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PREGNANCY MONITORING
Pregnancy Follow-up Step by Step
Congratulations! It is a privilege for us that you wish to go through your pregnancy journey with Nadezhda Hospital! This short guide will take you through the main steps, from the moment you see a positive pregnancy test to the moment you give birth.
Pregnancy is filled with new sensations, experiences and dreams. We would therefore like to be by your side and help you navigate each trimester, examination and test with peace of mind by explaining everything in detail, step by step.
Booking Appointments for Upcoming Examinations and Tests Before Your Pregnancy Follow-up Has Officially Begun
Booking an appointment with an obstetrician-gynaecologist at Nadezhda Hospital to confirm your pregnancy (not for antenatal care)
The quickest and most convenient way to do this is online, through our appointment booking form, where you can select your preferred obstetrician-gynaecologist, date and time.
You can also contact the hospital’s Call Centre for assistance with booking an appointment with an obstetrician-gynaecologist.
Booking an appointment for your first, early fetal morphology scan, performed in the 12th week of pregnancy or between 11 and 13 weeks of gestation
You should book this appointment in advance, when you are approximately 8 weeks pregnant, as appointments with our prenatal medicine specialists fill up quickly and the waiting time is approximately one month.
Appointments for this examination can only be booked through the Call Centre or in person at the Reception Desk at Nadezhda Hospital or Nadezhda Medical Centre in Paradise Center.
The appointment schedules for our prenatal medicine specialists for each calendar month become available on the 1st or 2nd day of the preceding month.
Booking your first antenatal care appointment, which takes place after the 13th week of pregnancy and after your first fetal morphology scan
When you are approximately 8 weeks pregnant, choose an obstetrician-gynaecologist at Nadezhda Hospital who will monitor your pregnancy until delivery and book your first appointment.
At Nadezhda Hospital, we have 32 doctors who provide pregnancy follow-up care. All of them are highly qualified specialists. You can find the full list of their names on our website, www.nadezhdahospital.com , under “Departments” – “Pregnancy Follow-up ” – “Team”.
Antenatal care appointments can only be booked through the Call Centre or in person at the Reception Desk at Nadezhda Hospital or Nadezhda Medical Centre in Paradise Center.
The appointment schedules for obstetricians-gynaecologists providing antenatal care for each calendar month become available in the middle of the preceding month.
For your convenience, we recommend checking at the Reception Desk immediately after each examination or test whether the appointment schedule for your next visit is available, so that you can book your next appointment.
First Fetal Morphology Scan – Early Fetal Morphology
You should book an appointment for your first fetal morphology scan when you are 8 weeks pregnant.
The early fetal morphology scan is performed in the 12th week of pregnancy (or between 11 and 13 weeks of gestation), before you have registered for pregnancy follow-up, also known as antenatal care.
This is a specialised, non-invasive combined screening examination consisting of two parts: a blood test to measure pregnancy-related hormones and an ultrasound examination of the uterus and fetus. Both are performed on the same day.
The blood test measures hormones produced during pregnancy. The results provide a statistical risk assessment, expressed as a ratio, for fetal congenital abnormalities, including trisomies 21, 13 and 18 (Down syndrome, Edwards syndrome and Patau syndrome, respectively), among others.
The results are available within two weeks. They are not published in your patient portal because they need to be interpreted by a doctor. The prenatal medicine specialist who performed your fetal morphology scan will contact you by telephone to discuss the results only if there is anything concerning.
The ultrasound examination is a completely harmless examination of the uterus and fetus performed using highly specialised ultrasound equipment. The prenatal medicine specialist examines your baby in great detail, from head to toe, assessing each organ individually and taking measurements.
An important part of first-trimester screening is the assessment of NT – nuchal translucency (measurement of the thickness of the fluid-filled space at the back of the fetal neck). A normal nuchal translucency measurement is associated with a low risk of fetal chromosomal abnormalities. This risk can be calculated using a combination of the mother’s age, NT measurement and gestational age.
The examination also includes assessment of the baby’s blood flow, blood flow to the placenta, the cervix, placental position and other parameters.
