Your obgyn does two roles, the first is inspecting your fetus and making sure it is growing well and without complications and the second is inspecting you to make sure that you are adapting well to pregnancy and interferes when he detects any problems. Your doctor will also provide a safe delivery plan and support during the post delivery period till you return back to your pre-pregnancy shape. Good antenatal care has proven efficiency in reducing maternal and fetal problems and even death during pregnancy period or delivery period and after delivery period. In addition new techniques have been developed for prenatal testing that facilitated early detection of problems in the fetus which give parents time to check for medical or surgical treatment after birth and also to prevent the same problems from happening again in other pregnancies.

Inspecting the mother

• Your doctor will start an antenatal care file for you then he will ask you some questions which have to be answered accurately like: Blood group and Rh factor? What illness did you have before? Did you do any operation before? Are you taking any medication? Where you pregnant before and how did it go? When was the first day of your last period? Is there any a familial disease or hereditary traits in your family. And some other questions which will help him have a general idea on any risk factor that might happen during your pregnancy period.
• Your weight and blood pressure will be recorded in the first visit and you will be asked to do some laboratory investigations (e.g. Blood Group, Rhesus factor, complete Blood picture, Blood Sugar, urine analysis, etc) and the doctor will decide upon the first ultrasound scan which will be around the 7th week of pregnancy. Usually the scan will be through your abdomen and you should have a full bladder. Sometimes the scan will be done through the front passage (vagina) but the ultra sonographer will talk to you about this if it proves necessary.
• He will give you instructions regarding nutrition, resting and exercising and will teach you the danger signs during pregnancy e.g. (vaginal spotting, fatigue, lower abdominal pain, severe vomiting or headache) any of which if you feel, you contact him at once. He will also explain all the fetal wellbeing exams that are performed.
• Each visit you will be inspected for weight, blood pressure, general inspection with the addition of inspecting the baby inside you .The doctor makes sure that everything is all right and there are no signs of danger like e.g. pre eclampsia, gestational diabetes. Then he prescribes the appropriate nutrition for your pregnancy interval and exercises which are suitable for you.
• Your doctor arranges your visit schedules according to your case. You have to follow your doctor instructions well to deliver a healthy baby. You have to discuss with your doctor any changes that happen so that he can differentiate between normal and abnormal changes.
• Sometimes surgical interference occur (E.g. Cervical Cerculage)

Effect of drugs on baby: Drugs can pass to the baby through the placenta. Taking medications and drugs without your doctor's approval can result in problems and fetal anomalies.

Inspecting the baby

 Fetal inspection is done to check the normal growth of the fetus including its internal parts, the absence of any growth anomalies due to hereditary or genetic factors, absence of any disease in any organ of the fetus.

Ultrasound

 uses ultrasound waves to draw the internal organs of the mother and fetus on a display screen. There is two dimensional black and white ultrasonography, 3D ultrasonography which gives a more detailed 3 dimensional picture of the fetus, 4D ultrasonography which gives 3D picture in motion.

Ultrasound is used to :

• Confirms presence of pregnancy and its location and accurate dating of pregnancy.
• Placental location and status.
• Cervical canal length measurement.
• Detailed scan at about 20 weeks to check any abnormalities in the baby's structural development and growth.
• Doppler scanning for fetal growth retardation and repeated abortions.  
• Amniotic fluid details.  
• Baby presentation.               
• Fetal sex.
• Biophysical profile by checking the baby respiration, muscle movement and tone.
• Expected date of delivery.
• Baby's weight.    

First trimester scan

• It is a test performed at 11-13 weeks of pregnancy that can identify more than 85% of babies with Down syndrome and trisomy 18. The screening involves ultrasonographic measurement of nuchal translucency (a skin fold behind the neck). A positive result is not diagnostic but indicates that an increased risk for a problem exists and that additional testing should be considered.
• Chorionic villous sampling in week 13 which is taking a sample of the chorionic villi of the placenta for genetic analysis under the guidance of ultrasound machines for safety.

Second trimester scan

• It is a test performed at 14-17 weeks of pregnancy that can identify more than 85% of genetic abnormalities. The screening involves biochemical analysis of maternal serum levels of beta-hCG (From the placenta), Free Estriol (From the fetus and placenta) and alphafeto protein (From the fetus).  A positive result is not diagnostic but indicates that an increased risk for a problem exists and that additional testing should be considered.
• Ultrasound anomaly scan at 18-21 weeks: The head is usually examined first to check its shape and internal structures, and then the doctor will look at the baby's face to see its features. Then he looks at the spine in different sections to make sure that all the vertebrae are in alignment and that the skin covers the spine at the back. The baby's abdominal wall is then checked to make sure it is intact. After that comes the heart which is looked at for its size and shape, and the valves should open and close with each heartbeat and then major blood vessels. The stomach should be visible below the heart. The doctor will then check your baby's kidneys, and that urine flows freely into the bladder. Lastly Hands and feet are examined and the fingers and toes are looked at. About half of all major abnormalities will be seen on a scan and half will not be seen as published by the Royal College of Obstetricians and Gynecologists in London. Problems detected: Anencephaly (absence of the top of the head) 99%, Exomphalos / gastroscisis (defects of the abdominal wall) 90%, Major limb abnormalities 90%, Spina bifida (open spinal cord) 90%, Major kidney problems 85%, Diaphragmatic hernia (hole in the muscle separating chest and abdomen) 60%, Hydrocephalus (excess fluid within the brain) 60%, Down's syndrome 40%, Major heart problems 25%. Some problems may not be visible until later in your pregnancy. If a problem is found or suspected, you will be told straight away and an appointment to have another scan with a fetal medicine specialist should be made immediately.
• Amniocentesis: It is performed at 16-20 weeks and it consists of a study of amniotic fluid after taking a sample of it by an aspiration needle guided through the abdomen by ultrasound to choose the safest and best location for aspiration. The baby sheds cells into the fluid continuously. The study is beneficial to give an idea about genetic problems, blood hemolytic diseases due to Rhesus factor difference between the sensitized mother and fetus and to know fetal lung maturity. The exam is safe but there is a small miscarriage possibility.

Biophysical scan

• Ultraosund scan is done to document the fetus movement : breathing, limb extension, closing and opening of his hands, amniotic fluid volume which is an excellent indicator for placenta function. it also includes the follow up of fetal heart beats for 20 minutes or more. It can be done 1 or more times per week according to the necessity. If the exam results are not comforting like decreased amniotic fluid volume, prompt delivery should be done.
• Non stress test: A simple non invasive examination which consists of putting two probes on the mother abdomen, one to measure fetal heart rate and the other to measure uterine contraction. The mother presses a button whenever she feels a fetal movement within the 20 minute exam time. The theory is that there should be a deceleration rate and pattern in the fetal heart rate that normally occurs after fetal movement in case of a well oxygenated fetus; if the pattern is not there exams should be done to know if there is a problem due to insufficient placental function, umbilical cord compression or drugs taken by the mother. If the exam results are not comforting prompt delivery should be done.
• Doppler scan: a Doppler can detect movement, it can be used to detect blood flow in vessels and is used in certain ultrasound machines while the other type can be used in clinics to hear fetal heart beats (sonic aid).