Mnogobrojna su pitanja, strepnje i strahovi koji se tokom ovog istodobno dugog i kratkog perioda iznova stvaraju. Umirujuća je istina da trudnoća nikada nije bila tako sigurna i da nikada ranije bebe nisu imale toliko izgleda da se rode žive i zdrave. Kako bismo uspješno postigli zajednički cilj – rođenje zdravog i živog djeteta, molimo Vas da slijedite upute liječnika, te ga izvještavate o svim, pa i naizgled beznačajnim promjenama tokom ovog razdoblja.
Prvi pregled
Kod prvog pregleda, kada se utvrđuju trudnoća i njezino tačno trajanje, osim ginekološkog i ultrazvučnog nalaza, obavlja se i PAPA test ako je od zadnjeg citološkog probira prošlo više od godinu dana, te se daju preporuke za temeljne laboratorijske testove i vitaminske nadopune u trudnoći.
Cervikalni ,Vaginalno bris te bris na Uroplazmu i Mycolplazmu
Tijekom prvih 12 nedelja dovoljno je dodatno uzimati samo folnu kiselinu (1,500 µg/dan), kasnije se preporučuje uzimati neku od kompletnih vitaminsko-mineralnih formula sadržanih u različitim pripravcima, osim ako je u prethodnoj trudnoći dijagnosticirana neka od komplikacija zatvaranja neuralne cijevi a pritom je preporuka uzimati 5 mg folne kiseline dnevno.
Kombinirani probir
Kombinirani probir označuje procjenu fetalnog rizika za hromosomopatiju procjenom kombinacije ultrazvučnih biljega kromosomopatija i biokemijskog probira (određivanje serumskih biljega PAPP-A i free ß-hCG). Što su to ultrazvučni biljezi za hromosomopatije? Radi se o specifičnim ultrazvučnim pokazateljima koji nisu obvezno i anomalije, a obuhvaćaju procjenu nuhalnog nabora, prisutnosti nosne kosti, dvije umbilikalne arterije, procjenu protoka kroz duktus venozus i prisutnost trikuspidalne regurgitacije. Procjenjuju se prema strogim kriterijima koje je propisao FMF – Fetal Medicine Foundation, London. Ukoliko trudnica spada u skupinu s niskim rizikom nisu nužne daljnje mjere, kao i kod trudnica s umjerenim rizikom kada daljnje mjere nisu nužne ako su ultrazvučni biljezi negativni.
Ako su ultrazvučni biljezi pozitivni kod trudnica s umjerenim rizikom, te kod trudnica s visokim rizikom za hromosomopatiju preporučuje se kariotipizacija ili analiza fetalnih hromosoma.
Trudnicama su danas na raspolaganju dvije skupine ovih testova: NIPT – neinvazivno sekvenciranje fetalnih eritrocita iz majčine krvi i invazivni testovi tipa biopsije horionskih resica (CVS) ili punkcije plodne vode (amniocenteza), kada se iz dobivenih fetalnih stanica određuju broj i izgled hromosoma bebe. Plava poliklinika je FMF certificirana ustanova za obavljanje kombiniranog prenatalnog probira za kromosomske abnormalnosti, a među mnogobrojnim NIPT testovima odabrali Nifty test
Ukoliko trudnica ne stigne obaviti kombinirani probir u 1. trimestru ili rezultati ovog probira nisu jednoznačni, postoji mogućnost obavljanja biokemijskih testova u 2. trimestru (triple test), odnosno NIPT sve do 20. tjedna trudnoće. Triple test omogućuje usporedbu određenih parametara u krvi trudnice (alfa-fetoprotein, ß-hCG i estriol) i njene starosti s standardnim krivuljama i na taj način procjenu individualnog rizika za Downov sindrom. Točnost samog testa se procjenjuje na 60 – 70%. Test se izvodi uobičajeno između 15.-18. tjedna trudnoće.
18-24 nedjelja trudnoće
Drugi najbotniji pregled u trudnoci ( poslije Kombiniranog probira )jeste 4 D Organ screening ultrazvučni pregled pri kojem se detaljno prati fetalna anatomija i otkrivaju eventualne strukturne abnormalnosti fetusa.
Ako postoje rizični čimbenici
Ako prije trudnoće nisu napravljeni mikrobiološki obrisci vrata maternice, preporučuje se načiniti obrisak vrata maternice na klamidiju između 12. i 16. nedelja trudnoće, u sklopu otkrivanja čimbenika koji bi mogli dovesti do spontanog pobačaja. U slučaju prisutnosti rizičnih čimbenika u 20. tjednu trudnoće izvodi se test opterećenja glukozom (OGTT),
U trećem tromjesečju
Sa 28. nedelja ponavljaju se laboratorijske pretrage, a između 35. i 37. nedelja preporučuje se ponovit Cerviklani i Vaginalni bris te ako postoji indikacija ponoviti Mycoplazmu i Uroplazmu Prijenos bakterija na novorođenče tijekom porođaja može dovesti do nastanka meningitisa.
Još nekoliko informacija
Kod svakog pregleda trudnicu će se izvagati, izmjerit će joj se krvni pritisak i test trakom provjeriti mokraća. Sa 35 nedelja načinit će se i prvi CTG zapis.
Do 32. nedelja trudnoće pregledi se obavljaju svaka četiri nedelje, nakon tog svaka tri a zatim svaka dvije nedelje , a od 38 nedelje do kraje trudnoće svakih nedelju dana.
Sa 35 nedelja trudnoće sa svakom trudnicom nužno je razmotriti i osobne rizike za porođaj, s tim da dva posljednja pregleda treba obaviti i klinici u kojoj se žena želi poroditi.
Za uspješno postizanje zajedničkog cilja, trudnica treba slijediti upute liječnika i izvještavati ga o svim promjenama
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