The examination is performed in 2D ultrasound mode, producing black-and-white images. This is the appropriate mode for the examination because it allows the fetus to be viewed “from the inside”, in cross-sectional images, so that all organs can be assessed.
The 3D and 4D modes (the orange images that every expectant mother is so eager to see) provide only an overall image, which the ultrasound machine creates by combining multiple 2D images to display the surface. In other words, 3D and 4D images do not show the details required for this examination.
By combining all these findings, the specialist assesses fetal anatomy, calculates the probability of chromosomal abnormalities and evaluates whether there are any risks to the mother during pregnancy.
IMPORTANT! Please bring all your medical records relating to previous and existing medical conditions, treatments, surgical procedures and other relevant medical information so that your medical history can be taken accurately.
Please arrive at the examination room 15 minutes before your scheduled appointment to read and sign the informed consent form before the examination.
Registration for Pregnancy Follow-up – Antenatal Care
At Nadezhda Hospital, antenatal care is provided by a single obstetrician-gynaecologist of your choice, who will monitor your pregnancy until delivery.
As mentioned above, by approximately 8 weeks of pregnancy, you should have chosen the obstetrician-gynaecologist at Nadezhda Hospital who will monitor your pregnancy and booked your first appointment with them. This appointment should take place at approximately 13 weeks of pregnancy, after your first fetal morphology scan.
You may choose to purchase a Care Package or pay separately for each examination and prescribed test.
On the day of your appointment, you will need to pay for your pregnancy follow-up package at the Reception Desk. The package also includes your first appointment.
If you do not wish to purchase a package, you will pay for the individual appointment and the tests prescribed by your obstetrician-gynaecologist. This marks the beginning of your pregnancy follow-up at Nadezhda Hospital.
We offer two types of pregnancy follow-up packages : “Care – Basic” and “Care – Extended”.
We call them packages because we have combined the examinations and various tests that we consider necessary for the appropriate monitoring of your pregnancy into a single offering.
By combining these services into a package, we can offer an overall price with a substantial discount, as multiple services are purchased together. If the same services were paid for individually at their regular prices, outside the package, the total cost would be higher.
The “Care – Basic” Package is the more frequently chosen option.
The “Care – Extended” Package includes additional tests and examinations for women with pre-existing medical conditions or high-risk pregnancies.
We recommend discussing with your obstetrician-gynaecologist whether you need to purchase this package. If the need arises after you have already purchased the “Care – Basic” Package, it is possible to upgrade to the extended package by paying the difference.
Each package is divided into two parts. The first covers the necessary examinations and tests from the beginning of your antenatal care until the 24th week of pregnancy. The second covers pregnancy follow-up from the 24th week until delivery. Each part is paid for separately.
When purchasing a package, you will receive a printed copy of its full contents and sign an informed consent form confirming that you accept the general terms and conditions of its use.
Pregnancy Follow-up – What to Expect
Depending on the package you have purchased, you will undergo different examinations or tests each month. Your obstetrician-gynaecologist will determine and discuss with you when these should take place.
Whenever you visit Nadezhda Hospital, you should first go to the Reception Desk so that the relevant request for your examination or test can be activated.
Before leaving the consultation room at the end of your appointment, we recommend clarifying with your obstetrician-gynaecologist which tests you need to undergo next, how and when they will review your results, and when they would like to see you again.
We also recommend booking your next appointment at the Reception Desk immediately afterwards, provided that the relevant specialist’s appointment schedule is available for that period.
Appointments can only be booked by calling the Call Centre or in person at the Reception Desk.
If you need hospitalisation or treatment at home during your pregnancy, you can obtain a medical certificate for sick leave to justify your absence from work.
An initial sick leave certificate for treatment at home, or an extension of sick leave if necessary, is issued only after an examination by an obstetrician-gynaecologist who establishes the need for it.
An administrative fee is charged for each sick leave certificate issued through a Medical Advisory Committee (LKK).
You will need to complete a form providing information about your employer(s), job title and other relevant details, which will subsequently be entered online when your sick leave certificate is issued.
The certificate will be ready on the next working day and can be collected from the Information Desk after 4:00 p.m.
The 45-day maternity leave certificate preceding delivery is issued only upon your request to a midwife at the Antenatal Care Unit.
