When to register for pregnancy and how to do it

Why is registration necessary?

Most often, women find out about their pregnancy at 6-11 weeks. Already during the first visit, the gynecologist suggests registering with the antenatal clinic in order to avoid disturbances in the development of the embryo.

In Russia, the Law on Registration determines that pregnant women have the right to receive free treatment and medical supervision during all 3 trimesters of pregnancy. This is explained by the fact that systematically visiting doctors, undergoing a number of examinations and taking tests can prevent a large number of problems.

Registration in the early stages of pregnancy has the following advantages for the child and mother:

1. At the very beginning of fetal development, important organs and systems are formed. During this period, you need to take vitamins and follow many recommendations.
2. After conception, immune function decreases, chronic pathologies worsen, which can negatively affect the condition of the fetus. The doctor helps correct discomfort and prevent complications.
3. Early diagnosis increases the likelihood of a successful pregnancy.
4. By passing all the necessary tests, you can determine whether the expectant mother will experience any complications during childbirth.
5. There are also material benefits from the production. If the expectant mother registers before the 12th week of pregnancy, she will receive a lump sum payment (after the birth of the child). The amount of funds is symbolic - about 600 rubles, but the state guarantees its receipt.

Reviews

Medical monitoring of pregnancy helps prevent health problems in the expectant mother and fetus; Pathologies detected early in development are easier to treat than advanced ones. Free choice of antenatal clinic and attending physician is an achievement of state medicine in recent years, which previously could only be dreamed of. So do not neglect the opportunity to register for pregnancy - and calmly bear your little miracle.

A professional television journalist, she worked for many years as a special correspondent and commentator on federal television channels (VGTRK, TVC). Author of documentaries. I have awards, including state ones. In recent years, he has been the editor-in-chief of the private television company PUL.

Where to be observed and how to choose a doctor?

According to Russian law, the girl has the right to independently choose a clinic. During the period of gestation, you can be observed in the following institutions:

1. LC (antenatal clinic). This accounting is standard. You can register at any branch of such a medical institution. But if you register at a location other than your place of registration, you will have to additionally register for registration.
2. Perinatal center. This institution is a maternity hospital with special conditions and wards that are intended for patients with severe pregnancy. Doctors in such centers use modern equipment and technologies in their work. A number of organizations additionally assist in childbirth.
3. Private clinic. These organizations offer a whole range of services. For this purpose, future mothers enter into an agreement. The insurance company opens an account in the name of the expectant mother. The insurance includes examinations, tests and gynecological examinations. The only disadvantage of this option is the high cost.
4. Registration at the maternity hospital. Some maternity hospitals have special departments for monitoring the condition and well-being of pregnant women. To use this service, you need to enter into an agreement with an insurer cooperating with the organization.

When concluding an agreement with a private institution, you need to carefully study the footnotes in the document. They indicate what services the company provides. You should also read the “Exceptions” section. It reflects additional conditions and possible reasons for termination of the contract.

When is the best time to register for pregnancy?

There is no legal norm that would prescribe the exact date of pregnancy registration. However, women who register before the 12-week period receive an additional small cash benefit.

In difficult situations, the condition of the expectant mother begins to be monitored from the 5th week. The standard period is from 8 to 11 weeks. At this interval of gestation, a number of important procedures are performed. There are the following reasons to urgently visit a doctor:

• chronic diseases;
• hazardous conditions in the workplace;
• general deterioration of health;
• previous miscarriages and severe diseases of the uterus;
• age over 35 years.

The optimal time to register for pregnancy is before the 12th week. Only in this case can you have time to undergo all the necessary examinations and receive a sick leave certificate.

What specialists should you visit besides an obstetrician-gynecologist?

A gynecologist is not the only medical specialist that a pregnant girl should visit. The list of doctors is compiled depending on the presence of concomitant pathologies, however, there are doctors whom you need to visit regardless of your health.

Therapist

A general practitioner advises a pregnant woman regarding diseases not related to the reproductive organs. If the expectant mother is plagued by problems such as headaches, high blood pressure, swelling, low hemoglobin, colds, gastrointestinal pathologies, the specialist will prescribe the correct treatment that is safe for the embryo.

In the case when the girl in the position feels normal and there are no complaints, the therapist is visited according to the established schedule - twice during pregnancy (in the 1st and 3rd trimester).

