# Pregnancy and Birth — Frequently Asked Questions

> Answers to the 95 questions asked most often under pregnancy and birth. Each question links to the page that explains the subject.

The questions under this subject are grouped by the page the answer comes from. For your own situation, please speak to your doctor.

## [4D Ultrasound](https://www.muratalpay.com.tr/en/tedaviler/4-boyutlu-ultrason/)

### Is four-dimensional ultrasound better than two-dimensional?

They are used for different jobs. The real value of three- and four-dimensional ultrasound is that it **shows what two-dimensional cannot**: the view of the womb from above, exactly aligned sections in examining the brain, and reconstruction of the spine. Routine screening, on the other hand, is done with two-dimensional ultrasound.

### Why is three-dimensional requested for the structure of the womb?

Because the difference is large. In diagnosing congenital differences of the womb, the accuracy is **97.1% with three-dimensional**; with two-dimensional it is 51.4% on first assessment and 82.9% in experienced hands. Distinguishing a **septum** inside the womb from a **double womb** is particularly critical — the treatment of the two is entirely different, and the distinction matters in infertility and recurrent pregnancy loss.

### Does ultrasound harm the baby?

Ultrasound **involves no radiation** and is regarded as safe in clinical use; there is no independently confirmed study showing otherwise. Even so the **ALARA principle** is applied: the lowest power sufficient to make the diagnosis is used and the scan is kept as short as possible.

### Is extra care needed with Doppler?

Yes. Doppler studies emit **considerably more energy** than standard imaging. For this reason the thermal index is kept below a certain limit in pregnancy and the time is limited to **generally not more than 5–10 minutes**. **In the first 11 weeks of pregnancy** Doppler should not be used unless there is a medical necessity.

### Can I have an ultrasound just to see my baby's face?

That is not what the guidelines recommend. The recommendation of the international ultrasound society is clear: **ultrasound should not be performed on its own solely to please the parents or to obtain a commercial keepsake image.** The reasoning is that any scan without a medical purpose violates the ALARA principle and exposes the baby to unnecessary sound energy. This does not mean that images obtained during a medical examination cannot be shared.

### Can the images be reviewed again later?

Yes, and this is an important advantage of three-dimensional ultrasound. The volume data acquired **can be stored** digitally; the image can be reviewed from different angles and the measurements repeated even after you have left. This makes the assessment less dependent on the person performing it.

### Who should perform the examination?

Guidelines look for the following criteria: being **trained in diagnostic ultrasound and in safety**, performing fetal ultrasound regularly, taking part in continuing medical education, having a referral pathway in place for doubtful findings, and carrying out **quality audit** regularly.

## [Your Baby's Development](https://www.muratalpay.com.tr/en/tedaviler/bebegin-gelisimi/)

### When is the heartbeat seen?

Movement of the heart can generally be seen on ultrasound **from weeks 5–6**. The heart rate rises until week 10 (an average of 171 beats a minute), then falls to around 156 by week 14 — **the rate falling after a while is to be expected** and is not a cause for concern.

### When will I feel the baby's movements?

Movements in fact begin **as early as week 12**, but the mother does not feel them straight away. The time they are first felt is generally **weeks 18–20.** In those who have given birth before it can come as early as **week 16**; in a first pregnancy it may extend a little beyond week 20. **Both are normal.**

### Do movements decrease in the last months?

**No — this is a widespread but false belief.** From week 32 the frequency of movements reaches a level and stays there; **it does not decrease.** Because there is less room the **character** of the movements changes (strong kicks instead of large turns), but their frequency does not fall. **If you notice a reduction in movements, do not wait** — tell your health service.

### Does my baby sleep?

Yes. In the third trimester the baby has regular cycles of sleep and wakefulness lasting **20–40 minutes** (up to 90 minutes at most). Short periods without movement may be related to these cycles; but if there is **a marked reduction in your usual pattern of movements**, it should be assessed.