Please bear in mind that you are entitled to 180 consecutive days of sick leave without having to appear before a Territorial Expert Medical Commission (TELK), prior to the 45-day maternity leave period.
If you need to extend your sick leave beyond 180 days, you must appear before TELK.
Second Fetal Morphology Scan – Detailed Fetal Anatomy Scan
The second fetal morphology scan is performed during the second trimester of pregnancy (14–27 weeks of gestation), usually between 20 and 22 weeks.
During this examination, also known as the detailed fetal anatomy scan, both the fetus and the uterus are assessed.
The specialist examines the cervix, placental position, amount of amniotic fluid, placental and fetal blood flow, and the structure and development of the baby’s visible organs in detail, including the brain, heart, kidneys, lungs, spine and all bones, limbs, face, sensory organs and other structures.
Before the detailed fetal morphology scan, the specialist may, at their discretion, recommend an additional examination between 16 and 18 weeks of gestation.
This examination is not included in the pregnancy follow-up packages and is paid for separately.
IMPORTANT! We would like to remind you once again to book your appointment at least one month before your preferred examination date.
Appointments can only be booked by calling the Call Centre or in person at the Reception Desk.
Third Fetal Morphology Scan – Late Fetal Morphology
The third and final fetal morphology scan of your pregnancy, also known as the late fetal morphology scan, is performed between 28 and 32 weeks of gestation.
This examination assesses the rate of fetal growth, bone lengthening, placental maturity and position, the amount of amniotic fluid, fetal and placental blood flow, and fetal anatomical structures.
This examination is not included in the pregnancy follow-up packages and is paid for separately.
IMPORTANT! We would like to remind you once again to book your appointment at least one month before your preferred examination date.
Appointments can only be booked by calling the Call Centre or in person at the Reception Desk.
Fetal Heart Rate Monitoring
From the 34th week of pregnancy, fetal heart rate monitoring – NST (non-stress test) – usually begins.
This is a non-invasive method that records your baby’s heart rate and detects whether you are having uterine contractions.
The examination is performed weekly, six times until the end of pregnancy, and is included in the pregnancy follow-up packages.
The examination is performed while you are lying down. Two belts will be placed around your abdomen to secure transducers connected to a fetal monitor.
One transducer detects and measures your baby’s heart rate, while the other measures the strength, frequency and duration of uterine contractions.
The examination takes approximately 20 minutes. Once it is completed, you will need to present the recording to the obstetrician-gynaecologist on duty for interpretation.
You can book an appointment online through our website, by calling the Call Centre or immediately after your current fetal heart rate monitoring session.
What to Pack for Your Hospital Stay
Before you start preparing your hospital bag, please read about what we provide.
FOR YOU:
Nightgowns specifically designed for your hospital stay;
A soft dressing gown for wearing outside your room. It is not intended for use as a bathrobe;
A personal care kit (toothbrush, toothpaste, comb, towel and one packet of tea to stimulate lactation);
Hairdryer;
Shampoo and shower gel in dispensers in the shower;
Liquid soap;
Breast pumps – manual breast pumps and one electric pump, which are sterilised in the hospital’s Sterilisation Department at 121°C.
The dining areas on the second and third floors and in the Intensive Care Unit are equipped with:
Water dispenser with a special five-stage filtration system providing hot and cold water – pre-filter + + + +. Latest-generation filters, free from sand and rust, chlorine and other chemicals, viruses and bacteria;
Coffee machine and coffee;
Tea;
Microwave oven;
Steriliser;
Refrigerator.
Meals are served in the dining area on porcelain plates with metal cutlery. However, during a pandemic and under stricter safety measures, meals are served in patients’ rooms in disposable containers with disposable cutlery.
Each day, you can choose your meals for the following day from two different menus or combine dishes from both.
If you require a special diet, you can discuss the options for preparing a separate menu with your doctor and midwife.
FOR YOUR BABY:
Cotton clothing;
Disposable nappies;
Baby wipes;
High-quality hypoallergenic baby skincare products;
Different brands of infant formula, if necessary.
You can choose to have your baby stay with you in your room at all times. In this case, you will be provided with disposable nappies, baby wipes and clothing.