Oculist

Since a woman’s body experiences increased stress when carrying a child, this also affects her vision. Even if the girl had normal vision before conceiving the baby, and she is not registered with an ophthalmologist, consultation with a specialized specialist is necessary twice during the entire period of bearing the baby - in the first and third trimester.

During diagnostic procedures, the doctor not only checks visual acuity, but also examines the condition of the retina. Degeneration or dystrophic changes in the retina pose an obstacle to natural delivery; in this case, it is recommended to perform a cesarean section to preserve the vision of the expectant mother.

However, dystrophic changes in the retina can be corrected during pregnancy. For this purpose, laser coagulation is performed. For this, the patient is not hospitalized; the operation takes a few minutes and can be performed until the 36th week of pregnancy. Thanks to the laser beam, the retina is strengthened, which will prevent its detachment during childbirth, when a woman must push.

Dentist

Since during the period of gestation the beneficial microelements necessary for maintaining teeth are spent on the formation of the embryo, a visit to the dentist is a mandatory procedure. In addition, caries is a source of microbes that enter the bloodstream and are dangerous to the fetus. The first visit to the dentist is prescribed by the gynecologist upon registration. If there are no problems with the oral cavity, a second consultation is necessary at the end of the second trimester.

Prosthetics and tooth extraction during pregnancy are carried out only in extreme cases, but treatment of caries and other diseases of the oral cavity is not dangerous for the child.

Documents for registration

A number of documents must be provided to the medical institution:

• compulsory medical insurance policy – ​​allows you to receive free medical treatment;
• passport – required to obtain a personal card;
• SNILS.

To undergo a routine examination, you need to additionally prepare shoe covers, a disposable diaper, a pencil and a notepad for recording the doctor’s advice.

The medical center registers 2 personal cards:

• exchange card - the most important document of a pregnant patient, issued to her at the 21st week of gestation (required for registration of a woman upon admission to the maternity hospital);
• Individual sheet of the mother in labor - this document is kept by the gynecologist who conducts routine medical examinations.

These papers contain the results of tests and examinations for the entire period, information about the development of the fetus.

In each trimester of pregnancy, routine medical examinations are performed free of charge. The specialist monitors the condition of the pregnant woman’s body, gives professional recommendations, prescribes tests and examinations.

Refusal to be observed at the antenatal clinic

An obstetrician-gynecologist caring for a pregnant woman is responsible for the health of the mother and baby. He makes appointments and contacts the woman or her relatives after she missed the day of the screening visit. If the expectant mother is not in the mood for such frequent “meetings” at a medical institution, she can write a refusal to visit the doctor and undergo examinations. In this case, the gynecologist is obliged to explain to her in detail, in an accessible form, what health risks this decision poses.

What happens if you don’t register with the consultation? Formally, a woman is not required to have her pregnancy examined by a doctor or regularly visit a medical facility. If you abandon the traditional surveillance scheme, there are two main scenarios:

1. The woman does not visit a doctor and is not examined. With the onset of labor, she can be hospitalized in the maternity hospital, but only in the observational - “doubtful” department: there is no exchange card, there is no information about infections, the risks of concomitant diseases, or possible fetal pathology. She also cannot receive sick leave for pregnancy and childbirth, starting from 28-30 weeks, since she is not observed anywhere.
2. A woman visits a private medical center and undergoes examinations. Closer to the 30th week, she can receive an extract and go to the antenatal clinic to obtain a sick leave certificate and a birth certificate. The likelihood of ending up in a “doubtful” department depends on whether the examinations have been completed in full or not.

The optimal time for the first visit to the antenatal clinic for pregnancy is 8-10 weeks. A woman who has a compulsory medical insurance policy can be observed in any institution in the Russian Federation. Visiting an obstetrician-gynecologist and following his recommendations will help you carry and give birth to a healthy baby.

How to register for pregnancy without registration?

To register without registration in your passport, you need to take your compulsory medical insurance policy and passport with you to the hospital. Russian legislation has established the following services provided free of charge:

1. The state program fully covers the cost of medical care for the patient in the event of an insured event, regardless of the region of the Russian Federation. Medical insurance guarantees free treatment. It includes therapy during pregnancy, childbirth and the postpartum period.
2. The compulsory medical insurance certificate allows you to independently choose a medical center from the list included in the insurance system at the legislative level.
3. Change your doctor by writing an application addressed to the head physician, within the framework of the current insurance program.

