Prof. Dr. Ali EKİZ

Frequently Asked Questions

Perinatology is a branch of science that identifies high-risk and problematic pregnancies and deals with the diagnosis and treatment of diseases of the baby in the womb.

The aim of Perinatology, which diagnoses negative conditions during pregnancy and applies the necessary treatment, is to plan pregnancy follow-up and necessary treatment.

Perinatology;

  • Improving the health of expectant mothers and their babies,
  • Early diagnosis of fetal abnormalities,
  • Screening for chromosomal abnormalities,
  • Prevention of miscarriages and stillbirths,
  • Identifying and preventing preterm birth,
  • Diagnosis of problems that may occur in multiple pregnancies

in the fields of

  • Miscarriage and recurrence of miscarriage
  • Premature birth
  • Birth of a very thin and very overweight baby
  • Poisoning during pregnancy
  • Experiencing excessive bleeding during labor
  • Having had uterine fibroid surgery
  • Uterine rupture
  • Ectopic Pregnancy

Risky pregnancy covers a very wide range of patients. Grouping people who are likely to have a high-risk pregnancy;

  • Current risks of expectant mothers
  • Risks from a previous pregnancy
  • Fetal and obstetric risks
  • Detailed Fetal Ultrasonography
  • Fetal Anomalies
  • Fetal Echocardiography
  • Fetal Heart Anomalies
  • Prenatal Diagnosis
  • Diagnostic Procedures in the Womb
  • Pregnancy Complications
  • Four Dimensional Fetal Imaging
  • Diagnosis of Genetic Diseases in the Womb
  • Counseling in Risk Pregnancies
  • Management of Multiple Pregnancies

 

The triple screening test, also known as the “Triple test”, is a screening test that is performed on pregnant women between the 16th and 20th week of pregnancy.

In the blood sample taken from the expectant mother, 3 different hormones are measured. These hormone measurements are entered into a special computer program and processed together with variables such as the age, weight and smoking status of the expectant mother and the week of pregnancy.

It is a screening test for chromosomal abnormalities of the baby during pregnancy, especially chromosomal disorders such as Tisomy 21 (Down syndrome), Trisomy 18 (Edwards Syndrome) and anomalies called “Neural tube defects”. As with the double test, the triple test is a screening test that screens the high-risk group. The success rate of the triple test in detecting Down syndrome is approximately 70%.

The only advantage of the triple test is that a high AFP level is a warning sign for neural tube defects (spinal closure defects). However, since neural tube defect is a pathology that can be detected by ultrasound and AFP measurement can be performed alone, triple testing is not necessary in patients with normal double test results.

Cervical insufficiency or cervical insufficiency is a condition in which the cervix is not sufficient to allow the pregnancy to continue.

In such pregnancies, as the pregnancy progresses, the cervix or cervix shortens and opens, resulting in premature birth. This sometimes results in the miscarriage of a fetus that is too small to survive between 16-20 weeks and sometimes in the premature birth of a fetus that can be kept alive in intensive care between 24-34 weeks.

Although the cause is not generally identified, cervical insufficiency can be caused by operations that cause loss of tissue in the cervix such as conization, abortions usually between 14-16 weeks, congenital uterine abnormalities and normal birth trauma.

If such a pregnancy loss has occurred once, the length of the cervix should be monitored in subsequent pregnancies, and the patient should be evaluated for the necessity of cervical cerclage (narrowing of the cervix by suturing).

In cases where the cervix is dilated, this procedure can be performed under emergency conditions. However, there is a possibility of premature birth, uterine infection and opening of the amniotic sac (water retention) after the procedure. Especially emergency procedures or procedures performed after the 20th week of pregnancy are more risky.

  • A condition in which the amniotic fluid is more than normal is called “polyhydramnios”. The amount of fluid is more than 2000 ml or the amniotic fluid index measured on ultrasound is above 24 cm. It is observed in 0.4-.3.3% of all pregnancies. 2.6% develops due to multiple pregnancies.

    Causes

 

  • Diabetes in the mother
  • Congenital anomalies and genetic syndromes

 

Idiopathic In 34% of polyhydramnios, no cause can be found.

It is very important to be informed about every moment of the baby, its developmental stages and general health status during pregnancy. For this reason, the development of the expectant mother and the baby is followed in detail during the pregnancy. Ultrasound can be shown as one of the miraculous inventions that provides information to the doctor and the expectant mother about everything related to pregnancy from the beginning to the end of pregnancy.

Detailed ultrasound (second level ultrasound, color ultrasound) is usually performed at 20-23. It is an examination carried out over a period of weeks.

All organs are evaluated in detail and 80-90% of the diseases that can be seen in newborn babies can be diagnosed.

This examination can also be considered as a check-up of the baby in the womb. The examination takes approximately half an hour on average. The baby’s position and mobility may take a shorter or longer time depending on the mother’s subcutaneous fat tissue.

