Pregnancy follow-up: what you need to know about the 7 mandatory consultations

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Each month, these appointments will punctuate your pregnancy. In France, pregnant women benefit from seven birth and parenthood preparation sessions which can be carried out by a doctor or a midwife. Fully reimbursed by social security, this medical follow-up is essential to ensure the smooth running of the pregnancy and prevent the risks associated with it. Moreover, during these nine months of pregnancy, three ultrasounds must also be performed.

More concretely, every month from the fourth month of pregnancy, you will be subjected to a a series of systematic examinations with the doctor or midwife who is monitoring you. They will ask you about different topics:

  • your weight ;
  • your blood pressure to prevent the risk of pregnancy-induced hypertension. “It is the most frequent health problem in pregnant women” according to the Health Insurance. “HTA is present in 5 to 10% of pregnancies.”
  • the height of the uterus;
  • baby’s heart
  • a urine test for sugar (to prevent gestational diabetes), protein in the urine in case there is a renal manifestation of pregnancy-induced hypertension, and for leukocytes and nitrites produced during pregnancy a urinary tract infection.

But ideally, “one should consult even before becoming pregnant”, advises Laura-Charlotte Bruneau, midwife at the Maternity of Bluets in Paris. “It is preconception consultation. It will allow to take stock of the medical history of the future mother. For example, for people with diabetes, it is important to anticipate the disease well in order to balance it before becoming pregnant. This preconception consultation will also allow start prescribing folic acid for prevention”.

As a reminder, take a daily vitamin supplement that contains folic acid may reduce your baby’s risk of having a neural tube defect. This is an essential need during the very first weeks of pregnancy.

1st consultation: prenatal examination before 3 months of pregnancy

First of all, this first prenatal consultation officially confirms the pregnancy and makes it possible to define the medical follow-up to come. It must be done before the end of the third month of pregnancy and generally it is done before the first ultrasound. In addition, the doctor or the midwife will make you aware of the need not to take medication on your own initiative, as some may have an impact on the child. He can prescribe folate (vitamin B9) up to 12 weeks of amenorrhea to prevent certain abnormalities of the nervous system. This is also the time to address other difficulties such as quitting smoking or drinking alcohol.

This first consultation will also allow the doctor or midwife to learn about your state of health. “We are going to propose to the future mother to make samples of all serologies such as HIV, toxoplasmosis, rubella, syphilis, hepatitis C, CytoMegaloVirus (CMV) or hepatitis B”, indicates the midwife. “We also do a cardio-pulmonary examination, then sometimes we offer, if it has not already been done, screening for cervical cancer.”

The first ultrasound

Performed at 12 weeks of amenorrhea, this first ultrasound will make it possible to fix the term of the pregnancy and to specify whether it is single or twin. “By measuring the fetus, doctors will be able to predict a baby’s date of birth”, confirms the midwife. “We confirm the number of fetuses present, we make sure that it is in the uterus and that it is developing correctly.” It is also during the first ultrasound that the doctor or midwife will suggest that you screening for trisomy 21in particular by measuring the nuchal translucency.

Trisomy 21 screening

The doctor or midwife will suggest that you assess the risks of trisomy 21 through screening. “We will measure the nuchal translucency, which corresponds to the thickness of the fetus’s neck,” explains Laura-Charlotte Bruneau. “If the couple agrees to be subjected to this screening, we will carry out a blood test to measure the dosage of serum markers.” These are substances secreted by the placenta or the fetus and present in the mother’s blood. “If this level is higher or lower than normal, it could be a sign of trisomy 21,” says Ameli.

If the results are good, the rest of the pregnancy follow-up will be done normally. However, if they are bad, there are several options :

  • A complementary test called non-invasive prenatal screening (NIPT). “It will measure free fetal DNA circulating in your blood,” Ameli reads. “The DNA fragments from the fetus, mixed with yours, are then isolated and analyzed.
  • If the result is negative, your pregnancy benefits from regular follow-up.
  • But if the DNA from chromosome 21 is present in large quantities, it is likely that the child has Trisomy 21. In this case, a diagnosis of trisomy is proposed. It consists of carrying out a fetal karyotype (an analysis of the chromosomes of the fetus) by taking a sample of amniotic fluid (amniocentesis) or a sample of a fragment of the placenta (choriocentesis);
    • Either, you immediately resort to a fetal karyotype if the risk of trisomy 21 is very high.

