cannot be carried out during the first weeks of pregnancy. In fact, this is not entirely true. The doctor does not perform a rough examination, but understanding that you are pregnant, he will do everything delicately.

Issuing referrals for tests and additional examinations when registering with a gynecologist in the first weeks of pregnancy

When you register, your doctor will give you many referrals for various tests, namely:

• general blood test - to assess the level of hemoglobin and exclude anemia, as well as to identify hidden inflammatory processes in the body of a pregnant woman;
• general urine analysis is a mandatory test to assess the general condition of the kidneys and to exclude acute and chronic diseases of the urinary system (cystitis, pyelonephritis, glomerulonephritis), as well as to control the level of acetone in case of toxicosis;
• RW analysis is a mandatory analysis to exclude the presence of syphilis; if syphilis is present, there is a high probability of miscarriage or stillbirth;
• HIV blood test is a mandatory test to identify the risk of infection of the fetus with this disease;
• blood test for hepatitis B – a mandatory test to identify an increased risk of infection of the fetus;
• a blood test for hepatitis C is not a mandatory test, but it is recommended to identify the possibility of intrauterine infection of the fetus;
• analysis of thyroid hormones and antibodies to them is not a mandatory analysis, but recommended; a normal TSH level is very important for the full development of the child’s organs and systems;
• blood sugar test – to rule out diabetes;
• analysis of the mother's blood type and Rh factor - a mandatory analysis to exclude the possibility of Rh conflict and blood group conflict between the mother and child;
• Blood biochemistry analysis is a mandatory test for diagnosing liver and kidney function and excluding their pathologies;
• a coagulogram is not a mandatory test, but it is recommended; with poor hemostasis, there is a high probability of miscarriage;
• blood test for antibodies to TORCH infections (toxoplasmosis, rubella, cytomegalovirus, herpes - a mandatory test, all these diseases directly affect the normal development of the fetus;
• Bacteriological urine culture is not a mandatory test, but it is recommended to detect bacteriuria and treat it in a timely manner.

Also, a gynecologist can prescribe additional examinations such as:

• ultrasound examination – to establish a uterine or ectopic pregnancy, to clarify the gestational age, to identify aggravating factors such as tone and others.
• cardiogram – examination of the mother’s heart function.

At the first appointment, the gynecologist will give you a referral for a routine examination by such specialists as:

• ENT – to exclude chronic ENT infections;
• ophthalmologist – to assess the vision of a pregnant woman; if vision is severely impaired, the question of delivery by caesarean section may arise;
• endocrinologist – to evaluate the results of tests for thyroid hormones and blood sugar and to exclude diseases of the thyroid gland and pancreas;
• dentist – to assess the health of teeth and eliminate diseases, since calcium and phosphorus are washed out during pregnancy;
• therapist – to identify and treat concomitant diseases.

[ 2 ], [ 3 ]

Recommendations for registering with a gynecologist in the first weeks of pregnancy

When you first come to the antenatal clinic, the gynecologist will prescribe special vitamins for pregnant women and other (if necessary) medications, answer all your questions, schedule your next appointment and send you to attend a school for expectant mothers, where you will learn a lot of interesting information about proper balanced nutrition and lifestyle during pregnancy. Also, if necessary, the gynecologist can issue a sick leave and write a certificate to ease the work schedule.