### Is it normal for the bowel to be seen outside at an early stage?

Yes, and it is an important detail: part of the bowel protruding outside the abdomen is **normal up to week 11** and is a stage of development that resolves on its own. The bowel returns to the abdominal cavity **from week 12**. For this reason, at the 11–14 week ultrasound this finding is distinguished from a true opening in the abdominal wall.

### What is "the injection to develop the lungs"?

It is a drug treatment given to the mother when there is a risk of premature birth. Its purpose is to speed up the development of the baby's lungs and to **reduce the risk of breathing difficulty** after birth. The substance that allows the baby to breathe on its own begins to be produced rapidly in the third trimester; this treatment speeds up the process.

### How is the baby's size measured?

In the first trimester the **crown–rump length** is measured — in this period the baby almost **doubles in size** from week 11 to week 14. From week 14, measurements of the head, abdomen and thigh bone are taken and the **estimated weight of the baby** is calculated. In the last period growth is followed at the examination by measuring over the abdomen and, if there is a risk, by ultrasound at intervals of 2–3 weeks.

## [Ectopic Pregnancy](https://www.muratalpay.com.tr/en/tedaviler/dis-gebelik/)

### My pregnancy test is positive but nothing was seen on ultrasound — what does that mean?

This is called a **pregnancy of unknown location**. The guideline's warning is clear: until the location of the pregnancy is established, **it must be accepted that it could be an ectopic pregnancy.** This is why follow-up and reassessment are requested.

### Why do they take blood again after 48 hours?

Because the pregnancy hormone in the blood (hCG) **does not show where the pregnancy is** — it shows how the process is progressing. Two measurements are made as close as possible to **exactly 48 hours apart**. **A rise of more than 63%** favours a pregnancy inside the womb (an ectopic pregnancy is still not ruled out), **a fall of more than 50%** favours the pregnancy not continuing; results in between require assessment **within 24 hours**.

### My test result was fine but I have pain — can I wait?

No. The guideline emphasises this in particular: **your symptoms are more important than your test results.** If your complaints change or worsen, your situation must be reassessed whatever the previous results were. You should be told in writing how to reach emergency help 24 hours a day.

### Is treatment possible without an operation?

Yes, there are two further options. **Expectant management**: if your condition is stable, there is no pain, the pregnancy is smaller than 35 mm with no heartbeat, the hCG is below the threshold and you can attend for follow-up. **Medical treatment**: under similar conditions and if a pregnancy inside the womb has been ruled out. Which is appropriate is decided according to your findings.

### If I choose expectant management, will my tube rupture?

The guideline reports, **stating that it rests on limited evidence**, that no difference appears between expectant and medical management in terms of **the risk of the tube rupturing**. Likewise no difference was found in the rate at which the ectopic pregnancy resolves on its own, the need for further treatment, or scores for mental state. But it should be known that **emergency admission may be needed** if the situation worsens.

### How often will I be checked under expectant management?

hCG is repeated on **days 2, 4 and 7** after the first test. If the value is **falling by 15% or more** at each measurement compared with the previous one, weekly follow-up continues until a negative result is reached. If it is not falling, stays the same or rises, the situation is reassessed and a senior opinion is obtained.

### Can I have children after this?

The guideline states that expectant and medical management are expected to be similar in terms of the time the ectopic pregnancy takes to resolve and **future fertility outcomes**. In addition, if you have any concern in the early stage of a future pregnancy, **you can refer yourself directly to the early pregnancy assessment unit**; you should be told about this.

## [Pregnancy Due Date Calculator](https://www.muratalpay.com.tr/en/tedaviler/gebelik-haftasi-hesaplama/)

### From when are the weeks of pregnancy counted?

In the common method the starting point is not the day of conception but **the first day of the last menstrual period.** For this reason there is in fact no pregnancy yet in the first two weeks of "pregnancy" — that is how the calculation is set up.

