Pregnancy
Pre-Pregnancy Things to Do
Preconception Evaluation
Before pregnancy, it is recommended that women planning to conceive undergo an evaluation by an obstetrician and gynecologist. This assessment includes a review of necessary medical tests, examination of the reproductive organs through gynecological examination and ultrasound, and, when indicated, cervical screening (Pap smear).
In addition, women planning pregnancy are advised to take 400 micrograms of folic acid daily to help reduce the risk of fetal anomalies known as neural tube defects, which result from incomplete closure of the spine during early fetal development.
Preconception Health Recommendations
If a woman smokes, it is strongly advised to quit smoking or, at a minimum, reduce cigarette consumption to fewer than five per day. Beginning pregnancy at an ideal body weight is important. Women who are overweight are advised to lose weight under medical supervision, as this may help reduce the risk of pregnancy-related complications such as gestational hypertension and gestational diabetes.
Before pregnancy, it is beneficial to perform rubella screening, hepatitis B testing, complete blood count, and thyroid function tests. Women who are not immune to rubella are advised to receive vaccination prior to pregnancy.
Women with a personal or family history of thalassemia (Mediterranean anemia), sickle cell disease, cystic fibrosis, or other inherited conditions—or those known to be carriers—should be evaluated together with their partners and receive genetic counseling.
Chronic Medical Conditions and Pregnancy Planning
Women with chronic medical conditions such as heart disease, kidney disease, diabetes mellitus, asthma, epilepsy, or similar conditions are strongly advised to remain in close contact with their physicians and to plan pregnancy during a period when their condition is well controlled.
Choosing a Healthcare Facility for Pregnancy Care
When selecting a healthcare facility for pregnancy follow-up and delivery, it is important to consider the availability and adequacy of labor and delivery units, neonatal intensive care services, and operating room facilities as essential criteria.
Women who have heart disease, kidney disease, diabetes, asthma, epilepsy (epilepsy) or similar chronic illnesses before pregnancy are advised to stay in close contact with their doctors and become pregnant while their illnesses are under control.
When choosing a healthcare center where you plan to have your pregnancy follow-up, it should be kept in mind that the adequacy of the delivery room, neonatal intensive care unit, and operating room conditions are important criteria.
Pregnancy Calendar
Duration of Pregnancy
The total duration of pregnancy is 40 weeks, calculated from the first day of the last menstrual period. Pregnancy is divided into three distinct stages, known as trimesters:
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Weeks 1–13: First Trimester
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Weeks 14–28: Second Trimester
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Weeks 29–40: Third Trimester
In some cases, labor may not begin even after the 40-week period is completed. Under close medical supervision, it may be appropriate to wait approximately 7–10 days to allow for the onset of spontaneous labor during this period, which is referred to as post-term pregnancy (postmaturity).
Common Problems During Pregnancy
Although pregnancy is a physiological and natural process, the changes that occur in a woman’s body during this period may, at times, reach levels that can be serious or even life-threatening for the mother and/or the baby. In other cases, these changes may significantly affect the expectant mother’s quality of life.
Early recognition and diagnosis of certain pregnancy-related conditions are of great importance for the effectiveness and success of treatment. Being well informed helps expectant parents avoid unnecessary anxiety over minor issues, while also enabling early detection of more serious conditions, which can improve treatment outcomes.
Common Problems During Pregnancy
Bleeding in Early Pregnancy
Approximately 50% of pregnancies may be accompanied by some degree of vaginal bleeding, particularly during the first 10 weeks of gestation. Bleeding that occurs within the first 20 weeks of pregnancy is generally described as threatened miscarriage (abortus imminens).
Despite this finding, only about 15% of pregnancies ultimately result in miscarriage.
Causes of Miscarriage
The majority of miscarriages are caused by genetic abnormalities in the embryo. Embryos with significant chromosomal abnormalities are unable to develop normally and are naturally eliminated. This biological mechanism contributes to the continuation of healthy pregnancies.
Less Common Causes of Miscarriage
Less frequently, miscarriage may be associated with:
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Poorly controlled diabetes mellitus
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Untreated thyroid disorders (hypothyroidism or hyperthyroidism)
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Structural abnormalities of the uterus
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Genetic mutations associated with clotting disorders
When these conditions are appropriately diagnosed, treated, and managed, they do not necessarily lead to miscarriage.
Common Misconceptions
There are many misconceptions in the community regarding miscarriage:
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Light physical activity or non-strenuous exercise does not cause miscarriage.
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Bed rest has not been proven to prevent miscarriage. However, it may be recommended in selected cases, such as when bleeding is associated with a subchorionic hematoma. Scientific evidence supporting this practice remains limited.
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At present, there is no definitive medication that can completely eliminate the risk of threatened miscarriage.
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In cases of hormonal insufficiency, particularly suspected progesterone deficiency, progesterone or hCG supplementation may be beneficial in selected cases; however, this remains a subject of ongoing debate.
Other Important Conditions to Consider (Differential Diagnosis)
Other conditions that may cause bleeding in early pregnancy include:
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Ectopic pregnancy: Implantation of the embryo outside the uterus, most commonly in the fallopian tubes.
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Molar pregnancy (hydatidiform mole): A rare but serious condition characterized by abnormal and excessive growth of placental tissue.
Ectopic Pregnancy
An ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity. In the vast majority of cases (90–95%), implantation occurs in the fallopian tubes. Ectopic pregnancy accounts for approximately 1% of all pregnancies and is one of the leading causes of maternal mortality during the first trimester.
After fertilization in the fallopian tube, the embryo normally travels toward the uterine cavity. When this migration is interrupted for any reason, implantation may occur outside the uterus.