  • Twin or multiple pregnancies
  • Developmental retardation in the fetus
  • Blood incompatibility in the baby
  • Water being less or more than normal
  • Posture disorder in the uterus
  • Diseases detected in the baby
  • Multiple gestational births
  • Abnormal adhesion of the baby’s partner to the uterine wall
  • The baby’s partner comes before the baby
  • Risk of excessive bleeding
  • Risk of hysterectomy
  • The 4-way screening test is one of the tests that basically screens the baby for Down syndrome during pregnancy. The success rate of the quadruple test in detecting Down syndrome is approximately 75%.

    The quadruple test is so named because it uses four parameters from the pregnant woman’s blood.

    These are Alpha-fetoprotein (AFP), Human Chorionic Gonadotripin (HCG), Inhibin A and Estriol. The 4-way screening test should be performed between 16 and 20 weeks of pregnancy. Ideally, it is also performed between 16 and 18 weeks.

    The test also uses AFP to check for any abnormalities or problems in the fetal brain, spinal cord and other nerve tissues in the central nervous system (neural pathway).

    The Quad Screening Test is performed with a blood sample taken from the mother after an ultrasound scan. The blood sample is sent to a laboratory for analysis. It can take several days to receive the results.

    Translated with DeepL.com (free version)

The ideal daily calorie intake for pregnant women is between 2,500-2,700 calories. The food eaten must contain vitamins, minerals and nutrients.

Protein and calcium intake is also very important. The four basic food groups of meat, milk, cereals, fruits and vegetables should be taken regularly every day. It is very important to consume chicken, meat and legumes, which are protein sources, throughout pregnancy.

Foods must be washed thoroughly before consumption. In addition, care should be taken not to consume fruits that are out of season. Another important factor during pregnancy is fluid consumption. Completing the daily amount of fluid in the body is very beneficial for both the baby and the mother. This fluid can be met from water, buttermilk, fresh fruit juices and milk.

The initial period of pregnancy, i.e. the first 3 months, is the period when pregnant women gain the least weight. The ideal weight to be gained during this period is between 1 and 2.5 kilograms. After the 3-month period, half a kilogram should be gained every month. However, it should be especially noted that overweight expectant mothers should gain 250 g per week.

If you exceed the weight gain recommended by your doctor; the likelihood of delivery by caesarean section can increase by 20% to 30%.

In addition, problems such as complaints of back and hip pain and high blood pressure may also occur. All these complaints are the source of having a difficult birth. Less weight gain than required during pregnancy is an indication of malnutrition. This may cause developmental delay in the baby.

Diabetes mellitus occurs in people who are predisposed to it due to changes in hormones during pregnancy. Depending on the characteristics of the population, diabetes occurs in 6-7% of all pregnancies. 90% of these are gestational diabetes, that is, diabetes that occurs during pregnancy.

It is more common in mothers over 35 years of age, in obese women, in women with a large baby or a history of gestational diabetes and in women with a family history of diabetes.

Gestational diabetes is detected with a sugar loading test performed at 24-28 weeks of pregnancy. These tests are performed in every pregnancy. The diagnostic test for gestational diabetes, which is mistakenly known as a sugar loading test and whose real scientific name is “Glucose Tolerance Test”, does not harm the mother or fetus.

The oral glucose tolerance test is performed as a one-stage or two-stage test. In the 75 gr. glucose one-stage loading test, blood values are checked at the 1st and 2nd hour after drinking sugar after 8 hours of fasting.

The 50 gr. sugar test is a non-fasting test with a 1st hour blood glucose measurement and, if high, a 100 gr. test with 1st, 2nd and 3rd hour blood glucose readings. These tests are not an alternative to tests that only look at fasting and postprandial sugars.

Treatment in patients with gestational diabetes is to ensure that blood glucose regulation is kept at normal levels with diet and exercise. If this is not successful, insulin should be administered. Self-monitoring of blood glucose at home is taught and medical nutrition therapy is explained.

The aim of medical nutrition therapy is to regulate the balance of carbohydrate, protein and fat in the pregnant woman’s diet. It is aimed to keep fasting blood glucose below 95 mg./dl and to keep 1st hour postprandial glucose below 145 and 2nd hour postprandial glucose below 125.

If the targeted blood glucose levels are not achieved with medical nutrition therapy and exercise, insulin treatment is recommended. After starting insulin, the pregnant woman should continue to follow a diet and self-measure her blood glucose.

The expectant mother

  • Under 18 and over 40 years of age
  • History of recurrent miscarriage
  • Being overweight or underweight
  • Being related to his/her spouse
  • Above normal smoking or alcohol consumption
  • Presence of one or more of the following thyroid diseases: blood pressure, goiter, heart, diabetes, liver, vascular, epilepsy
  • Previous major surgeries,
  • Use of medication for any reason

are among the existing risks.

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