### How do I work out the estimated due date by hand?

**Go back 3 months from the date of your last period and add 7 days.** An example: if the last period was on 10 January, three months back is 10 October, and adding seven days gives an estimated due date of **17 October**. This gives the same result as adding 280 days to the date of the last period.

### The calculator and the ultrasound gave different answers — which is right?

**The ultrasound is taken as the basis.** According to the guidelines, the **crown–rump length** measured in the first trimester is the most reliable measurement for determining the week of pregnancy. If there is a difference, the week found by ultrasound is used and all subsequent care is planned according to it.

### Why is it only an estimate?

Because the calculation assumes that the menstrual cycle is **28 days** and that ovulation takes place **on day 14**. In fact the length of the cycle varies from person to person and from month to month, ovulation does not always happen on day 14, and the date of the last period is not always remembered clearly.

### Does the birth happen on the estimated date?

Generally no. **The estimated due date is not a target but the midpoint of a range.** The birth is not expected to take place on exactly that day.

### My periods are irregular — does the calculation still apply?

With an irregular cycle, a calculation based on the date of the last period is **less reliable.** In that case dating by an ultrasound done early becomes particularly important; use the calculator only to get a rough idea.

## [Preconception Counselling](https://www.muratalpay.com.tr/en/tedaviler/gebelik-oncesi-danisma/)

### When and how much folic acid should I take?

The standard recommendation is **400 micrograms a day**; it is **started before pregnancy** and continued through the **first 12 weeks** of pregnancy. In some situations, however, **5 milligrams a day** is needed and should be started **at least 1–3 months before** pregnancy. Your doctor decides which is appropriate for you.

### Who needs high-dose folic acid?

Those with a history of a **defect in the development of the spine or brain** in themselves, their partner, a previous pregnancy or the family; those with **excess weight** (body mass index above 30), previous obesity surgery, **diabetes**, **epilepsy** and the use of medicines for it, sickle cell anaemia or thalassaemia.

### I have had a miscarriage — should I take high-dose folic acid?

In recurrent miscarriage of unexplained cause — where the special situations above (diabetes, epilepsy and so on) do not apply — **high-dose folic acid is not routinely recommended.** This is a common mistake.

### Which vaccines should I have before pregnancy?

The **measles-mumps-rubella** and **chickenpox** vaccines contain live virus and **cannot be given during pregnancy.** If you are not immune you need to complete these before pregnancy and to avoid pregnancy for **at least 1 month** after vaccination. The influenza and COVID-19 vaccines can safely be given before or during pregnancy; the whooping cough vaccine is repeated **in every pregnancy**.

### I was vaccinated without knowing I was pregnant — what should I do?

First, know this: having been given a live vaccine while unknowingly pregnant **is not a reason to end the pregnancy.** Tell your doctor about it; your follow-up plan is then made accordingly.

### Should I stop my epilepsy medicine?

**Definitely do not stop it on your own.** Epilepsy medicines must never be stopped suddenly without consulting a doctor — having a seizure can pose a greater risk than the medicine itself. The right course is for the type and dose of medicine to be reviewed **with a specialist** when a pregnancy is being planned.

### If I need to lose weight, when should I do it?

**Before pregnancy.** Weight lost before pregnancy **directly reduces** the risk of pre-eclampsia, stillbirth and a large baby, and increases the chance of a normal birth after a previous caesarean. Medicines that help with weight loss are also **not recommended during pregnancy** — which is another reason the preparation needs to be done beforehand.

### Is being underweight also a risk?

Yes. A body mass index **below 18.5** increases the risk of miscarriage in the first three months and the likelihood of poor growth in the baby. A balanced weight matters in both directions.

### Does my partner need to do anything too?

Yes, particularly about smoking. Smoking is **the most important modifiable risk factor** for placental insufficiency, premature birth and stillbirth, and it is recommended that **both partners** stop when a pregnancy is being planned — in the father's case to prevent **damage to sperm DNA**. Alcohol should also be stopped completely when a pregnancy is being planned.