Symptoms and Clinical Importance
In the early stages, ectopic pregnancy may mimic the symptoms of a normal pregnancy. Findings such as missed periods, positive pregnancy tests, nausea, vomiting, and breast tenderness may be present.
As the pregnancy grows within the fallopian tube, it may eventually cause stretching and rupture of the tube, leading to internal bleeding. If not recognized and treated promptly, this condition can be life-threatening and may result in maternal death. The serious nature of ectopic pregnancy arises from this risk.
Treatment Options
When ectopic pregnancy is diagnosed early, medical treatment with methotrexate may be considered. Methotrexate is a chemotherapeutic agent that is used at high doses and multiple administrations in certain cancers; however, in ectopic pregnancy, low-dose treatment (usually one or two doses) is typically sufficient.
If the diagnosis is delayed and tubal rupture and internal bleeding have occurred, surgical intervention becomes necessary. Surgery may be performed using laparoscopy or open surgery, depending on the clinical situation. In suitable cases, the affected fallopian tube may be preserved; however, in some situations, removal of the involved tube may be required.
Expectant (Conservative) Management
In selected cases without tubal rupture, and when specific clinical criteria are met, close monitoring without immediate intervention (expectant management) may be considered. This approach may help avoid surgical treatment and reduce the risk of surgery-related complications such as adhesion formation or loss of the fallopian tube.
However, expectant management carries significant potential risks. Therefore, patients must be carefully selected, thoroughly informed about their condition, and closely monitored. Patients and their families should be clearly educated about the signs of internal bleeding and instructed to seek immediate medical attention if such symptoms occur.
Nausea and Vomiting During Pregnancy
Nausea and Vomiting in Pregnancy
Nausea and vomiting during pregnancy are very common. They may occur to varying degrees in approximately 50–70 out of every 100 women. In about 1% of cases, symptoms may become severe and require hospitalization. This more serious condition is known as Hyperemesis Gravidarum.
When Does It Start and When Does It Improve?
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Symptoms typically begin around the 6th week of pregnancy and tend to improve after the 14th–16th weeks.
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In some pregnancies, symptoms may start earlier or, less commonly, persist throughout the entire pregnancy.
Does Every Woman Experience It the Same Way?
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Although nausea is more commonly seen in first pregnancies, this is not a strict rule.
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The same woman may experience different levels of nausea in different pregnancies.
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Mild weight loss is usually not a cause for concern; however, if the expectant mother is unable to eat or drink adequately, medical evaluation is necessary.
Does Nausea Mean the Pregnancy Is Healthy?
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In many cases, yes. Nausea may be a sign that the pregnancy is progressing.
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However, absence of nausea or very mild symptoms do not necessarily indicate a problem.
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If nausea symptoms suddenly stop, the healthcare provider should be informed.
What Causes Nausea During Pregnancy?
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Nausea is thought to be related to rising levels of hCG and estrogen hormones.
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In severe cases, additional tests such as liver function tests, thyroid function tests, and hepatitis screening may be required.
Sensitivity to Smells and Environmental Triggers
Sensitivity to odors often increases during pregnancy. Cigarette smoke, perfumes, and food odors may become particularly bothersome.
For this reason:
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Strong smells should be avoided at home.
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Cleaning products should be chosen with sensitivity in mind.
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The expectant mother should not be pressured to eat; instead, she should be supported in consuming light foods that she can tolerate.
Hypertension and Preeclampsia in Pregnancy
Hypertension During Pregnancy
Hypertension during pregnancy occurs in approximately 7–10% of all pregnancies and may pose significant risks to both maternal and fetal health. The diagnosis is made when blood pressure readings of 140/90 mmHg or higher are recorded on two separate measurements taken at least 6 hours apart.
Types of Hypertension
Types of Hypertensive Disorders in Pregnancy
Chronic Hypertension
High blood pressure that is present before pregnancy or diagnosed before 20 weeks of gestation.
Gestational Hypertension
High blood pressure that develops during pregnancy and resolves after delivery, without other signs of preeclampsia.
Mild Preeclampsia
High blood pressure accompanied by protein loss in the urine.
Severe Preeclampsia
Blood pressure of 160/100 mmHg or higher, accompanied by significant proteinuria and systemic symptoms such as edema, headache, and visual disturbances.
Superimposed Preeclampsia
Development of preeclampsia in a woman with pre-existing chronic hypertension.
Eclampsia
A severe condition characterized by seizures and/or loss of consciousness, occurring in addition to the findings of preeclampsia.
Who is at Risk?
Risk Factors for Preeclampsia
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First pregnancy
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Family history of preeclampsia
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Pregnancy at under 20 years or over 40 years of age
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Multiple pregnancy (twins or more)
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Chronic hypertension, kidney disease, or overweight/obesity
Possible Maternal and Fetal Complications
Preeclampsia may be associated with an increased risk of:
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Maternal complications:
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Impairment of kidney, liver, or brain function
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HELLP syndrome (approximately 20% risk in severe cases), characterized by liver dysfunction, destruction of blood cells (hemolysis), and clotting abnormalities
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Fetal complications:
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Fetal growth restriction
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Low amniotic fluid levels (oligohydramnios)
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Placental insufficiency
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When Does It Occur?
Preeclampsia typically occurs after the 20th week of pregnancy, most commonly around the 28th week, or within the first 48 hours after delivery.
Symptoms
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High blood pressure (≥140/90 mmHg)
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Generalized swelling (edema), particularly of the hands and face
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Protein loss in the urine (proteinuria)
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Headache, visual disturbances, and upper abdominal pain
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Decreased urine output, confusion, and seizures (in cases of eclampsia)
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