Diagnosis of Pregnancy During the First Contact - Essay Example

?Based on the National Institute of Health and Clinical Excellence (NICE), pregnant women are recommended to visit appropriate healthcare providers at certain weeks of gestation. At these times, different techniques are used to determine whether or not the pregnancy is going on as expected. Since pregnancy weeks are described based on their biochemical, hematological, physiological, and anthropometric characteristics, techniques that can measure these are necessary to assess pregnancy. Diagnosis during the first contact Diagnosis seems to be the easiest part of managing pregnancy, as it can be done by urine pregnancy tests, which are biochemical tests based on the levels of human chorionic gonadotropin (HCG) hormone present in the urine. This hormone is produced in high amounts during pregnancy. Upon fertilization, the body produces HCG, so that two weeks after this process there is already enough HCG for the pregnancy test to detect it. Thus, the test can be taken first day of the missed period or three weeks after the last sexual intercourse. A positive result is almost always indicative of pregnancy, and at that point the woman is at least two weeks pregnant. However, intake of promethazine, medications for Parkinson’s disease, hypnotics, diuretics, anticonvulsants, or infertility medications can result to false positive results. This must be taken into consideration when taking the pregnancy test. On the other hand, a negative result does not mean the woman is not pregnant. The test can be repeated after a week (National Health Services, 2011). After confirming pregnancy, determining the age of gestation (AOG) is important in identifying at what stage the pregnancy is in, and in subsequently determining the tests needed to ensure its normalcy, and project the date of childbirth. This can be deduced from the first day of last menstrual period. Booking appointment (10 weeks AOG) Ultrasound At this point (10 – 13 weeks AOG), gestational age can be determined more accurately using transvaginal ultrasound imaging. Depending on the physical features imaged, the corresponding week can be accorded to the fetus. As such, the sex of the fetus can also be determined (National Collaborating Centre for Women's and Children's Health, 2008a). It is also especially important for those at risk of ectopic pregnancy (previous history of ectopic pregnancy, infertility, pelvic inflammatory disease (PID) or tubal surgery, or current use of intrauterine device (IUD) contraceptives). Before doing the ultrasound, AOG can be estimated from the first day of the last menstrual cycle. Although measuring the fundic height (anthropometric) is also an option, this anthropometric technique can only be done after 16 weeks AOG (VA and DoD, 2009). In addition, it might be difficult to accurately measure, especially for women with abdominal obesity. Nutritional assessment This time should also be dedicated to identifying existing risk factors that may complicate pregnancy. Assessment of the woman’s BMI (anthropometric) is necessary to determine whether there are concerns regarding her nutrition and risk for gestational diabetes mellitus. Those with personal medical and family medical histories of diabetes mellitus II (DMII), prior macrosomia (previous newborn weighing more than 4.5 kg), gestational diabetes mellitus (GDM) or obesity are likely to have hyperglycemia during the current pregnancy (National Collaborating Centre for Women's and Children's Health, 2008a). On the other hand, an underweight pregnant woman can also have a difficult pregnancy as well, as she may not have enough room or nutrition to allow the growth of the fetus. Infection Urine and blood microbiological tests can determine ongoing asymptomatic bacteriuria, which may complicate into pyelonephritis, and transmissible hepatitis B and human immunodeficiency virus (HIV) infection. It can also detect syphilis infection, which may cause miscarriage, stillbirth or an ill newborn (National Collaborating Centre for Women's and Children's Health, 2008a). Pre-eclampsia Measurement of blood pressure (physiological) and urine protein levels (biochemical) can identify those with pre-eclampsia. This is especially important for those at risk for developing this condition, such as age of 40 years and older, first pregnancy, pregnancy interval of more than a decade, family and previous history of the same condition, obesity, hypertension, existing renal disease, and multiple pregnancy (National Collaborating Centre for Women's and Children's Health, 2008a). Early detection and management of pre-eclampsia is important to prevent seizures, stroke, renal failure, pulmonary edema, jaundice, HELLP syndrome (hemolysis, elevated ALT and AST levels, and low platelet count), and