## [Pregnancy Care](https://www.muratalpay.com.tr/en/tedaviler/gebelik-takibi/)

### How many check-ups will I have?

In a pregnancy that runs without problems, **about 10 check-ups are expected for those in a first pregnancy** and **7 for those who have given birth before**. It is recommended that the booking visit take place **before week 10** (by week 14 at the latest).

### What is done at every check-up?

**Blood pressure is measured and the urine tested for protein** (screening for pre-eclampsia), the baby's heart sounds are listened to, generally from week 28 the **height of the womb** is measured and plotted on a growth chart, and **the baby's movements are asked about, particularly after week 28.**

### Is measuring the height of the womb reliable in everyone?

No. In those with a **body mass index above 35** or with a large fibroid in the womb, this measurement can be misleading. These women are followed up directly **by ultrasound**.

### Which tests are requested at the first visit?

Blood group and antibody screening, a full blood count, screening for **HIV, hepatitis B and syphilis**, a urine culture, measurement of exposure to smoking and assessment of mental health. Guidelines **do not recommend routine screening in the general pregnant population** for chlamydia, bacterial vaginosis, genital herpes and hepatitis C — these are requested according to the level of risk.

### Is the glucose tolerance test done for everyone?

In the guidelines the test is carried out **in those with risk factors** between weeks 24 and 28: excess weight, diabetes in the family, gestational diabetes in a previous pregnancy and so on. National programmes differ; ask your doctor about your own situation.

### I am Rh negative — what should be watched at week 28?

Antibody screening is repeated in this week, and there is a **critical order**: the blood sample must be taken **immediately before the anti-D injection is given**. Getting the order wrong makes the result difficult to interpret.

### In which situations is an ultrasound requested in the last months?

In the last three months growth is followed at the examination by **measuring the height of the womb**; ultrasound is used to complete the assessment. The situations in which it is particularly requested: **a plateau or deviation from the chart** in the measurement, **a reduction in the baby's movements**, a newly developed condition in the mother (high blood pressure, bleeding), and situations in which the measurement is not reliable.

### Why does the threshold for anaemia change?

Because the volume of blood increases in pregnancy, so the values naturally fall. In the **first three months** a haemoglobin below 11 g/dL is regarded as anaemia, while **around week 28** the figure is below 10.5 g/dL. For this reason the same value is interpreted differently at different weeks.

## [Screening Tests in Pregnancy](https://www.muratalpay.com.tr/en/tedaviler/gebelikte-tarama-testleri/)

### Is the 11–14 week ultrasound just the nuchal measurement?

No, that is a common misunderstanding. The nuchal translucency is only one of the values measured. This examination also looks at the **head and brain, face, heart, abdominal organs, arms and legs and the placenta**; it confirms that the pregnancy is viable and how many babies there are, establishes the gestational age and assesses the risk of pre-eclampsia.

### Why is my gestational age determined by ultrasound?

Because the **crown–rump length** measured at this stage is **the most reliable measurement** for determining gestational age. The accuracy of all subsequent care and tests rests on this dating.

### They said the nasal bone was not seen — what does that mean?

This is **an indicator of risk, not a diagnosis.** In about **50–60%** of babies with Down syndrome the nasal bone is not seen — so its not being seen does not by itself mean a conclusion, and its being seen does not remove the risk altogether. The result is assessed together with the other findings and tests.

### Why is Doppler done?

For two separate purposes: **in the baby**, the flow in certain vessels going to the heart and at a heart valve is examined to assess markers of risk for chromosomal differences and heart defects. **In the mother**, the flow in the uterine arteries is measured and, together with blood pressure and blood tests, a **risk calculation for pre-eclampsia** is made.

