Outpatient clinic appointments during pregnancy

The ultrasound screening examination in early pregnancy is performed either vaginally or from the top of the abdominal wall. The bladder should be empty. The examination will provide us with more information on the duration of the pregnancy, the due date, the number of fetuses, and the fetal heart rate. We will also examine the general structure of the fetus. We can also perform a nuchal translucency scan associated with screening for chromosomal aberrations which may be a first indication of a structural abnormality of the fetus.

The structural ultrasound examination will be performed from the top of the abdominal wall. We will determine the structure and growth of the fetus, the volume of amniotic fluid, and the location of the placenta in the uterus. A fetal sex determination is not part of the examination, but we can try to determine the sex of the fetus, if the parents so desire.

At this point, you can already feel the movements of the fetus, which will have become more distinct. The baby may already grab its toes or put a finger in its mouth. If the position of the fetus is favorable, the ultrasound examination may even allow us to admire the baby's side profile.

The screening for chromosomal disorders (Down syndrome and Edwards syndrome) is based on a risk calculation that also takes into account your age. In the combined screening, we will take a blood sample from you during pregnancy weeks 9–11 and use an ultrasound scan to measure the size of your fetus (crown-rump length) and the nuchal translucency during pregnancy weeks 11–13+6.

The maternity clinic (neuvola) will make you a referral for a laboratory test for pregnancy week 10+0, as estimated by your menstrual cycle. The ultrasound examination will be scheduled for 11+5 to 13+0 weeks of pregnancy. With the combined method, we can find up to 80% of chromosomal aberrations.

Any further examinations in the Uusimaa region will be conducted in the Fetomaternal Medical Center (FMC) at Women's Hospital.

NIPT (non-invasive prenatal testing) is a screening method that allows more accurate screening for the most common fetal chromosomal abnormalities than combined screening. NIPT screening can be carried out in place of combined screening or as a more in-depth follow-up test. The City of Helsinki offers NIPT instead of combined screening to pregnant Helsinki residents for whom it is suited. Your maternity clinic will provide additional information about the screening practices in your area.

NIPT screening is carried out on a sample of blood taken from the pregnant woman. The sample is used to determine if the fetus is at risk of having 3 common chromosomal abnormalities. The most common abnormality is trisomy 21, or Down syndrome. Trisomy 13 and trisomy 18 are rarer and usually manifest as severe congenital structural abnormalities. The screening does not test for other chromosomal abnormalities or hereditary conditions, and will not show the sex of the fetus.

The maternity clinic and the HUS Prenatal Screening Units will assess whether NIPT screening is suitable for you. If NIPT screening is suitable for you, a sample of blood can be taken after your first prenatal screening ultrasound.

If the results of your NIPT screening are normal, you will receive your results by letter. If the results of your NIPT screening are abnormal, you will be contacted by the Prenatal Diagnostics unit at the Women’s Hospital for possible further testing. An abnormal result does not necessarily mean that the fetus is sick. We offer the possibility of taking a sample of amniotic fluid to verify the result.

• Hypertension
• Plural pregnancy
• Premature contractions
• Abnormal presentation, such as the fetus being in breech presentation
• Glucose metabolism disorder (gestational diabetes)
• Assessment of the delivery method when the previous childbirth has been a Cesarean section or when there is a suspicion that the fetus is growing to be too big
• Need for special support for social, mental, or substance-related reasons.

​In the maternity outpatient clinic, we provide information on the effect of gestational diabetes on the baby and on the long-term risks for the mother. During the appointment, we provide guidance on the home monitoring of blood glucose and the treatment of gestational diabetes with diet and medication. Our treatment team includes a midwife and a physician.

Treatment and monitoring objectives:

• Normalization of blood glucose levels during pregnancy
• Home monitoring of blood glucose and the success of any drug therapy
• Adopting healthy eating habits and increasing physical activity
• Preventing further complications resulting from gestational diabetes
• Reducing the risk of developing type 2 diabetes.