The legislation determines that the expectant mother has the opportunity to change medical center once a year. This does not include cases of temporary change of residence or relocation.

So, no problems should arise when registering an expectant mother without registration. In this case, the pregnant woman must have a Russian passport and a compulsory health insurance policy.

To register at the selected medical center, you must submit an application addressed to the head physician, indicating in it the addresses of registration in the passport and actual stay, and the insurance policy number. If a refusal is received, a request should be sent to the appropriate authorities.

Which medical institution can I go to?

The easiest and most accessible way is to register at the nearest clinic or antenatal clinic of the residential complex (on a territorial basis).

In this case, you can choose specialists, subject to their consent, independently and be serviced by them (with Part 1 of Article 21 No. 323-FZ of the Russian Federation).

In this case, you can change a doctor only once a year (with the exception of the situation when a change of medical organization and service specialists is made in connection with a move).

ALSO INTERESTING TO READ: Polymorphisms of genes of the blood coagulation system

At the same time, when deciding where to receive medical care, a woman expecting a child has the right to receive complete and reliable information:

• about the institution itself

• about the services that this organization provides to the population

• about the qualifications of doctors, their work experience, education

• this right is enshrined in law (Part 7, Article 21 No. 323 of the Federal Law of the Russian Federation).

There are advantages to choosing a clinic at your place of residence, close to your home:

• many tests, ultrasounds, consultations and examinations are free. In addition, you will be able to receive some medications for free if prescribed by a doctor.

• It is not necessary to register at your place of registration; you can also register at your actual place of residence. You can choose a consultation closer to home, this will make life easier in the last months of pregnancy

• medical supervision at the place of residence will provide the attending physician with complete information about the state of health, previous problems, diseases, test results, etc.

• in a municipal medical institution you will not have to worry about issuing an exchange card, sick leave, or birth certificate.

It can be noted that many people do not like the fact that in the state free clinic they do not devote too much time to women, sometimes there are queues, but in the state clinics there are very good specialists with many years of experience.

This may not necessarily be a clinic; you can entrust your health and the health of your unborn baby to a private clinic, as well as to a specialist who carries out medical activities individually (Article 15 No. 326-FZ of the Russian Federation).

What is your first appointment with a doctor?

During the first medical examination, the specialist carefully examines the pregnant woman’s card and her gynecological indicators. He pays special attention to records of the duration of menstruation, the number of pregnancies completed and the nature of their course.

To make a conclusion, the doctor may request information about the parents: whether they have hypertension, diabetes, cancer or mental pathologies. The medical record contains data on the physique of the expectant mother, her diet and body weight. In addition, the obstetrician records the dimensions of the pelvis and carefully examines the uterus. Then the gynecologist determines the gestation period and the possible date of birth of the child. Additionally, an ultrasound examination is prescribed.

Blood pressure is measured at every doctor's visit.

Analyzes and examinations

The gynecologist prescribes consultations for the pregnant woman with an ENT doctor, an ophthalmologist, an endocrinologist and a gastrointestinal therapist. This is required to assess possible risks by examining the expectant mother for serious illnesses and restrictions on natural childbirth.

You need to visit a dentist and therapist 4 times, an ophthalmologist and otolaryngologist twice.

Also, the expectant mother needs to undergo the following laboratory procedures:

• urine analysis - to detect protein concentration;
• bacterial urine test;
• blood serum analysis to detect hepatitis B, as well as Rh factor and group;
• general testing for HIV infection and syphilis;
• testing the walls of blood vessels - allows you to find out the concentration of antibodies in the blood;
• smear for cytology.

The father of the unborn child is prescribed a general blood serum test and fluorography.

Based on the results of the first examinations, it is possible to determine the presence or absence of deviations in the formation of the embryo. If necessary, the gynecologist refers the woman to a blood serum test for antibodies and glucose sensitivity.

At 11-12 weeks of gestation, it is necessary to undergo an ultrasound examination. After this, a biochemical test is prescribed. Repeated ultrasounds should be performed at 19-23 and 32-36 weeks after conception.

These tests must be taken by all pregnant women. In addition, the doctor can give directions for auxiliary studies.