### What is examined in the 18–22 week ultrasound?

**All the baby's organ systems** are examined in detail: head and brain, face, heart, lungs, abdominal organs, kidneys and bladder, spine, arms and legs. Growth measurements are also taken, the amount of **amniotic fluid** is assessed and **the relation of the placenta to the cervix** is established.

### Were my baby's fingers counted?

**Counting fingers is not a required part of routine screening.** The symmetry, length, position and movement of the bones in the arms and legs are assessed. This is a point worth knowing so that expectations are set correctly.

### They said my placenta is low — should I be worried?

If the placenta is closer than a certain distance to the cervix, **a repeat look** in the third trimester is recommended. This does not mean there is a problem at the time — the placenta can **move upwards** as the pregnancy progresses. If you have had surgery on the womb, additional findings are also looked for with regard to a problem of attachment.

### They said there is dilatation in the baby's kidney?

Dilatation of the renal pelvis is one of the findings looked at in the detailed ultrasound. If it is above a certain measurement, **follow-up is needed** — in most cases it is managed by monitoring. Your doctor decides how often checks are needed according to the degree of the finding.

## [Abortion (Termination of Pregnancy)](https://www.muratalpay.com.tr/en/tedaviler/kurtaj/)

### Up to how many weeks can an abortion be carried out in Türkiye?

Under Law no. 2827 on Population Planning it can be carried out on request **until the 10th week of pregnancy is complete**, provided there is no medical objection in terms of the mother's health. **After 10 weeks it cannot be carried out on request**; after that point it is considered only where the pregnancy threatens the mother's life or where severe disability for the child to be born is involved, with reasoned reports from two specialists. The week is established precisely **by ultrasound**.

### How is an abortion done, and how long does it take?

In the early weeks the surgical method is **vacuum aspiration (emptying by suction)**: the pregnancy is removed through the neck of the womb with a thin tube, without any incision. The emptying stage usually takes **5–10 minutes**, and after a short rest you usually go home the same day. Beforehand, a medicine that softens the neck of the womb and a preventive antibiotic are recommended.

### Is general anaesthesia given for an abortion?

General anaesthesia is one of the options, but not the only one. The NICE guideline lists four options: **local anaesthesia only**, **conscious sedation (light sleep) with local anaesthesia**, **deep sedation** and **general anaesthesia**. Which one suits you is discussed at the examination. After general anaesthesia or sedation you should not drive that day.

### How long does bleeding last after an abortion?

Bleeding can last **a few weeks**; in the first days there may also be cramps similar to period pain. Using pads is recommended so that the amount can be monitored. If there is **heavy bleeding**, pain or bleeding that does not ease within a few days, fever or foul-smelling discharge, seek help without delay.

### When can you get pregnant after an abortion?

It is **possible** to get pregnant again straight after the procedure. For this reason it is recommended that contraception is started straight away to prevent an unwanted pregnancy; contraceptive methods can be started on the same day as the procedure, and a coil can be inserted in the same session as the surgical procedure.

### Does abortion cause infertility?

According to the NICE guideline, abortion is **not associated with an increased risk of infertility, breast cancer or mental health problems**; after a procedure without complications, the chance of becoming pregnant returns to its previous level. The main thing that can cause problems later is untreated infection, which is why symptoms such as fever and unusual discharge should be taken seriously.

### What does the overall expense of an abortion depend on?

Under the regulations, no figures are given on this page. The main factors that determine the expense are the week of pregnancy, the type of anaesthesia (local, sedation or general anaesthesia), the tests needed before the procedure and the follow-up examination. Information about your own situation becomes clear after an examination.

### If I am married, is my spouse's consent required?

Where the person whose consent is sought is married, the law also requires **the spouse's consent**. However, this condition applies to **elective termination within 10 weeks**; a termination carried out after 10 weeks for medical necessity does not fall within the scope of that provision. In addition, in life-threatening emergencies the permission requirement does not apply.

