Management of Pregnancy and Delivery

Follow up of normal pregnancies:

  • 1st visit (7-8 weeks). Ultrasound scan to confirm viability of pregnancy and to order a first trimester blood test.
  • 2nd visit (12 weeks). Ultrasound scan of the first trimester (11-13 weeks) and to order the maternal serum screening (Test EBA) to detect fetal chromosomal anomalies.
  • 3rd visit (15 weeks). Maternal serum screening results and arrangement of the 20 weeks scan.
  • 4th Visit (20 weeks). Ultrasound of second trimester (high definition) and to order a second trimester blood test. Booking of the Labor Preparation Course if wished.
  • 5th visit (25 weeks). Second trimester blood results and the option to have a transvaginal ultrasound scan to measure the cervical length in order to prevent premature labor. To book the 4D ultrasound (optional).
  • 6th visit (27 weeks). Only if you choose to have a 4D ultrasound.
  • 7th visit (29 weeks). Ultrasound scan of the third trimester, to check the growth of the baby.
  • 8th visit (33 weeks). Follow up of pregnancy and to order a third trimester blood test.
  • 9th visit (36 weeks). Third trimester blood results, ultrasound scan to check the growth of the baby and to take a rectal and vaginal swab in order to detect the presence of Streptococcus Agalactiae in the patient.
  • 10th visit (38 weeks). To perform a Non stressful test (NST) and a vaginal examination.
  • 11th visit (39 weeks). To perform a Non stressful test (NST) and a vaginal examination.
  • 12th visit (40 weeks). To perform a Non stressful test (NST) and a vaginal examination.
  • 13th visit (41 weeks). To perform a Non stressful test (NST) and a vaginal examination. To arrange for an induction of labor between 41-42 weeks.

In high risk pregnancies such as twin pregnancies monochorionic or bichorionic, Intrauterine growth retardation, pre-eclampsia, we do a strict ultrasound control of the growth and a Doppler ultrasound to evaluate the utero-placental circulation that allow an investigation of fetal hemodynamic responses to physiologic and pathologic events.

The Delivery will take place essentially in Hospital Quirón Teknon, with the exception of the insured of SANITAS will be assisted on CIMA and in Centro Médico Teknon too and the insured of Asistencia Sanitaria Colegial that it will be in the Hospital of Barcelona, and always it will be performed by a member of the obstetric team of Institut Dr. Flores, all of them get to know the patient during the follow up visitations of her pregnancy.

Prenatal Diagnosis

There are several tests that allow us to discover a great variety of pathology that could affect the fetus and we call them Prenatal diagnosis:

  • 11-13 weeks ultrasound scan: The nuchal translucency (ultrasound image of some subcutaneous fluid in the nuchal of the fetus) at 11-13 weeks scan in combination with the maternal age is an accurate screening of Down syndrome.
    It gives us, as well, confirmation of pregnancy viability, exact gestational age, early diagnosis of major fetal anomalies and to see the chorionicity, highly important in multiple pregnancies.
pliegue nucal
  • EBA Test: It’s a maternal serum screening taken between 11 and 13 weeks of pregnancy. It works with some hormonal results that together with maternal age, weight, gestational age, nuchal translucency and CRL, will give us a risk index for Down Syndrome and Edward Syndrome. The detection rate is about 85-90%.
  • Noninvasive prenatal diagnostic test: since early 2013 is available in Spain a new screening test to assess noninvasively alterations in chromosomes 13,18, 21 and sex chromosomes. This test is a maternal blood test to rule out Patau, Edwards, Down and Turner syndromes, respectively, also allows the detection of fetal sex. It has the advantage of greater sensitivity and specificity than the EBA test and it is also a noninvasive test (without any risk of miscarriage).
  • Amniocentesis: Performed from 15 weeks of pregnancy onwards. The technique is the introduction of a thin needle, under ultrasound guidance, in the amniotic sac and the extraction of 20cc. of amniotic fluid. It’s the most accurate test to diagnose chromosomal anomalies (close to 100% fiability) but the risk of miscarriage is about 0,5%.
    After this test it is essential to do complete rest for about 48hr. The results take 20 days to come back from the lab, but there is a quick result in 24-48hr (FISH for the 13, 18, 21 and X, Y Chromosomes) that you can ask for at the same time.
    In the actual guidelines of prenatal diagnosis of the ICS, maternal age is Not a determinant factor to do an amniocentesis, the age of the patient is included in the EBA test.
    amniocentesis
  • Chorionic Villous sampling: It is the subtraction of chorionic villous to do some fetal analysis. It’s done from 11 weeks onwards (between 11 and 14 weeks) and it can be done through the abdomen or the vagina depending on the placental site. It gives us the same information that the amniocentesis but it can be performed earlier.
    After it, the patient must rest for 48 hr. The miscarriage rate is about 1-2%. The preliminary results are at 48-72 hr but the definitive ones at 20 days.