First visit to the doctor

A detailed conversation with a doctor, examination and referral for tests - these are the stages of registering a woman at a clinic or medical center.

How to prepare

Since you're about to be examined by a gynecologist, you should bring a clean towel just in case (although most offices have disposable paper towels). A responsible mother will also bring a pen and notepad to write down the doctor's recommendations.

You will have to answer many questions; it is also better to prepare for such a “test” by remembering, at a minimum, what diseases you have had throughout your life, as well as what genetic pathologies have been passed on in the family from generation to generation.

Surely the woman will also have questions for the doctor; In order not to forget anything, it is better to write it down.

What documents to take

The expectant mother will need:

• general passport;
• compulsory medical insurance policy;
• pension insurance card, where SNILS is indicated - personal account number.

Residents of the capital no longer need a certificate of registration in Moscow; since 2010, the document has been excluded from the list of requirements, since the free choice of a medical institution has been legalized.

At the clinic, the woman will have to write an application addressed to the head physician, where she will indicate the address where she lives, as well as the health insurance policy number.

What will the doctor ask?

During the first conversation, it is important for the doctor to obtain as much information as possible about the pregnant woman’s health; The information contained in the patient’s chart is not enough - especially since changes occur in the body associated with the birth of a new life, and the doctor needs to know everything.

A competent doctor will take the time to ask questions to the patient in order to get a complete picture of the woman’s health and possible threats to the fetus.

The gynecologist will ask:

• whether the woman was pregnant before, how many times;
• how long were the intervals between pregnancies;
• how each pregnancy proceeded, how it ended (childbirth, premature birth or miscarriage);
• whether complications occurred during or after childbirth;
• how much the newborns weighed, how they developed, what illnesses they had;
• whether the woman has previously suffered from infectious diseases (rubella, herpes, sexually transmitted infections), whether she is a carrier of HIV;
• does the pregnant woman suffer from chronic diseases, endocrine system disorders, or mental disorders; has bad habits;
• what operations did you undergo; does he suffer from increased bleeding or allergies;
• what is the duration of menstruation, was the cycle disrupted, did she experience pain or not; whether the woman uses contraceptives;
• how old is the child’s father, what is his blood type, Rh factor; are there any hereditary pathologies in the family;
• whether there are genetic diseases in close relatives of the pregnant woman; Some of them suffer from diabetes, hypertension, tuberculosis, cancer, mental disorders;
• whether the patient’s relatives had multiple pregnancies; whether children were born with congenital pathologies.

How is the inspection carried out?

After the conversation, the doctor will take a number of measurements and conduct an external examination of the pregnant woman. The doctor needs to know:

• the patient’s pulse rate and blood pressure (pressure is measured in both arms);
• weight (women who are too thin and too fat are placed under special control);
• color of mucous membranes, skin, eye sclera;
• Are heart sounds normal, the condition of the lungs (determined by listening);
• How does the thyroid gland feel in a pregnant woman?
• what is the condition of the mammary glands and lymph nodes?

During an obstetric examination in the chair, the gynecologist finds out:

• pelvic dimensions;
• the size of the uterus, which will determine whether the patient is actually pregnant;
• condition of the cervix, vagina and its walls; Thus, a shortened or dilated cervix threatens miscarriage;
• what is the gestational age?

An examination in the gynecologist's chair reveals the first data about the unborn child, including its approximate age.
After determining the due date, the doctor calculates the approximate date of birth. If the doctor has any doubts, he will prescribe an ultrasound and a blood test to determine the amount of the hormone hCG (human chorionic gonadotropin). This hormone will not let you down: its level in the body clearly indicates the presence or absence of pregnancy.

During the examination, the doctor will take smears for examination. In total, a chair examination is carried out at least three times during pregnancy, in each trimester, and more often if pathologies are detected in the woman or fetus.

After the procedure, completing the first consultation, the doctor will give the patient individual recommendations - on nutrition, lifestyle, taking vitamins - and will also discuss the schedule of visits. Next, the woman will have to visit the offices of a therapist, endocrinologist, ophthalmologist and other specialized doctors. Tests required:

• general urine analysis;
• bacterial culture of urine;
• blood test with leukocyte formula;
• blood to determine the group and Rh factor;
• blood test for biochemistry (taken from a vein) - to detect viral hepatitis, diabetes, cancer;
• blood tests for HIV infection, syphilis;
• coagulogram (determines blood clotting).