### What is the rule for those under 18?

This is a commonly misunderstood point: for minors, **both the minor's own consent and the guardian's permission** are required — the guardian's permission alone is not enough. For people under guardianship who are not adults or not of sound judgement, the consent of the person and of the guardian is required together with **the permission of the magistrate**.

### Is curettage needed straight away after a pregnancy loss?

No. **The approach guidelines recommend first is to wait 7–14 days**, and **most women need no other treatment.** Surgery is only one of three options; you decide, on an informed basis, which is used.

### Might waiting not be right for me?

Yes, in some situations the other options should be considered: **a high risk of bleeding** (for example being towards the end of the first trimester), a previous **negative or traumatic experience** relating to pregnancy (stillbirth, miscarriage, bleeding before birth), **a clotting disorder** or not being able to receive a blood transfusion, and signs of **infection**.

### I do not want to wait — what happens then?

If waiting does not feel right for you, **medical treatment is recommended.** An approach coming first in a guideline does not mean you have to accept it — all three options should be discussed with you and the choice should be yours.

### What should I expect with medical treatment?

Where the pregnancy has stopped but the miscarriage has not started, two medicines are used; the second is given **48 hours after** the first. In an incomplete miscarriage a single medicine is given as a single dose. You are given painkillers and anti-sickness medicine; the duration and heaviness of the bleeding and possible side effects such as pain, diarrhoea and vomiting should be explained beforehand. **If bleeding does not start within 48 hours of the second medicine**, tell your health service.

### Why are the names and doses of the medicines not given?

They are **prescription medicines used under a doctor's supervision** and are not appropriate for self-administration; for this reason no dose information is given on this page. The guideline also notes that some of these uses are **outside the licence**. The appropriate medicine and dose are decided by your doctor according to your situation.

### If surgery is needed, will I have to have a general anaesthetic?

No, options should be offered. The guideline requires that a choice be offered between two options: **manual vacuum aspiration (drawing out by suction) under local anaesthesia, in outpatient or clinic conditions**, or a surgical procedure **under general anaesthesia in an operating theatre**.

### When is a check needed after the procedure?

After both waiting and medical treatment, **a urine pregnancy test is done at home 3 weeks later**. If the test is positive you need to be seen, to rule out pregnancy tissue remaining in the womb, a molar pregnancy or an ectopic pregnancy. If the test is negative but heavy bleeding continues, or there are symptoms such as pelvic pain or fever, assessment is again needed.

### My pregnancy is continuing but I am bleeding — am I miscarrying?

Bleeding in a pregnancy inside the womb in which a heartbeat is seen does not always mean a miscarriage. If you have not had a miscarriage before: if the bleeding increases or **lasts more than 14 days**, reassessment is needed; if it stops, routine antenatal care continues. If you have had a miscarriage before, **micronised progesterone** by the vaginal route is recommended and, if a heartbeat is confirmed, continued **until week 16 of pregnancy is completed**.

## [NIPT (Cell-Free DNA Test)](https://www.muratalpay.com.tr/en/tedaviler/nipt/)

### In which week of pregnancy is NIPT done?

Once enough of the baby's DNA has built up in the mother's blood, it can be done **from the start of week 10** of pregnancy. In blood taken earlier, the proportion of the baby's DNA may be too low and no result may be obtained.

### Can NIPT harm the baby? Is there a risk of miscarriage?

No. The test is done using only **a single tube of blood** taken from the mother's arm; the baby and the pregnancy sac are not touched. For this reason NIPT does not carry a risk of miscarriage.

### If my NIPT result is normal, does that mean nothing is wrong with my baby?

No, it does not mean that. NIPT screens only for certain chromosome differences and is a screening test. It does not show the baby's organs or structural development; this is why the week 11–14 and detailed ultrasound examinations are needed even when NIPT is normal.

