FIRST TRIMESTER (WEEKS 1-16) 

When you have taken a home pregnancy test and that has come back as positive, we recommend that you book an appointment with a gynaecologist. The first visit could happen between 6 to 9 weeks of the pregnancy. The fetus becomes visible via ultrasound at approximately 6 weeks. 

If the pregnancy test has come back as positive, but there are stomach pains or bleeding from the vagina, the woman should turn to the gynaecologist as quickly as possible.

At the first visit, we will perform a vaginal ultrasound to determine the size, viability and location of the pregnancy, identify the number of fetuses and assess the condition of the ovaries. In addition, it is possible to take tests from the cervix – to perform a PAP test to evaluate the cells of the cervix and to test for chlamydiosis if the last test was done more than 6 months ago.

To assess the health status of the pregnant woman and any risk factors that may affect the development of the fetus, during the first visit, the gynaecologist will ask you questions regarding your lifestyle, chronic illnesses, work conditions, eating habits, etc. The gynaecologist will also consult regarding any questions that you may have by that point, will help create a pregnancy monitoring plan and explain examinations and tests that are performed during the pregnancy.

It is recommended that blood tests be performed at 11 weeks of gestation to assess antibodies to various infectious diseases, blood haemoglobin, blood sugar, blood group and rhesus factor, and to perform hormonal tests for the OSCAR test.

A urine test examines the presence of glucose, protein, leukocytes and bacteria and we perform a urine culture which is important to rule out urinary tract infections.

It is also possible to give a blood sample after the 10^th week of gestation for the Niptify test, which is the most accurate and safest way to assess the risk of chromosome diseases for the fetus. The Niptify test also gives 100% accurate information regarding the sex of the fetus early on in the pregnancy.

SECOND TRIMESTER (WEEKS 16–28) 

We recommend coming to the gynaecologist’s reception every 4-5 weeks during the second trimester, which means that there should be a minimum of 3 visits to the gynaecologist during the second trimester. 

During every visit, the gynaecologist will assess your weight and swelling, will measure your blood pressure and will ask about your complaints and mood. The gynaecologist will measure the fundal height starting from week 16 and will ask you about feeling any movements of the fetus from week 20. The gynaecologist will also listen to the fetal heartbeat, to assess their well-being.

The best time for the second-trimester ultrasound screening is between the 19th and 21st weeks of gestation. By that time all organs of the fetus have developed and the gynaecologist can perform a thorough examination to assess the fetal development and possible deviations.

During the fetal anatomy screening, we examine:

• The anatomic structures of the fetus
• The fetal heart rate
• The amount of amniotic fluid 
• The location and structure of the placenta and umbilical cord attachment to the placenta
• Assessment of the gestation and adjusting due date, if needed
• If the parents wish, the gender of the fetus

When the ultrasound examination is complete, the gynaecologist gives the parent(s) an overview of the status of the fetus. If the parent(s) wish, they can get a coloured picture of the fetus as a keepsake for this special moment. 

We take a blood sample between weeks 24 and 28 to measure the haemoglobin and blood sugar.

Every visit after week 24 will include a urine test.

THIRD TRIMESTER (WEEKS 28–BIRTH)

We recommend visiting the gynaecologist at least every 4 weeks between weeks 28 to 36, every 2 weeks between weeks 36 and 40, and at least once per week during weeks 40 to 42.

During every visit, the gynaecologist will assess your weight and swelling, will measure your blood pressure and will ask about your complaints and mood. The gynaecologist will measure the fundal height, will ask you about feeling any movements of the fetus and will listen to the fetal heartbeat, to assess their well-being. From week 30, the doctor will also assess the position of the fetus in the uterus.

Between weeks 28 and 32 we repeat the tests for HIV, rhesus factor, and antibodies, and measure the haemoglobin levels.

Urine tests need to be performed before every visit. 

We recommend visiting us for a third-trimester ultrasound examination between 30 and 36 weeks of gestation. It is also the best time to take pictures of the fetus’s face, given that the positioning is suitable and there is enough amniotic fluid. 

The gynaecologists of the Valvekliinik perform the third-trimester screenings to assess the following:

• Fetal position
• Assumed weight
• Circulatory parameters
• Amount of amniotic fluid
• Placental position
• The child’s well-being
• Adjusting the due date, if needed

If you have not given birth by the 42nd week of pregnancy, you will be referred to the antenatal ward to induce childbirth. In case of a double pregnancy, induction of labour is recommended at 38 weeks of gestation.

Source: Society of Estonian Gynaecologists „Raseduse jälgimise juhend“, 2018 https://rasedajalgimine.weebly.com