In addition, an electrocardiogram and ultrasound are performed.

Why do you need an exchange card?

This card is the main medical document of the expectant mother. It duplicates information from the pregnant woman’s individual card, which is kept by the attending physician. The paper is given to the patient after the 28th week of pregnancy, and with this card she is admitted to the maternity hospital. It is important not to lose the document, especially on the eve of childbirth, when there is no time to run to your doctor for a copy. Without an exchange card, a woman will not be allowed into a regular maternity ward; she will be placed in an observation room, next to infectious patients. If you're going on a trip, don't forget to take the map with you - you never know...

The doctor fills out the exchange card and gives it to the patient closer to the birth; from now on it is better for a woman to keep the document with herself

Information that the exchange card contains:

• first name, last name, age of the woman in labor;
• a brief information about the biological father of the unborn child - in particular, what diseases he suffered;
• where both parents work; if one of them works in hazardous work, this may have a bad effect on the health of the fetus; at the request of the doctor, in this case the woman is looked for a less dangerous place of work;
• diseases in the mother that the baby can inherit; gynecological pathologies affecting the course of pregnancy;
• results of tests and examinations;
• if you have had previous pregnancies, how they went; if there were complications, the doctor takes into account the possibility of avoiding such problems in the current situation.

How to get maternity leave?

The specialist issues the patient a certificate confirming her incapacity for work. It is completed by the doctor who conducted the examination or by an obstetrician-gynecologist. The following deadlines exist for this:

• stable course of gestation - from 30 weeks. The duration of maternity leave is 140 days - 70 days before childbirth and 70 after;
• multiple pregnancy - from 28 weeks, leave is granted for 180 days.

In case of complications, the validity period of the certificate of incapacity for work is increased by 16 days. In this case, its duration will be 156 days.

How often should you visit a doctor?

The frequency of visits to the gynecologist is also officially established. Traditionally it looks like this:

• until the 15th week of gestation, the obstetrician should be visited every 3 weeks;
• in the period from 15 to 29 weeks of pregnancy - every 14 days;
• from 29 weeks - every 7-10 days.

Additionally, you will have to visit other medical specialists. Moreover, if you need to leave your place of stay for a long time, you must notify your doctor about this.

What happens if a pregnant woman does not register?

In some situations, it happens that a pregnant woman herself refuses to register with a medical institution and goes to the doctor before giving birth. The entire period of gestation can be stable and without complications, and the child will be born completely healthy. However, if problems arise that can lead to fetal development disorders or miscarriage, no one will help the expectant mother. Such a neglectful attitude towards the unborn child and one’s own health can lead to extremely undesirable consequences.

The state does not impose any penalties for refusal to register. In this case, the woman punishes herself by losing professional support, diagnosis and treatment. Even if a pregnant woman is in excellent health and has already undergone more than one birth, it is still advisable for her to undergo all the necessary examinations and tests. It is difficult to predict how the entire pregnancy will unfold. If conception has been confirmed, but placement in the LCD is complicated by a long trip or some other reason, you can make an appointment with the doctor a little later.

There is no exact deadline for registering at the antenatal clinic. All pregnant women independently decide in what week they should seek support from a medical institution. For short periods of time, the obstetrician-gynecologist may even refuse the application and schedule a second consultation after 2-3 weeks. To avoid problems and misunderstandings, it is recommended to register during the 1st trimester of pregnancy, because routine examinations, examinations and tests are prescribed during this period.



Organization of medical care in the antenatal clinic

When registering with the antenatal clinic, the expectant mother brings with her statements from other specialists, results of laboratory and instrumental studies. During the visit, the doctor collects anamnestic information, studies medical documentation, interviews the woman about possible complaints and conducts a full examination.

Questioning a pregnant woman during registration

The obstetrician-gynecologist will clarify whether the expectant mother is concerned about any changes in her condition, for example, such as:

• discomfort, abdominal pain;
• unusual discharge from the genital tract;
• headaches, dizziness, weakness;
• changes in tastes, nausea and vomiting.

