Pregnancy Follow-up in Turkey

What is Pregnancy Monitoring?
Pregnancy is a process that starts from the missed period and continues until birth, lasting approximately 40 weeks. After a positive pregnancy test, the process continues with the detection of the gestational sac in the uterus, observation of the heartbeat, and the subsequent growth of the fetus.
During pregnancy monitoring, both the mother’s and baby’s health and the baby’s monthly development are tracked. This includes screening tests according to the gestational week, detailed ultrasounds, glucose tolerance tests, other blood tests, cervical length measurements, baby’s weight measurements, and pelvic examinations.
How Should Pregnancy Monitoring Be Conducted?
Pregnancy monitoring should be done regularly and at a frequency determined by the patient's risk status. Regular monitoring is crucial because specific tests need to be performed every week. Since the baby’s organ development is ongoing, irregular monitoring may delay the detection of developmental abnormalities.
When Should I First See a Doctor After Becoming Pregnant?
You should consult an obstetrician within the first week after a positive urine or blood pregnancy test. An ultrasound is performed according to the level of the pregnancy hormone (beta hCG) in the blood. The gestational sac should be visible in the uterus on a transvaginal ultrasound when the hCG level is above 1500-2000 mIU/ml and on an abdominal ultrasound when it is above 4000-6000 mIU/ml. If the sac is not seen at these levels, an ectopic pregnancy should be suspected, and close monitoring is necessary.
Pregnancy Monitoring Doctor in Ankara
Since pregnancy monitoring lasts for about 9 months, it is a very special process. If there is no problem with compatibility, it is healthier for the pregnancy to be monitored by the same doctor throughout the process.
What is Checked During Pregnancy Monitoring?
At the initial sighting of the gestational sac, routine blood tests, including hemogram, blood type, biochemistry, thyroid function tests, hepatitis tests, toxoplasmosis, CMV, rubella tests, and bleeding time tests, are performed. Between the 11th and 14th weeks, a double screening test is performed; between the 16th and 18th weeks, a triple or quadruple test is conducted; at the 20th week, a detailed ultrasound is done; and between the 24th and 28th weeks, glucose tolerance tests are administered.
During the process, monthly hemogram and urine tests are checked. If there are no risk factors, ultrasound monitoring is conducted monthly until the 32nd week, then every two weeks at the 35th week, and weekly after the 37th week. If there are risk factors, more frequent monitoring, such as weekly or bi-weekly, may be required.
How is Pregnancy Monitoring Conducted?
In pregnancy monitoring, the mother’s blood pressure, pulse, weight, blood and urine tests are evaluated, while the baby is assessed based on its development, weight, amniotic fluid, placental location, blood flow, and cervical length.
How Often Should Pregnancy Monitoring Be Done?
If there are no risk factors, pregnancy monitoring is conducted monthly until the 32nd week, bi-weekly after the 35th week, and weekly after the 37th week. If there are risk factors, monitoring may be done weekly or bi-weekly as needed.
Week-by-Week Pregnancy Monitoring
After a positive pregnancy test, the ultrasound date is determined based on blood values. The gestational sac is seen between 4-5 weeks from the last menstrual period, and the heartbeat is seen between 5-6 weeks. Detailed blood tests are requested. The next check-up occurs between the 11th and 14th weeks. During this week, the nuchal translucency and nasal bone are measured, and a double screening test is performed, which evaluates these measurements along with blood hormone levels. The next check-up is between the 16th and 18th weeks, with ultrasound measurements and the triple/quadruple test evaluating hormone levels.
Between the 20th and 22nd weeks, a detailed ultrasound is performed for anomaly screening. Between the 24th and 28th weeks, a glucose tolerance test is done to screen for gestational diabetes. From the 34th-35th weeks, a non-stress test (NST) evaluates the baby’s heart rate changes in response to movements, thereby assessing the baby’s overall health. Subsequent weeks include blood counts, complete urine tests, and continued monitoring of fetal growth via ultrasound. Patients wishing for a natural birth are evaluated with a pelvic examination at the 37th week.
What Tests Are Performed During Pregnancy Monitoring?
During the initial examination, detailed blood tests, including blood type, blood count, thyroid hormones, biochemistry, bleeding tests, toxoplasmosis, CMV, rubella tests, and hepatitis tests, are conducted. In the following process, patients who want to perform risk analysis for chromosomal abnormalities, particularly Down Syndrome, are offered double, triple, or quadruple tests at the appropriate weeks.
For those who want a screening test with higher accuracy, the non-invasive prenatal test, which isolates the baby’s DNA from the mother’s blood, can be performed. If the screening tests indicate high risk, chorionic villus sampling, amniocentesis, or cordocentesis is recommended for a definitive diagnosis. Amniocentesis is a procedure that involves taking a fluid sample from the sac surrounding the baby with a needle and provides a definitive diagnosis.
The glucose tolerance test is recommended as an objective screening test for gestational diabetes. For pregnancies with Rh incompatibility, the indirect Coombs test is done at the beginning of pregnancy and at the 28th week. The NST (Non-Stress Test) evaluates the baby’s general well-being and is typically performed from the 34th week onwards if there are no risk factors.
When Are Risky Conditions Detected During Pregnancy?
During pregnancy monitoring, elevated blood pressure may be detected during measurements. This can be indicative of preeclampsia, also known as pregnancy toxemia, and should be followed up with a protein test in the urine and blood tests.
Screening tests may reveal a risk of chromosomal abnormalities. In such cases, chorionic villus sampling, amniocentesis, or cordocentesis, which are definitive diagnostic tests, are recommended. If a chromosomal abnormality is detected, the case is managed with the family in consultation with the perinatology department.
A detailed ultrasound is very important as it can also predict the baby’s health after birth. If the baby has a life-incompatible anomaly or the presence of markers indicating chromosomal abnormalities, counseling is provided by the perinatology department regarding the management of the process.
If the glucose tolerance test is elevated and gestational diabetes is diagnosed, the pregnancy is followed up with the endocrinology department and a dietitian. Dietary recommendations and blood sugar monitoring are suggested.
If the estimated fetal weight, measured by head, abdominal circumference, and femur length during ultrasound follow-ups, is lower than expected for gestational age, this indicates growth restriction, and the amount of amniotic fluid and Doppler flows are closely monitored. If the measurements are large for gestational age, the pregnancy is evaluated for gestational diabetes.
Even if there is no growth restriction on ultrasound, low amniotic fluid is a risky condition and should be monitored closely. If the NST indicates abnormalities in the baby’s heart rate, it suggests fetal distress, and a decision for delivery may need to be made.
When Should the First Ultrasound Be Performed?
An ultrasound should be performed one week after pregnancy is detected in the blood or urine to confirm the presence of the gestational sac within the uterus.
Vitamins and Mineral Supplements During Pregnancy Monitoring
Folic acid supplements should be started before pregnancy and continued until the 12th week of pregnancy. After the 12th week, vitamin D supplements are started, and after the 16th week, iron supplements are initiated. Fish oil-containing multivitamins can also be started after the 12th week when nausea typically subsides.
Sugar in Pregnancy Monitoring
In cases where amniotic fluid increases or the baby is macrosomic (large),a glucose tolerance test or fasting and postprandial blood sugar measurements are performed. If gestational diabetes is diagnosed, the pregnancy is managed in conjunction with the endocrinology and diet departments.
What Should Be Considered During Pregnancy Monitoring?
During pregnancy, maintaining a healthy diet, regular monitoring, consistent use of necessary medications, and engaging in activities such as swimming, walking, Pilates, and yoga—if there is no risk of preterm birth—are very important for both physical and mental health during pregnancy.