You will need to take your baby back to the Neonatology Department for their daily hygiene care and medical examinations, after which you can bring your baby back to your room.
An information folder is available in your room, containing the daily schedules for the Postnatal Ward and Neonatology Department, information about how the departments operate, details of the documents required to register your baby, and other useful information.
What do we recommend bringing from home?
Although Nadezhda Hospital provides everything necessary for a pleasant and comfortable stay after delivery, there are still some items that you will need or may prefer to bring from home.
Here are our suggestions:
Reusable water bottle;
Flip-flops and/or slippers;
Bath towel;
Sanitary pads – preferably highly absorbent night-time pads (4 packs);
Mobile phone and charger;
Breast pads;
Nipple cream;
Nipple shields, if you have inverted nipples;
Personal toiletries and cosmetics;
Cotton underwear and nursing bra;
Socks;
Contact lenses or glasses (if you wear them);
Protective face masks (in the event of a worsening epidemiological situation);
For discharge: a blanket, baby carrier or swaddling cloth; baby clothes appropriate for the season; an infant car seat; and clothes and shoes for yourself to wear when leaving the hospital.
Documents Required for Admission for Delivery and Registration of Your Newborn
Upon admission for delivery:
Identity card.
Pregnancy record card issued by your antenatal care provider.
Hospitalisation referral No. 7, issued by your antenatal care provider or general practitioner, only if your pregnancy has not been monitored at Nadezhda Hospital. In the event of an emergency admission, the referral is issued by the hospital.
Test results, if your pregnancy has not been monitored at Nadezhda Hospital:
Vaginal microbiology test confirming the absence of infection, performed no more than one month before your expected delivery date;
Virology tests (hepatitis B, hepatitis C, Wassermann test, HIV) – original laboratory report bearing the signature and stamp of the laboratory where the tests were performed. Please note their validity periods: hepatitis B, hepatitis C and HIV test results are valid for 6 months, while the Wassermann test result is valid for 3 months;
Blood group confirmation bearing a signature and stamp;
Original medical documents relating to any pre-existing medical conditions;
Hospital discharge summaries from previous surgical procedures, if applicable;
Results of other tests performed during pregnancy.
An essential part of your hospital bag is the documentation you need to prepare for registering your baby and submitting the birth notification required for the issuance of a Bulgarian Personal Identification Number (EGN) and birth certificate.
A photocopy of the father’s identity card, required for preparing the child’s birth notification.
A document certifying your marital status:
If you are legally married: A copy of your marriage certificate confirming your marriage to the baby’s father.
If you are cohabiting without being legally married: An original notarised declaration of acknowledgement of paternity by the father. This must be prepared and submitted on the day of the child’s birth or the following day and delivered in its original form to the Information Desk at Nadezhda Hospital.
The declaration of acknowledgement of paternity may also be prepared before the child’s birth. In this case, the child’s name should not be included in the declaration.
Notaries have the necessary templates, so the father does not need to prepare the wording of the declaration himself.
If you are divorced: A copy of the court’s divorce decree, including its number and date.
If you do not have a partner who will acknowledge paternity of the newborn: Under Bulgarian legislation, if your father is alive and wishes to declare his consent for your child to bear his names, a notarised declaration from him is required.
If you are widowed: A copy of the death certificate.
Delivery
Vaginal Delivery
If you are in labour and planning a vaginal delivery , please first go to the Reception Desk if you arrive between 8:00 a.m. and 8:00 p.m. Our team will assist you immediately.
If you arrive at the hospital between 8:00 p.m. and 8:00 a.m., please go directly to the On-Call Examination Room on Level −1.
You can enter through the underground car park, located at the rear of the hospital.
The On-Call Examination Room is clearly signposted. Use the telephone on the wall and dial extension 444 to alert the Delivery Suite team so that the obstetrician-gynaecologist on duty can attend to you.
At Nadezhda Hospital, we do not have a separate pre-labour room.
If you are admitted for a vaginal delivery, you will spend the hours leading up to the birth of your baby in the same delivery room on the first floor, in an environment designed to feel as close to home as possible, with the support of a loved one and discreet monitoring by our team.