If a woman complains, the doctor will clarify how often the discomfort occurs and how much it interferes with normal activities. Next, the gynecologist collects an obstetric history, which includes information about:

• when did menstruation begin, cycle length, regularity;
• at what age did the first sexual contact occur?
• whether the woman or her partner had venereal, sexually transmitted diseases, tuberculosis, HIV, chronic hepatitis;
• whether the woman had rubella or measles, whether she received preventive vaccinations;
• what kind of pregnancy occurred, if the woman was pregnant earlier - how the previous ones ended (medical abortions, miscarriages, childbirth);
• how other pregnancies and births proceeded, whether there were any children with genetic abnormalities or hereditary diseases;
• Does the woman have genitourinary diseases?

Then the doctor will ask the expectant mother about her somatic and mental health; diseases such as diabetes mellitus, hypertension, varicose veins, heart defects, and myopia require special attention. These conditions require special attention during pregnancy and in preparation for delivery.

In addition, the gynecologist will inquire about the health of the child’s father: infectious, hereditary diseases.

How is the first inspection carried out?

After interviewing the woman, the gynecologist begins a physical examination. He weighs the patient and measures her height. This is necessary to calculate your body mass index. The doctor then measures blood pressure, examines the mammary glands and conducts an examination in a gynecological chair. The gynecologist uses a bimanual examination to assess the condition of the uterus and appendages. Based on changes in the size of the uterus, density and other signs, the doctor assumes the presence of pregnancy. At the same time, he takes a smear to determine the microflora of the vagina.

If the first examination takes place during a late visit to the LC, the gynecologist measures the abdominal circumference, the height of the uterine fundus, and the child’s heartbeat.

Examinations upon registration

After the examination, the doctor will tell the expectant mother what tests to take, give directions, and recommendations for visiting other specialists.

So, when registering, a woman needs the following examinations:

• analysis of beta-hCG hormone levels;
• analysis to determine blood group and Rh factor;
• general blood analysis;
• general urine analysis;
• blood sugar;
• HIV antibody test;
• analysis for viral hepatitis;
• analysis for antibodies to syphilis, toxoplasmosis, rubella, herpes, cytomegalovirus;

The woman’s husband also undergoes tests to determine group and rhesus affiliation and does FLG.

If you have chronic diseases, you will need to consult other specialists, for example, an ophthalmologist for myopia. After the first visit, the woman will be offered an appointment for the first screening test.

Frequency of visits to antenatal clinic

After registration, the gynecologist explains how often you need to visit a medical facility as planned:

• in the 1st trimester – once a month;
• in the 2nd trimester – once every 2 weeks;
• after 36 weeks - weekly.

If a pregnant woman is worried about something, she should not wait for a scheduled appearance; she should consult a doctor immediately. Warning symptoms include:

• frequent vomiting with weight loss;
• stomach ache;
• bloody or other discharge from the genital tract;
• dizziness, headaches;
• fluctuations in blood pressure;
• sudden or gradual increase in edema;
• change in the child's activity;
• suspicion of leakage of amniotic fluid.

If the condition worsens, the obstetrician-gynecologist prescribes treatment on an outpatient basis (including in a day hospital for gastrointestinal tract diseases) or decides on hospitalization in a department with round-the-clock stay.

There are standards for the frequency of examination of pregnant women by doctors. So, in a physiological course, it is recommended:

• obstetrician-gynecologist – at least 7 visits;
• therapist, dentist – at least 2 visits;
• otolaryngologist, ophthalmologist – at least 1 visit.

If necessary, the gynecologist refers the expectant mother to other specialists. The frequency of visits may increase, even if the woman herself is not worried about anything, and screening studies have revealed developmental anomalies or other conditions that threaten the baby’s health.

Screening studies in antenatal clinics

Monitoring protocols for pregnant women involve 3 planned studies to determine the child’s health status. The table below lists the dates and their purpose.

If a pregnant woman does not register and undergo examinations in a private clinic on her own, she may not know that her long-awaited baby is not viable. Or the newborn will have severe developmental defects that require urgent medical intervention and long, expensive rehabilitation.

Unfortunately, the tendency to refuse examinations with the formulation “I will accept my child as anyone” does not always stand the test of reality. Experience of working with families raising special needs children suggests that timely information about the health status of the fetus allows parents to get help from a psychologist, prepare for changes, contact clinics ready to help after birth - in other words, not to get confused and miss time.