### My NIPT is positive — does my baby definitely have Down syndrome?

No. NIPT **is not a diagnostic test**. The chance that a positive result is correct can fall to 40–50%, or even lower, especially in young pregnant women at low risk. The result is not considered final until it is confirmed, depending on the week of pregnancy, by **chorionic villus sampling** (a tissue sample from the placenta) or **amniocentesis** (a sample of the fluid around the baby).

### How reliable is NIPT?

The detection rates reported in the guidelines are over 99% for Down syndrome, about 97–98% for trisomy 18 and about 93–95% for trisomy 13. For sex chromosome differences and microdeletions (a very small piece of a chromosome missing) the reliability is lower.

### What does a "no result" report mean?

When the share of DNA in the mother's blood that belongs to the baby (the **fetal fraction**) is too low, no result may be obtained in about 1–5% of pregnant women. The main causes are the mother's weight being high, the blood being taken before week 10, or the use of blood-thinning medicine. In this case the options of a detailed ultrasound, a repeat blood sample or an invasive diagnostic test are considered.

### Does NIPT replace combined screening and the week 11–14 ultrasound?

It does not replace ultrasound. The week 11–14 ultrasound assesses the nuchal translucency, the baby's structures and the risk of pre-eclampsia; NIPT does not show these. If the nuchal translucency is 3.5 mm or more, or a clear structural difference is seen, the guidelines recommend going directly to an invasive diagnostic test instead of NIPT.

### Can NIPT be done in a twin pregnancy?

Yes. In twin pregnancies the detection rate of NIPT for Down syndrome is around 98–99%, and ISUOG accepts its use for screening for trisomies 21, 18 and 13 in twin pregnancies. If one of the twins was lost early (vanishing twin), this can lead to a false positive result.

### Can NIPT be done in an IVF pregnancy?

Yes, NIPT can be used in IVF pregnancies, including those achieved with donated eggs. In twin pregnancies conceived by IVF and when the mother's weight is high, the chance of no result is somewhat higher.

### Is NIPT recommended for every pregnant woman?

The guidelines differ: ACOG and ACMG recommend that NIPT be offered to all pregnant women as one of the screening options, while RCOG, NICE and many European guidelines offer NIPT mainly as a second-step test to pregnant women found to be at intermediate or high risk in combined screening. Which test is suitable is decided together with your doctor.

## [High-Risk Pregnancy](https://www.muratalpay.com.tr/en/tedaviler/riskli-gebelik/)

### What does being told I have a "higher-risk pregnancy" mean?

It means the pregnancy **will be watched more closely**. An important point: **the level of risk is not fixed** — it can change through the pregnancy and, according to the guidelines, **is reassessed at every examination.** It is not a label attached once and left.

### My baby's movements have reduced — can I wait?

**No, do not wait.** The sources describe a reduction in the baby's movements as **one of the most important warning signs** that the placenta is not working well enough and that the baby is under strain. Tell your health service as soon as you notice it.

### How often will I have an ultrasound?

It depends on the level of risk. **At moderate risk**, a growth ultrasound **every 4 weeks** from week 32; **at high risk**, **every 2–4 weeks from weeks 24–28**. If there is excess weight or a fibroid in the womb, the measurement over the abdomen is not reliable, so follow-up is done directly by ultrasound.

### Why is Doppler done?

To assess the blood flow going to and returning from the baby. Different vessels are looked at for different questions: the uterine arteries for the risk of pre-eclampsia, the umbilical cord artery for how the placenta is working — this is the basic tool for telling whether the baby is **"small but healthy"** or genuinely **under strain**.

### I have been given aspirin — why?

Those at high risk of pre-eclampsia are started on **low-dose aspirin in the evening from week 12**, continued **until week 36**. This is a preventive measure. Your doctor decides the dose and how it is used.

### I have polycystic ovary syndrome — is my pregnancy considered higher risk?

PCOS is among the conditions that increase the risk of **pre-eclampsia, gestational diabetes, miscarriage and growth restriction in the baby** during pregnancy. This does not mean you will have problems — it means you will be watched more closely. When planning a pregnancy, measuring blood pressure and a glucose tolerance test are recommended.

