Health care for pregnant women
Pregnancy monitoring process.
In Primary Care, the diagnosis of pregnancy is confirmed before the 12th week of gestation, and an assessment of the obstetric risk in the first trimester is made on the first visit. Visits with the midwife are planned to monitor the pregnancy, tests are requested and advice on healthy habits is provided.
Before the 30th week of gestation, workshops are given to prepare for childbirth and postpartum psycho-physical recovery, in which physical exercises are carried out before and after childbirth, as well as dynamic relaxation techniques, advice for the care of the newborn born and promotion of breastfeeding.
Consultation with your midwife
The midwife is the health professional who provides comprehensive care for women's reproductive, sexual and maternal health in their facets of prevention, promotion, care and recovery of health.
pregnancy monitoring
In the case of a low-risk pregnancy, there is a protocol that unifies and defines the set of actions and reviews, distributed in ten appointments, between the health center and the reference public hospital, which agrees on both the visits to be made in the corresponding health care area and the health actions that the pregnant woman needs, such as blood tests, prescription of folic acid, ultrasound scans, tests, vaccination against whooping cough, monitoring or risk assessment.
The objective of the procedure is to optimize the consultations and tests of the pregnant woman and the most appropriate environment, to promote closeness with the system, since it implies greater follow-up by the Primary Care midwife, and to reinforce coordination between these two levels of care.
Although there may be small differences between some hospitals and others, the description of the low-risk pregnancy care protocol visits is as follows:
1st visit
Recommended before week 8. Carried out by a Family doctor and a midwife in Primary Care. The fundamental activities are:
- Take a clinical history, classify the risk of pregnancy, review and update -if necessary- cervical cancer screening (cytologies), record blood pressure and body mass index, deliver brochures on health, nutrition and prevention recommendations. diseases (toxoplasma, listeria, Zika, Chagas), review the vaccination schedule, encourage the taking of vitamin supplements.
2st visit
Around week 8-10. Performed by an obstetrician at the Peripheral Specialties Center (CEP). The main activities to be carried out are:
- Reassess the medical history and risk factors, record blood pressure and body mass index, ultrasound study to date the gestation, check vitality and assess multiplicity, set up the appointment plan according to the last rule, request tests complementary studies of the first trimester (ultrasound and analysis).
3st visit
In week 12-14. Performed by the obstetrician in the First Trimester Consultation of the Hospital. The fundamental activities are:
- Evaluate the results of the first trimester analysis (especially the results of the O'Sullivan test to assess the risk of gestational diabetes and thyroid tests), perform the specific ultrasound of the first trimester, report the risk index for trisomy 21 or others congenital anomalies and the actions to be carried out if necessary, record blood pressure and body mass index, check requests for the 20-week ultrasound and the second trimester analysis.
4st visit
In week 16-18. Performed by a midwife in Primary Care. The fundamental activities are:
- Evaluate the fetal heartbeat, record blood pressure and body mass index, evaluate -and if necessary insist- on the control of maternal weight gain during pregnancy, reassess healthy habits, encourage compliance with the adult vaccination schedule (Influenza , Tetanus, Whooping Cough), reinforce previous advice and recommendations.
5st visit
In week 18-22. Performed by a sonographer in the Fetal Medicine Unit of the Hospital. The goals of the second trimester ultrasound are:
- Fetal anatomical study.
- Study of prematurity risk markers.
- Placenta, umbilical cord and amniotic fluid study.
6st visit
In week 26-28. Performed by a Primary Care midwife. The activities to be carried out are:
- Evaluate second trimester laboratory tests, perform a general examination and record blood pressure and body mass index, evaluate -and, if necessary, insist- on the control of maternal weight gain during pregnancy, re-evaluate healthy habits.
7st visit
In week 28-30. Performed by the CEP obstetrician. The activities carried out are:
- Evaluate the laboratory analysis of the second trimester, evaluate the result of the Oral Glucose Overload test (SOG 100) if necessary, perform a general examination and record blood pressure and body mass index, evaluate -and insist on it if necessary- on the control of maternal weight gain during pregnancy, reassess healthy habits, reassess risk factors and obstetric risk, perform a level I-II ultrasound, recommend and perform anti-D prophylaxis if the mother is Rh (-), reinforce previous advice and recommendations.
8st visit
At week 34. Performed by the obstetrician at the CEP. The fundamental activities are:
- Perform a third trimester ultrasound, in which the following is assessed:
- Fetal anatomical study.
- Study fetal situation and presentation.
- Assessment of fetal growth and estimation of fetal weight.
- Placenta and amniotic fluid study.
- Request 3rd trimester analysis (week 36) and group B streptococci (GBS). Carry out a general examination and record blood pressure and body mass index, evaluate -and if necessary insist- on the control of maternal weight gain during pregnancy, re-evaluate healthy habits, re-evaluate risk factors and obstetric risk.
9st visit
In week 37-38. Performed by a Primary Care midwife. The activities carried out are:
- Evaluate the third trimester analysis including GBS, carry out a general examination and record blood pressure and body mass index, evaluate -and if necessary insist- on the control of maternal weight gain during pregnancy, re-evaluate healthy habits.
10st visit
At week 40. Performed by the obstetrician at the CEP. The fundamental activities are:
- Focus on the end of the pregnancy, re-evaluate the results of the third trimester analysis including GBS, assess the result of the registration carried out at week 40, perform a level I-II ultrasound (confirm vitality, static, LA, etc.), re-evaluate factors of risk and obstetric risk, perform the gynecological examination to determine the maternal cervical conditions as well as the fetal presentation, schedule the induction in week 41+2 (Max. 41+6), deliver documentation related to the Consent for Childbirth Assistance and Induction, provide an informative document on "when labor begins", cesarean delivery or vaginal delivery after a previous cesarean section, according to the obstetric attitude towards the patient, reinforce previous advice and recommendations.
Postpartum controls will be carried out in Primary Care or in the CEP or in the Pathological Postpartum Consultation, depending on the risk of pregnancy and childbirth (according to established protocols). In these visits the activities will be:
- Evaluate postpartum evolution, insist on general maternal-neonatal care, perform a general examination and record blood pressure and body mass index (BMI), in cases of BMI > 30 insist on postpartum weight control, reassess healthy habits and breastfeeding care, reinforce previous advice and recommendations, give family planning advice.