Obstetric Ultrasound 3D and 4D

We perform 5 ultrasound scans during the pregnancy:

  • 7-8 weeks ultrasound:
    • Identify the fetal heart beat.
    • Number of fetus and chorionicity.
    • Accurate gestational age.
    • Location of pregnancy, intra or extra uterus (diagnosis of ectopic pregnancy).
  • 12 weeks ultrasound:
    • To confirm exact gestational age and viability.
    • Nuchal translucency measurement and other secondary markers of chromosomal defects (nasal bone, ductus venosus and tricuspid regurgitation).
    • Early diagnosis of major anomalies in the fetus and confirmation of multiple pregnancies. Diagnosis, too, of the twin pregnancies chorionicity.
    • Doppler of the uterine arteries to evaluate the flux so if there is a high resistance in the first trimester there is a higher risk of pre-eclampsia or intrauterine growth retardation in the early pregnancy (less than 34 weeks). There is some evidence that the administration of AAS in low dose before 16 weeks of pregnancy and up to 32 weeks could reduce the risk of these pathologies up to a 50%.
  • 20 weeks ultrasound:
    • High resolution ultrasound scan where we look at the anatomy of the fetus in order to discover any anatomical defects.
    • Evaluate ultrasound secondary markers of chromosomal defects.
    • Analyze placental side and umbilical cord location.
    • Evaluate amniotic fluid volume.
  • 29 weeks ultrasound:
    • Rate proper growth of the fetus and fetal static.
    • Doppler study to evaluate fetal hemodynamic responses.
    • Characteristics and location of the placenta.
    • Calculate the volume of amniotic fluid.
  • 36 weeks ultrasound:
    • Rate proper growth of the fetus and fetal static.
    • Doppler study to evaluate fetal hemodynamic responses.
    • Characteristics and location of the placenta.
    • Calculate the volume of amniotic fluid.

Optionally, you can perform the following scans:

  • 25 weeks: transvaginal ultrasound scan to evaluate the cervical length. It is a marker of preterm labor and it allows us to treat it so to decrease the risk. We also evaluate fetal growth with an abdominal ultrasound scan.
  • 27-29 weeks: 4D ultrasound scan it’s not a diagnosis scan but it allows to see the fetus in real time and to see its movements inside the uterus. We record it in DVD.

The High risk pregnancy, such as multiple pregnancy, will have as many ultrasound scans as considered necessary by the doctor.

Doppler Ultrasound

It can be performed any time during the pregnancy. It allows us to evaluate the utero-placental circulation by a noninvasive technique without any risk to the fetus.

Their most common signs are:

  • To evaluate ductus venosus and tricuspid regurgitation (secondary markers of chromosomal defects).
  • Intrauterine growth retardation fetus.
  • To evaluate cardiac pathology in the fetus.
  • Follow up on fetal anemia.
  • Pre-eclampsia screening.
  • Follow up of mono and bichorionic twin pregnancies.

Preparation of Labor Courses

This Course is an activity that allows the couple to enjoy and actively work in their pregnancy and delivery. The information given during the course works towards:

  • Decreasing the delivery fears.
  • To teach how to relax and breath during delivery in order to make it less painful.
  • To explain pregnancy development and natural and assisted deliveries.
  • To explain how to take care of the baby

The practical part of the course, is a psychological and physical training done by a midwife. It’s based on:

  • Physical exercise to increase the strength of some muscular areas so it helps the pregnancy and delivery.
  • Breathing exercises for the delivery.
  • Relaxation techniques to help decreasing muscular tension and improving women auto control.

The content of the talks, given by the Institut team Dr. Flores and the collaboration of Dr. Juan Francés Tutusaus (pediatrician), is to report on:

  • All about pregnancy.
  • Delivery.
  • Post partum.
  • Feeding and taking care of the baby.
  • Notions of childcare.
  • Family planning.

The course lasts for six weeks, once a week for two hours. The first hour is the practical part of the course (usually only the pregnant lady) and the second hour is for the couple and it’s the theoretical one. The Course can be taken from the 5th month of pregnancy onwards.