### I am expecting twins — is every twin pregnancy higher risk?

**Twins sharing a single placenta** in particular carry special risks, because the vessels of the placenta are shared. This can lead to problems with blood being shared between the twins. These pregnancies should be followed by a **multi-specialty team** and in centres with advanced neonatal intensive care.

### Where should I give birth?

Some situations require several specialties to work together — particularly **growth restriction starting before week 32** and problems in twins sharing a single placenta. It is recommended that these pregnancies be managed by a team of obstetric, fetal medicine, neonatal and anaesthetic specialists, **in centres with advanced neonatal intensive care**.

## [Diagnostic Curettage](https://www.muratalpay.com.tr/en/tedaviler/tanisal-kuretaj/)

### Why has diagnostic curettage been requested?

The purpose is **examination in pathology** of a tissue sample taken from the lining of the womb. The situation in which it most often comes up is **abnormal bleeding from the womb**; assessment of the inside of the womb may also be needed when investigating reproductive problems.

### What is the difference from hysteroscopy (viewing the inside of the womb with a camera)?

Hysteroscopy is **direct visualisation** of the cavity of the womb with miniaturised endoscopic instruments. What matters about it is that the inside of the womb is assessed by seeing rather than blindly, and that where necessary the sample can be taken **from the right point**. Guidelines state that this assessment can be done as an outpatient, without an operating theatre or general anaesthesia.

### Is an operating theatre and general anaesthesia needed?

In most cases no. In a randomised study comparing it with general anaesthesia, with the outpatient procedure the time to getting up was **0 minutes** (105 minutes under general anaesthesia) and time away from work **0.8 days** (3.3 days under general anaesthesia); people's ratings of their experience were high and equivalent with both methods. Even so, **alternative anaesthetic options should be explained to you** and you can choose them.

### Will it be painful?

The guideline addresses this openly: the procedure is well tolerated by most people, but it can be associated with **significant pain, anxiety and a feeling of embarrassment**. Taking a **painkiller by mouth an hour before** the appointment is recommended. With the vaginoscopic approach (carried out without an examination instrument) routine local anaesthesia is not recommended; conscious sedation should also not be used routinely.

### Is it likely to be more painful for me?

It is difficult to predict in advance, but you **should be told beforehand** that the procedure may be more difficult in these situations: having experienced faintness because of pain during periods; having experienced severe pain or anxiety during previous vaginal examinations (including a smear); **traumatic experiences**, particularly a history of sexual violence. Sharing these allows the procedure to be planned around you.

### Can I change my mind during the procedure?

Yes. **You can ask for the procedure to be stopped.** If you are anxious, the appointment can be rearranged according to the anaesthetic method you prefer. If you want someone close to you to be with you, this should also be accommodated unless infection control prevents it.

### Can treatment also be carried out in the same session?

Some procedures can be done as an outpatient: removing a polyp inside the womb, removing fibroids close to the lining of the womb, ablation of the lining of the womb, removing pregnancy tissue remaining in the womb and removing a lost intrauterine device. If treatment can also be carried out in the same session, this **should be stated clearly in the information given**.

### What should I be given before the procedure?

**Written information should be given before** the appointment: what the procedure is, its benefits and **its risks including pain**, advice on painkillers, the care options and contact details you can use. You should also be told that other settings and anaesthetic options exist.

[← All subjects](https://www.muratalpay.com.tr/en/sikca-sorulan-sorular/)

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Original page: https://www.muratalpay.com.tr/en/sikca-sorulan-sorular/gebelik-ve-dogum/  
Last updated: 2026-10-07

Op. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology  
Op. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya  
0505 351 77 88 · Monday – Saturday 09:00 – 18:00 · Closed on Sunday

*This information is for general guidance only and does not replace examination, diagnosis or treatment.*