At the appointments for mothers with substance abuse and drug problems (HAL), we provide information on the effects of alcohol and drugs on the fetus and on the course of the pregnancy, as well as provide motivation for a substance-free life. Our treatment team includes a physician, midwife, and social worker. HAL appointments are offered at the maternity outpatient clinics in Women's Hospital and Jorvi and Hyvinkää hospitals.

Treatment and monitoring objectives:

• Ending or reducing substance use, referral to detoxification
• Diagnosing and treating diseases and nutritional disorders threatening the mother's pregnancy
• Identifying fetal developmental and growth disorders caused by substance abuse
• Assessing the mother's ability to care for the newborn
• Assessing the need for child protection
• Assessing the potential for continuing a pregnancy
• Providing support for growth as a parent.

A midwife's or physician's appointment for fear of childbirth enables you to discuss issues causing anxiety or fear. We provide information and assistance in preparing for childbirth. For an appointment due to fear of childbirth, you need a referral which can be made by a physician or a nurse at the maternity clinic (neuvola) or by a private physician. If necessary, we can consult other occupational groups, such as experts in psychology.

Childbirth causes some nervousness and fear in nearly all people. A small amount of nervousness can even be beneficial, because it raises the adrenaline level and helps to prepare for childbirth. Actual fear of childbirth is when the fear interferes with normal life and overshadows the joy of pregnancy. This level of fear is experienced by 5–6% of women.

Taimi group counseling

In addition to supportive discussion offered by maternity health clinics and outpatient clinics for the fear of childbirth, we organize separate Taimi group counseling for people with fear of childbirth. The group is for first-time mothers and the instructor is a psychologist specialized in the themes of pregnancy and childbirth. This group suits you especially if you are afraid of childbirth, you wish to discuss matters related to pregnancy and childbirth with other pregnant people, and you wish to practice relaxation with the help of a psychologist.

The Taimi group meets five times during the pregnancy and once after the childbirth with the babies present. One of the meetings will take place in a delivery room with a midwife specialized in fear of childbirth. For one meeting, we hope that your spouse or other birthing partner would participate as well.

You can attend the group from gestational week 25 onwards. However, your maternity health clinic (neuvola) can refer you to the group earlier than this. When we receive the referral, our midwife will call you and guide you to the right group. Ask your maternity health clinic for the necessary referral.

The group meetings are held in Finnish. 

Small-group coaching

We offer small-group coaching for patients who are about to give birth for the first time and have a mild to moderate fear of childbirth. The coaching is held in the maternity hospital. The coach is a midwife specialized in the treatment of fear of childbirth. The coaching lasts for two hours. The groups are held in Finnish and English.

The goals of the coaching include increasing the participants’ sense of safety and control, providing tools to help them feel more comfortable during pregnancy and labor, and reducing their fear of childbirth. Your maternity health clinic’s public health nurse can make a referral for the coaching.

Sometimes when pregnant, you may need inpatient monitoring at hospital. The problem may be, for example, high blood pressure, threat of premature delivery, or abnormal bleeding. Inpatient care may also be required due to the wellbeing of the fetus.

We will plan your treatment individually in cooperation with the obstetricians and midwives. Family and other loved ones are welcome to visit you on the ward, but staying overnight on the ward is not possible.

​A pregnancy is post-term when it has lasted more than 42 weeks. Follow-up visits in late pregnancy are started when the duration of the pregnancy is 41 weeks and 5 days (41+5). You can book an appointment for a post-term checkup by calling either the induction unit or the maternity outpatient clinic at the maternity hospital.

In general, you can wait quite patiently for labor to start naturally. The purpose of post-term appointments is to monitor that late pregnancy is progressing safely and to detect any risks associated with an overdue pregnancy, such as insufficiency of the placenta.

During a late-pregnancy appointment, we will check the heart rate of the fetus by conducting a cardiotocogram (CTG) and an ultrasound examination. We will measure your blood pressure and proteinuria, and discuss how you are feeling. In some cases, we may start ripening the cervical canal, either mechanically or medicinally during the late-pregnancy monitoring appointments. In the case of mechanical ripening, you may usually still return home, but after medicinal ripening, you must stay in hospital care. Due to a post-term pregnancy, the induction of labor will be initiated at the latest after 42+1 weeks of pregnancy.