We have three individual delivery rooms that meet the latest medical standards, combining the facilities required for intensive medical intervention with comfort and a welcoming atmosphere.
Once the post-delivery observation period has ended, you will be assisted in getting up and moving around and then transferred to the Postnatal Ward.
Your hospital stay will be three days and nights.
Caesarean Delivery
Your doctor will determine when you should be admitted to hospital, usually on the day before your operation.
The Reception Desk will direct you to the Admissions Examination Room, where the doctor on duty will examine you and complete your admission documentation.
You will need to bring your identity document, hospitalisation referral No. 7 issued by your general practitioner, and pregnancy record card (for patients covered by the Bulgarian public health insurance system), as well as your test results (see the “Documents” section above).
Once the admission procedure is complete, a member of our staff will accompany you from the Admissions Examination Room to your room in the Gynaecology and High-Risk Pregnancy Department on the third floor.
Before the operation, you will have a consultation with an anaesthesiologist and/or an internal medicine specialist. Blood and urine tests and an ECG (if deemed necessary) will be performed, and a medical assessment will be prepared documenting the indications for delivery by Caesarean section .
You will be instructed on when to stop eating on the evening before your Caesarean section.
When the operation is scheduled for the morning, eating is usually stopped at approximately 6:00 p.m. on the preceding evening, with only light, easily digestible food permitted before that time.
You must not consume any food or water on the morning of the operation.
On the day of the operation, you will be taken to the first floor for preoperative preparation, where Nadezhda Hospital’s operating theatres are also located.
Immediately after the operation, you will be transferred to the Intensive Care Unit (Department of Anaesthesiology and Intensive Care), where intravenous infusions and pain management will continue, and your general condition will be monitored.
During this time, your baby will be in the care of our paediatricians and midwives in the Neonatology Department, where they will receive all the care they need.
A few hours after the operation, if you are feeling well and your baby’s condition allows, your newborn may be brought to you for a brief visit.
You will stay in the Intensive Care Unit for between 6 and 24 hours, depending on the anaesthesiologist’s assessment.
Once you have been assisted in getting up and moving around, you will be transferred to the Postnatal Ward, where the Neonatology team will reunite you with your baby.
Your total hospital stay will be four nights and five days, starting from the day of admission.
In the Postnatal Ward, healthy newborns and healthy mothers stay together continuously, except during the newborns’ morning medical rounds and the times when their hygiene care is provided.
We recommend that your baby stays with you during the night as well, so that you can breastfeed on demand and maintain continuous contact with your baby.
The Father’s Presence During Delivery
We welcome the father’s presence during the birth of your baby, depending on the epidemiological situation in the country. Please follow the “News” section of our website for any possible restrictions.
During a vaginal delivery, the father may accompany you, remain with you in the delivery room and provide support throughout labour and birth.
You must inform us of your wish for the father to be present in advance.
For a planned Caesarean delivery, the father should go to the Reception Desk on the scheduled day of delivery, which is usually the day after your admission.
The Reception Desk staff will call a midwife from the Maternity Department, who will accompany him to the first floor, where the operating theatres and delivery rooms are located.
He will be able to spend time with you immediately before delivery.
He will wait on the same floor while the operation takes place and will then be able to see and hold your baby and see you.
Emergencies During Pregnancy and Visiting the On-Call Examination Room
If you experience signs of a medical emergency before your expected delivery date, such as bleeding, severe pain or leakage of amniotic fluid, you can visit our On-Call Examination Room without a prior appointment.
If you arrive between 8:00 a.m. and 8:00 p.m., please first go to the Reception Desk. Our staff will arrange for you to be examined by the obstetrician-gynaecologist on duty.
If you arrive at the hospital between 8:00 p.m. and 8:00 a.m., please go directly to the On-Call Examination Room on Level −1.
Access is through the underground car park at the rear of the hospital.
The On-Call Examination Room is clearly signposted. Use the telephone on the wall and dial extension 444 to alert the Delivery Suite team so that you can be examined by the obstetrician-gynaecologist on duty.
See also
Maternity Department
Prenatal diagnosis and fetal therapy
Neonatology
Pediatrician
