Normal Pregnancy
Pregnancy is a physiological process between fertilization and birth. It is an important part of the human reproductive system. Only 5% of pregnancies are not "low risk" in terms of fetal or maternal pathology.
Monitoring a pregnancy is regulated and a number of consultations and examinations are reimbursed 100% by Social Security.
Pregnancy is suspected primarily on the absence of periods (amenorrhea) in women of childbearing age, between the onset of menstruation in adolescence and the loss thereof with menopause. But other signs, such as nausea and vomiting in the first trimester, persistant temperature above 37 ° over 14 days or breast tenderness may be suggestive of pregnancy. It is very important to date the pregnancy for two reasons: for medical, to evaluate the term will be important for many reasons (premature birth, fetal biometrics ...) legal, reasons pregnancy should be reported to social agencies before the 16th week of amenorrhea (SA) and the legal limit of abortion in France is 14 weeks. The term of pregnancy is not quantified in months of pregnancy, but in weeks of amenorrhea (SA)... It is calculated from the first day of the last menstrual period preceding the amenorrhea. After 2 weeks of gestation or 14 days, we date the beginning of the pregnancy. Pregnancy reaches term at 41 SA, but delivery is considered normal when it occurs between 37 and 42 SAThe dating of pregnancy is confirmed at the first ultrasound, by measuring a specific parameter which is the crown-rump length (length from the top of the head to the other end which resembles a small tail). This ultrasound is done between 7 and 12 SA and considers the term of pregnancy to 3 days away. (The 3 ultrasound examinations during pregnancy are detailed in "Investigations in obstetrics)..Monitoring of normal pregnancy is organized into 7 prenatal consultations and 1 postnatal consultation. During these various consultations, a physical examination appropriate to the term of pregnancy as well as laboratory tests (some mandatory, others recommended) will be carried out A chronological description is given here.3rd month - 10 to 15 weeks
Contrary to the following consultations that may be performed by a midwife in a normal pregnancy, this initial consultation must be with a physician. The latter will at the end of the consultation fill in the form for the declaration of pregnancy,2 components are sent to the "CAF" (family benefits) and third to the social security During this consultation, an examination as thorough as possible regarding the surgical, gynecological and obstetrical and family history of the patient will be asked. And high-risk pregnancies can be detected. The physical examination will be as thorough as possible including measure of weight, height, blood pressure, a general inspection and a breast examination as part of screening for breast cancer. A Pap smear will also be conducted as part of screening for cervical cancer during the speculum exam, according to the date of the last one made Some laboratory tests are required during this initial consultation: serology for rubella, toxoplasmosis (if it is negative it will be performed every month) and syphilis, blood group determination (unless blood group card complete) and research for irregular antibodies for sugar and albumin in the urine (simple examination of the urine, less invasive). Other tests are not mandatory but often carried out in practice: Hepatitis C serology, hepatitis B (provided by law at 6 months),HIV after approval by the patient and blood count (early detection of anemia). In addition, information on screening for trisomy 21 should be provided and proposed, conducted between 15 and 18 SA. Amniocentesis for the same reason is offered to women over 38 years,old 100% reimbursed by social security.The ultrasound for the first trimester is prescribed at this consultation. Lifestyle advice is finally given: cessation of smoking and alcohol, no self-medication, maintaining an appropriate activity at the end of pregnancy and harmless sexual activity without excess, . With regard to toxoplasmosis (if negative serology) it must be prevented by proper cooking of meat after freezing, thoroughly washing fruits and vegetables, avoiding cats and their excrement. Furthermore, the diet should be balanced, rich in calcium and fresh vegetables, but avoid the consumption of unpasteurized cheeses and cold meats to prevent listeriosis. 4th month - 16 to 20 weeks
A typical examination of a pregnant woman consists of a general examination a measure of weight and blood pressure, auscultation of fetal heart sounds and the search for active fetal movements (collected from 20 SA average), measurement of the height of the uterus (evaluation of amniotic fluid and / or size of the fetus), abdominal palpation and vaginal examinations. The reviews always include a simple examination of the urine looking for sugar and albumin and serology of toxoplasmosis (if previously negative) In the 4th month, there will be a standard examination and prescribed ultrasound Q2 which will be conducted at 22 weeks. 5th month - 21 to 24 weeks
A similar examination and reading the results of ultrasound morphology of the second trimester .6th month - 24 to 28 weeks
In addition to the tstandard examination , a gestational diabetes screening is offered at the 6th month. Screening for hepatitis B, it is mandatory at 6 months, and the blood count. The search for irregular antibodies must be made in rhesus negative women (A-, B-, O-, AB-) or previously transfused. Furthermore, the third ultrasound should be required to be made at 32. Also, 8 sessions of preparation for childbirth are reimbursed at 100% between 6 months until delivery, carried out by a midwife or doctor. It is from this consultation that a pregnancy monitored in a doctors practise will from then on take place in the clinic or hospital where they will give birth with their respective teams Month 7 - 28 at 32 weeks
In addition to the standard examination,the results of the ultrasound of the third trimester .will be read The blood group must be confirmed unless in possession of full blood card Some doctors recommend prophylaxis of vitamin D by taking a single dose during the 7th month.8th month - 33 to 37 weeks
The standard examination will be slightly modified, to observe the type of fetal presentation (cephalic, seat ...) and a physical examination of the pelvis is practiced in some teams. A vaginal swab is also performed to look for the presence of a bacterium, streptococcus B, which is not treated systematically, but only in cases of premature rupture of membranes or the start of labour. An anesthesia consultation should be planned in anticipation of epidural anesthesia during childbirthMaternity leave begins at 35 weeks. This is for the mother, if the first or second child, six weeks before childbirth and 10 after birth. Per diem equal to 100% of salary is paid by social security. Moreover, the length of leave increases for the third child and in cases of twins. Also, in case of complications during pregnancy, an extension of 14 days before delivery is required by law.Paternity leave also exists it varies from 11 to 18 days in a normal pregnancy or a multiple pregnancy (twins). 9th month - 37 to 41 weeks The standard examination will be carried out and the study of the presentation of the baby. The conditions of giving birth must be explained to the patient, so she knows when to come to the maternity ward or clinic(fluid loss, close and regular painful contractions) The day of the term, a consultation is planned if the patient has not given birth before, and daily thereafter in case of overflow term to determine whether the birth should be started or not, and to assess fetal wellbeing.Childbirth is treated in the chapter "Childbirth"Postnatal consultation
The mother is usually hospitalized for three days after giving birth then returns home, supported by a midwife either at home or at a health centre.Within the following 8 weeks f a consultation with a physician is mandatory under the law. During this consultation, a general clinical examination, an examination of the perineum and breasts should be done. After the consultation, about 10 perineal rehabilitation sessions may be prescribed if needed. However, discussion of contraception is vital.
Victor Hugo