    Note that if the diagnosis of trisomy 21 is confirmed, you have the choice between continue your pregnancy with more specific support, or terminate it medically.

    2nd consultation: prenatal examination in the fourth month of pregnancy

    Thereafter, as for the first consultation, you will have to resort to a series of examinations which make it possible to raise your blood pressure, your weight, the height of the uterus and your urine. “In the fourth month of pregnancy, we monitor the progress of the pregnancy. We will see how the patient feels, how the pregnancy goes, because at the beginning, the future mother can frequently feel nausea or vomiting”, continues Laura-Charlotte Bruneau.

    Moreover, if screening for trisomy 21 has not been offered to you, there is a good chance that the doctor or midwife will advise you to do so. During this month, it will also be necessary schedule the early prenatal examination. “It is done around the 22nd week of amenorrhea. This longer consultation, which is carried out with the couple, will rather touch on the social and emotional aspects of pregnancy”, explains the midwife. As a reminder, this is not a medical examination. “We will try to understand the couple’s environment. How do they live? Are they surrounded? This exam will therefore be the first preparation session for birth and parenthood.”

    2nd ultrasound

    During the fourth month of pregnancy, at exactly 22 weeks of amenorrhea, the mother-to-be will have to realize so-called morphological ultrasound. “It will make it possible to check that the baby is developing well”, indicates the midwife. “The objective is to observe the baby from every angle. We will check that he is well formed in the brain, kidneys, legs, feet, hands, heart or lungs. In other words, this ultrasound will allow the doctor and the midwife to check the absence of malformations and specify the size of the baby. If you wish, you can also know the sex of your child during this examination medical.

    3rd consultation in the fifth month of pregnancy

    In the fifth month of pregnancy, “we can start listening to the baby’s heart”, reveals Laura-Charlotte Bruneau. “We can also start measuring the mother’s belly to check that the baby is growing well.” On the other hand, “a blood test will be requested to count the red blood cells in search of anemia, the white blood cells and the platelets”, writes the Health Insurance.

    4th consultation in the sixth month of pregnancy

    As with each consultation, the usual checks are carried out again. The doctor or midwife will measure your blood pressure, weight, fundal height, and analyze your urine. This will also ensure that your pregnancy is going well. Furthermore, you can also start your series of seven birth preparation sessions and parenthood. As a reminder, whether individual or group lessons, they are led by a doctor or a midwife and 100% covered by health insurance.

    5th consultation the prenatal examination in the seventh month of pregnancy

    In the seventh month of pregnancy, your fifth appointment will take place. After carrying out the usual examinations, the doctor or the midwife will probably talk to you about the contractions you may feel for the next three months. Indeed, at this stage of pregnancy, the baby can move because the proportion between its size and the amount of amniotic fluid is perfect for it. The uterus enlarges and the amniotic fluid increases. It is also during this month that you will have to your third and final ultrasound.

    3rd ultrasound

    Scheduled at 32 weeks of amenorrhea, the growth ultrasound will ensure the baby’s good development. “Generally, it’s a little harder because he’s gained weight,” testifies Laura-Charlotte Bruneau. “Even if the baby is constantly measured during ultrasounds, the latter remains special because it will make it possible to verify that the child is within the standards. It is also an opportunity to see if he has upside down for childbirth.”

    6th consultation in the eighth month of pregnancy

    You are now in the eighth month of pregnancy. The doctor or midwife therefore ensures that the cervix is ​​closed and that you are not at risk of giving birth prematurely. Therefore, a vaginal examination is performed if you have uterine contractions. In addition, while the baby is normally in the position to be born, a consultation with the anesthetist must be scheduled. As a reminder, this examination is mandatory, even if you wish to give birth without an epidural.

    7th consultation in the ninth month of pregnancy

    This is the last time you go for this pre-delivery follow-up exam. It is therefore time for you to think about your return home. You can choose the midwife or the doctor who will ensure your follow-up as well as your baby’s. For this, there is in particular the PRADO. This service, which was set up by social security, offers mothers still in the maternity ward to choose, after their delivery, a midwife who will take care of them. And this as soon as hospitalization is no longer deemed necessary by the establishment’s medical team.

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