Confirmation of pregnancy
Although almost all newly pregnant women take a home pregnancy test or have their beta HCG hormone levels biochemically determined, an ultrasound is the best indicator that everything is fine with the new pregnancy, i.e. that the pregnancy is in the uterus and that the fetus has a heartbeat. This is most often achieved by transvaginal ultrasound examination. Examination in the first trimester is also important to accurately determine the duration of pregnancy, especially in patients with irregular menstrual cycles. The ultrasound in the first trimester can determine whether the pregnancy is single or multiple, and it also determines the type of twin pregnancy.
In certain cases, patients are suggested to take a urine pregnancy test in the office.
Complete prenatal care
Our practice offers complete prenatal care in all three trimesters. This service includes monitoring of the blood pressure and detection of proteins in urine, regular monitoring of weight gain, and consultation regarding nutrition and diet. Our patients are also advised on taking certain laboratory tests and are prescribed therapy if necessary. Gynecological exam in pregnancy includes a compulsory ultrasound examination of the fetus, as well as a risk assessment of preterm labor. According to the guidelines of the world’s leading professional associations, vaginal examinations are taken only in the third trimester. CTG and contraction monitoring are performed when indicated.
Vaginal examination during pregnancy
Although vaginal examination in pregnancy is performed only with indication, it is a valuable diagnostic method, especially for determining imminent preterm birth. This can be ruled out by manual or speculum examination. Inspection of the cervix is sometimes necessary in pregnancy to take a Pap test or cervical smear, but also to diagnose some other conditions, such as decidual polyps.
Twin pregnancy care
It is generally known that twin pregnancies belong to the group of high-risk pregnancies, because the female body is naturally best adapted to carry a single pregnancy. Twin pregnancies have some specific characteristics that a doctor should be aware of. In our office, we pay special attention to determining the types of twins in the first trimester, and later monitoring the growth and progress of twins. We take care of determining the synchronous growth of fetuses, but also their supply of oxygen and nutrients, with the help of an ultrasound and cardiotocography device, specially adapted for multiple pregnancies.
2D ultrasound examination in pregnancy
Two-dimensional ultrasound examination is the basis of every gynecological examination in pregnancy, because it allows us to analyze the fetal condition. With this examination, we are monitoring the growth of the fetus, not only to determine whether it is of appropriate size or not, but also to assess whether the fetus follows its own growth curve. The anatomy of the fetus can also be analyzed using 2D ultrasound, and many anomalies can already be detected prenatally. Ultrasound can also analyze the amount of amniotic fluid and the appearance of the placenta, which are also indirect indicators of the fetal condition. The addition of color doppler allows us to analyze the fetal blood flow, as well as the flow in the placental blood vessels.
3D ultrasound examination in pregnancy
Three-dimensional ultrasound examination is usually an addition to 2D imaging. Medically speaking, 3D ultrasound improves the analysis of the surface of the child’s body, especially the head and face. Although the 3D ultrasound image is very good, because it gives a true view of the fetus, which already creates an emotional bond between the mother and the child (and the father, if present), you should not always insist on it. Sometimes fetuses are positioned in a way that they are difficult to display with 3D technology, and the safety of using 3D ultrasound should be taken into account. Professionally speaking, 3D technology is essential in a detailed analysis of the fetal facial anatomy.
4D ultrasound examination in pregnancy
Four-dimensional ultrasound is a technical invention that allows us to analyze fetal movements. It is common knowledge that the fetus responds to most stressors by calming down and reducing the quantity of its movements. By observing fetal movements over a longer period of time, we can draw conclusions about the overall condition of the fetus. In addition to quantity, we can also analyze the quality of individual movements using 4D ultrasound. Assistant Professor Luetić took part in a working group that examined the quantity and quality of fetal movements at the Sveti Duh Clinical Hospital, and published the results of their research in the world’s most prominent scientific journals. Knowledge and experience gained from such scientific projects is now used in our everyday work with patients.
Detailed comprehensive examination of fatal anatomy (level 2 ultrasound)
Although fetal anatomy is extensively analyzed in almost every ultrasound examination, professional associations recommend a detailed examination of fetal anatomy (or level 2 ultrasound) at two stages of the pregnancy. The first examination should be done at the end of the first trimester; even though the fetus is still very small at this stage, it is large enough for the examination of almost all organ systems. This examination is combined with the measurement of nuchal translucency and nasal bone detection. The second detailed examination is performed around the 20th week, when all organs are developed enough for a detailed scan. It should be emphasized that level 2 ultrasounds usually last longer than usual. Besides regular measurements of fetal growth, the doctor will examine a lot of details, which is sometimes not feasible due to the baby’s position; the doctor might have to wait for the baby to change the position and allow a detailed examination.
Color Doppler pregnancy ultrasound
The application of Color Doppler during ultrasound provides an even more detailed assessment of the fetus, since it enables us to analyze fetal bloodstream on a larger scale, particularly the blood vessels in the brain and the abdomen. Since the bloodstream changes in any case of fetal distress, the analysis of parameters is used to diagnose and treat these conditions. Color Doppler can also be used to analyze the blood vessels in the placenta, hence indicating the possible faults in its functioning. The mother’s blood vessels can also be examined with the use of Color Doppler, particularly those that supply the uterus, therefore the placenta and the baby as well.
Cervicometry
Cervicometry is an ultrasound exam performed in order to measure the length of cervical canal, i.e. the canal inside the lower part of the uterus. The discovery and application of this exam has greatly reduced the necessity of digital examining of cervical dilatation, since frequent exams pose a risk for preterm labor. This exam helps determine whether the pregnancy might result in preterm labor, since preterm cervical dilatation is a clear indication. There are clear criteria for the appearance and minimum length of the cervical canal, which should be met for the pregnancy to be considered low risk for preterm labor. The examination can be conducted either with transvaginal or transabdominal ultrasound, as decided by the physician.
Cardiotocography (CTG) monitoring
Cardiotocography monitoring is one of the basic tools for fetal assessment, since it can monitor the baby’s heartbeat during rest and in the periods of fetal activity. If the woman has contractions, CTG monitoring can show how the fetus reacts to additional stress. CTG monitoring is usually conducted only in the third trimester, unless there are indications of certain abnormalities sooner. CTG device can also be used to rule out the possibility of contractions, if the doctor has assessed the risk of preterm labor.
It should be emphasized that successful CTG reading depends on multiple parameters. Therefore, it is not always feasible if the fetus is asleep or the mother is dehydrated, agitated or in the state of hypoglycemia. It is therefore strongly advised to women to eat and drink enough fluids before CTG monitoring.
