Preconception check

Teresa, 26, was overjoyed when the home pregnancy test kit showed a positive result. She then made an appointment to see me 3 weeks later.

Before her appointment, I received an urgent call from the husband informing me that Teresa was having severe tummy aches while they were out for dinner.

I rushed to the A&E department to find Teresa in pain on the examination couch.

“There was a sudden pain in my stomach and I felt sick. I vomited and almost fainted,” she recalled.

She was sweating. Her blood pressure was slightly low, her pulse rapid, and her abdomen was bloated and tender to the touch.

Ultrasound examination showed that she was 10 weeks pregnant with a healthy fetus. There was a 5 cm ovarian cyst in the right ovary and the womb was surrounded by some fluid

Teresa had a ruptured ovarian cyst. She was rushed to the operating theatre for an emergency operation .The cyst was successfully removed by the laparoscopic key-hole surgery. She recovered well and had a normal delivery 7 months later.

This case illustrates the importance of preconception check. It involves assessment of a woman's overall health and identifications of risks factors that may otherwise complicate pregnancy. It is essential in ensuring a healthy pregnancy and a healthy baby. If Teresa had the gynaecological assessment before conception, the ovarian cyst would have been detected, removed and a traumatic, emergency operation avoided.

In Singapore, many women do not visit a doctor for preconception check.

Ideally, preconception care should begin a year before conception.

During the check up, you will be asked:

· Your age and the age of your spouse

· Years of marriage

· Gynaecological history, including menstrual regularity, menstrual pain, vaginal discharge, sexual pain, previous contraceptive methods and history of sexually transmitted diseases.

· Lifestyle: smoking and drinking habits

· Dietary plan

· Exercise regime.

· Bodyweight: underweight or overweight is not conducive for conception

· Medical history including family history of high blood pressure, diabetes and other medical problems

· Past surgical history involving reproductive organs, hernia repair and appendicectomy

· Past pregnancy losses (miscarriages and stillbirths)

· Status of previous vaccinations especially German measles, hepatitis B and chickenpox.

· Genetic disorders that may run in your family.

From these medical evaluations, many risk factors leading to maternal complications and serious birth defects can be identified and appropriate treatment given.

For examples, diabetes can pose serious problems during pregnancy. If managed properly before pregnancy, the risk of birth defects can be greatly reduced; Obesity can lead to gestational diabetes and birth defects. It's better to have weight under control before becoming pregnant.

You will be advised on how to prepare your body optimally for a healthy pregnancy such as taking folic acid and other important nutrients .You should stop smoking and drinking alcohol before you are pregnant. If you have ovarian cysts or fibroids , they should be evaluated and removed prior to conception. Your exercise regime can be carefully planned so that you have a healthy bodyweight. You will be taught on how to detect ovulation so that you can determine the optimal time for conception.

Preconception check is so important with many advantages. You should make it a priority