maternal death (Sibai, et al., 2005; Duley, et al., 2006). Blood tests Various blood tests are recommended for pregnant women. Complete blood count (CBC) is necessary to screen for anemia (11g/100 ml). Although it is normal for pregnancy to cause a decrease in hemoglobin concentration, abnormal (high or low) levels of hemoglobin are associated with increased risk of poor fetal outcome. If anemia is detected, further study is warranted. Screening for red cell alloantibodies, such as anti-Rhesus D, anti-C and anti-Kell antibodies prevents hemolytic disease of the newborn, verifies a cause of anemia, and identifies future transfusion problems. Another probable cause of anemia is hemoglobinopathies, such as sickle cell and thalassemia. Screening for these is also recommended (National Collaborating Centre for Women's and Children's Health, 2008a). 16 weeks AOG Ultransound done between 18 – 20 weeks AOG can already be used to screen for structural abnormalities in the fetus. For example, screening for Down’s syndrome can be done by looking at the nuchal translucency. In addition, a repeat measurement of blood pressure and urine protein levels is warranted (National Collaborating Centre for Women's and Children's Health, 2008a) Aside from ultrasound findings, Down’s syndrome can be screened using the combined test (at 11 weeks and 13 weeks 6 days AOG), composed of measuring beta-HCG and pregnancy-associated plasma protein A serum levels, or the quadruple test (at 15 and 20 weeks AOG), which involves measurement of plasma levels of beta-HCG, unconjugated estriol, alpha-fetoprotein, and inhibin A. 25 weeks AOG At this point, for nulliparous women especially, the fundic height (anthropometric) is measured. This is the distance between the lowest and highest parts of the uterus. This is done to determine whether the fetus is growing normally. If the measurement is below the 10th percentile or above the 90th percentile on the fetal growth chart, then specialized imaging techniques, such as ultrasound biometry (anthropometry), amniotic fluid assessment (physiological) and Doppler flow (physiological) can be used to identify the cause of abnormal growth (National Collaborating Centre for Women's and Children's Health, 2008a). If the fetus has oligohydramnios, then it cannot move well around the womb, subsequently undermining its growth. It may also keep the lungs from developing properly. On the other hand, Doppler flow assesses blood flow in the fetus (Cunningham, et al., 2010). Pre-eclampsia is also closely monitored (National Collaborating Centre for Women's and Children's Health, 2008a). At this time, those at risk of GDM can also undergo measurement of two-hour 75g OGTT to definitively diagnose GDM (National Collaborating Centre for Women's and Children's Health, 2008b). 28-34 weeks AOG Every month after 25 weeks AOG, measurement of blood pressure, urine protein levels, hemoglobin levels, and fundic height may be repeated. Repeated blood pressure and urine protein levels helps monitor pre-eclampsia, while that of hemoglobin allows early management of anemia. If no growth (flat) or excessive growth (steep) was observed from the slope of the plot of all fundic height measurements, ultrasound biometry, amniotic assessment and Doppler flow can be done (National Collaborating Centre for Women's and Children's Health, 2008a). 36 weeks AOG to childbirth At this point forth, prenatal check-ups are done every two weeks. Aside from monitoring for pre-eclampsia and fetal growth, the position of the fetus is also determined at 36 weeks AOG, either by conducting a special physical examination (Leopold’s Maneuver) or ultrasound. This is important in planning for labor and birthing. A cephalic presentation offer less complications while giving birth, so if the position is breech, then external cephalic version may be recommended (National Collaborating Centre for Women's and Children's Health, 2008a). References Cunningham, F. G., Leveno, K. J., Bloom, S. L., Hauth, J. C., Rouse, D. J., and Spong, C. Y., 2010. Williams Obstetrics. NY: McGraw-Hill Duley, L., Meher, S.. and Abalos, E., 2006. Management of pre-eclampsia. BMJ, 332(7539), pp. 463-468. National Collaborating Centre for Women's and Children's Health, 2008a. Antenatal care: routine care for the healthy pregnant woman. London: Royal College of Obstetricians and Gynaecologists. National Collaborating Centre for Women's and Children's Health, 2008b. Diabetes in pregnancy. London: Royal College of Obstetricians and Gynaecologists. National Health Services, 2011. How soon can I do a pregnancy test? [online]. Available at: < http://www.nhs.uk/chq/Pages/948.aspx?CategoryID=54&SubCategoryID=140> [Accessed 26 January 2013] Sibai, B., Dekker, G., and Kupferminc, M., 2005. Pre-eclampsia. Lancet, 365(9461), pp. 785-799 Read More