Before pregnancy, the process begins with evaluating whether the mother’s body is sufficiently prepared to nourish and support the baby for nine months. It continues until birth with tests, ultrasound monitoring, examinations, and counseling.

Today, couples should say “We want a healthy baby” rather than simply “We want a baby,” because with current medical advances, many potential problems can be predicted and prevented during pregnancy.
A healthy baby requires a healthy egg and healthy sperm. However, it is not possible to identify the healthiest egg among 400,000, nor to know which of the 60 million sperm will fertilize the egg.

FAMILY HISTORY SCREENING


What can be done is to review your family history before pregnancy. Couples should question their family background: Are there any genetic diseases? Has there been infant loss in the family? If any concerns arise, genetic counseling should be sought to determine whether it is a diagnosable condition. Let’s assume there is no issue.

THE MOTHER SHOULD PREPARE HERSELF


The prospective mother, who will host the baby throughout pregnancy, should ask herself: “Am I physically ready for this?” Blood tests (hemogram) are used to check for anemia, iron deficiency, thalassemia carrier status, diabetes, or thyroid disorders. It is also important to determine whether she has had infections such as toxoplasmosis or rubella. If she has not had rubella, vaccination is recommended and pregnancy should be postponed for 3–4 months. In addition, deficiencies such as folic acid and vitamin B12 should be assessed, and folic acid supplementation should begin three months before pregnancy.


Pregnancy is achieved and the couple comes for evaluation. Whether the pregnancy is healthy can be understood through:
1. Physical changes
2. Biochemical changes
When the pregnancy implants in the uterus, the placenta secretes a specific hormone: Beta hCG. When Beta hCG levels exceed approximately 100 in tests, biochemical pregnancy is confirmed. When this hormone passes into the urine via the bloodstream, a positive pregnancy test is indicated by two lines.
During pregnancy, two major changes occur: the increase of Beta hCG, which is not normally present in the body, and the increase of progesterone, which supports pregnancy. These changes lead to secondary symptoms such as morning sickness, indigestion, frequent urination, metallic taste in the mouth, changes in saliva, gum swelling, and bleeding—prompting the mother to seek medical care.
If checked too early, the gestational sac may not yet be visible. It is generally not seen in the uterus until Beta hCG exceeds 1500 units, which corresponds to about 14 days.
 

Since fertilization occurs in the fallopian tube, sometimes the gestational sac may remain there instead of reaching the uterus. This is called an ectopic pregnancy. Once the sac is seen in the uterus, the pregnancy is clinically confirmed.


Seeing the sac is not sufficient. After confirming that it is not a chemical pregnancy, the next step is to determine whether the genetic structure is properly developing. This requires visualization of the fetus.
There are two types of pregnancy follow-up. One is empirical monitoring—observing visually. For example, the patient is seen at 6 weeks, then again at 8 weeks, then at 10 weeks, and growth appropriate for gestational age is observed.
The other is based on scientific data. Between weeks 11–13, screening tests are performed using established databases.
In addition to Down syndrome, conditions such as cleft lip and palate, abnormal foot positioning, separation of the big toe, and anomalies in the brain, heart, and kidneys may also be indicators.
If any suspicion arises in screening tests, referral for amniocentesis may be considered.
Double, triple, and quadruple tests mainly assess the risk of Down syndrome. However, other abnormalities such as brain or heart defects and abdominal wall defects are equally important. These are evaluated through a “second-level ultrasound,” also known as a detailed or fetal anomaly scan, which is essential.
Sometimes patients ask whether further testing is needed after amniocentesis. Certain conditions like cleft lip and palate cannot be detected by amniocentesis. The main aim of fetal screening is to evaluate five systems: nervous, circulatory, musculoskeletal, digestive, and excretory systems.
Even if all systems appear normal, Down syndrome cannot be completely ruled out.
In conclusion, after completing tests and fetal screening, we can say with approximately 85–95% accuracy that the baby is healthy. These evaluations should be completed by the 20th week.
After this, if no problems are found, the mother is followed up monthly.
She should be able to recognize:
1. Whether the pregnancy is progressing well
2. Whether the baby is healthy

AM I HUNGRY OR TIRED?
 

The mother should monitor fetal movements. If movements are felt, the baby is considered healthy. Especially after the 32nd week, the baby’s movements should be felt within 10–24 hours.
If movements are not felt, the mother should not panic. Instead, she should ask herself: “Am I hungry or tired?” If hungry, she should eat something sweet and lie on her left side for about 40 minutes. A healthy baby will move within this time. If no movement is felt, a doctor should be consulted immediately.


TO PREVENT PRETERM BIRTH
Screening is completed by the 20th week. If all tests indicate a healthy baby, the goal is to prevent birth until the baby reaches maturity (37 weeks).
To achieve this, the mother should:
* Avoid vaginal and nearby organ infections
* Inform her doctor if her body temperature exceeds 37.5°C
 

Frequent ultrasound examinations do not harm the baby. Although ultrasounds are often blamed for early pregnancy losses, this is not correct.


Ultrasound also allows the mother to connect with her baby. Especially in early pregnancy, frequent ultrasounds provide reassurance during a challenging period of hormonal and emotional changes.

What is the double test?
It assesses the risk of Down syndrome in early pregnancy. Measurements such as nuchal translucency and crown-rump length are taken, and maternal blood is analyzed. These data, along with maternal age and weight, are used to calculate risk.

What is the triple test?
Performed between weeks 16–22, it analyzes three hormones in maternal blood and calculates Down syndrome risk.
Abnormal results do not necessarily mean the baby has Down syndrome.

What is amniocentesis?
Amniocentesis involves sampling the amniotic fluid to examine fetal chromosomes. It is performed between weeks 16–20 (or up to week 22).
It is recommended if screening tests indicate increased risk. Although risks such as miscarriage and infection have decreased over time, there is still a small risk (about 1/200) of losing a healthy baby.
 

/ Obstetrics and Gynecology Specialist / İRENBE