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Pregnancy

Things You Need to Know about Tests and Screening During Pregnancy

Tests and Screening During Pregnancy

Embarking on the journey of pregnancy can be a wonderful experience. However, it can also be pretty daunting to a first-time mother-to-be who has no idea what to expect now that her annual trips to the gynecologist have become far more frequent visits, filled with tests, monitors and ultrasounds.

The process does not need to be frightening. Instead, with a bit of study and preparation, new moms can be aware of the importance of various tests that will be done, as well as the benefits of those tests and any potential risks that would make them not worth taking.

Each visit to the OB will begin the same way, with the exception of the initial visit. Each visit will require the mom-to-be to provide a urine sample, stand on the scale for a weight check and then sit calmly while the nurse does a blood pressure check and a temperature check.

All of these help document your vitals throughout the pregnancy and allow the doctor to pinpoint if any serious issues are developing, like gestational diabetes or pre-eclampsia.

Catching these conditions early on is very important, which is why monitoring weight gain and blood pressure, respectively, can make the difference in a doctor catching these conditions as soon as possible.

Other than these regular tests, there are various other blood draws and ultrasounds that will be done periodically. These tests are typically administered with very little to no pain, and they go a long way toward ensuring the safe growth and development of the fetus.

First Trimester

There is always an element of suspense and perhaps some anxiety around the first visit to the OB/GYN’s office. In order to confirm your at-home pregnancy test results, the doctor will give you a pregnancy test as well. They will also do an exam and even a PAP smear, if you are due for one and have not had it completed recently.

Most doctors will do an ultrasound or have one scheduled, so they can see how far along you are. Prior to that ultrasound, they will base your due date on the dates of your last period, so be prepared for that question when you head in for the appointment.

Once your pregnancy is confirmed, the next step is a blood draw for some pregnancy-related tests. Those tests include testing for your blood type, Rh factor, anemia, sexually transmitted infections, and cystic fibrosis.

The doctor or a nurse will also ask if you want to be tested for HIV, and if you do, that test will be performed at the same time as those previously listed.

The initial ultrasound is done typically within a week to 10 days after your first appointment if it is not done while you are at the office. This comes down to the personal preference and routines of the OB.

During that ultrasound, measurements are taken to see what stage of development the fetus has reached and whether a heartbeat can be found. That can help determine the accuracy of the initial due date assigned based on the mother-to-be’s last known period.

Here is a fact that is not widely shared: the first ultrasound is typically done vaginally, compared to those ultrasounds you see on tv where there is gel applied to the abdomen and the wand is simply moved over the stomach area.

Those ultrasounds happen later in the pregnancy when the baby is growing bigger and easier to find with the wand. However, that first ultrasound to determine the level of development for the fetus is completed through the vagina, similar to a Pap smear.

This can be slightly uncomfortable, but that discomfort is far overshadowed by the initial view of the life growing inside you.

First Trimester Screen

The next step on your testing journey is called the “First Trimester Screen,” and it is completed sometime between the 11th and 14th weeks of the pregnancy.

This test involves having blood drawn and also having an ultrasound completed. Both are done the same day, and this ultrasound is done after the initial one to determine how far along you are in the pregnancy.

The screening looks for markers for birth defects and chromosomal abnormalities. These include Trisomy 18, Down Syndrome and other issues.

These issues can be determined by testing for high protein levels in the blood, hence the blood test. They can also be determined through a measurement of the fluid levels in the back of the baby’s neck.

A high fluid level in this area can indicate these issues are present. However, the ultrasound is not necessarily required or even offered, by your OB/GYN. It is good to check with your doctor and see what tests they prefer to run.

Second Trimester

The Second Trimester starts off with a significant test. This test is known as the Multiple Marker test, also called the triple or quadruple marker screening. This test is administered to evaluate levels of a certain protein, alpha-fetoprotein, and two pregnancy hormones, estriol and human chorionic gonadotropin (hCG) in the blood.

For the quad marker, the additional substance of inhibin-A is measured as well. These measurements help doctors screen for Down Syndrome and neural tube defects. They are used in conjunction with the woman’s age, weight, race, the number of fetuses being carried and whether the woman is diabetic.

It also can be combined with the results of the first-trimester screen. This test is typically administered between the 15th and 20th weeks of pregnancy, although different doctors prefer different forms of the test – hence the triple or quadruple marker labels.

Tests and Screening During Pregnancy

Ultrasound

The fun test for the pregnancy, if you want to find out the gender, is administered during the second trimester. Sometime around the 18th to 20th weeks of pregnancy, another ultrasound is completed.

This ultrasound measures the chambers of the baby’s heart, as well as the amniotic fluid levels, evaluates the umbilical cord and other elements of the womb and the growing fetus. That is not the fun part though.

The fun part is, this ultrasound can determine the gender of your growing baby, allowing your plans to focus more on blue or pink, should you so choose. This makes numerous elements of the preparation more fun, although being surprised at the birth is definitely worthwhile for those with the patience and the belief that the surprise is part of the fun.

Glucose Test

This test is usually administered between the 24th and 28th weeks of the pregnancy. It requires the mother-to-be to drink a sugary beverage and have her blood drawn one hour after the drink is consumed. It also must be consumed within a specific time frame (a matter of minutes) to ensure the accuracy of the test.

Those who do not get a number within a certain frame are considered at risk for gestational diabetes, and further tests are required to determine the precautions to be taken going forward.

Those who have gestational diabetes have a risk for higher-weight babies at birth, as well as other risks. This test helps the medical professionals catch the issue, so the mom-to-be’s diet can be monitored and altered as necessary. In severe cases, the mother is required to have insulin administered as well.

Third Trimester

As the final trimester begins and moves forward, visits to the OB’s office become more frequent. They continue to do the urine test, weight check and blood pressure check at every visit – as mentioned before. However, the need for blood draws and tests in that manner decrease.

The heartbeat of the fetus is typically checked at every visit, and some doctors like to measure the growth of the fundus – or the top portion of the uterus. This is done using a measuring tape that is stretched from the hips to the top of your stomach as it grows to accommodate the fetus growing within.

Another ultrasound may or may not be done during this trimester, depending on the preference of your doctor or the coverage allowances of your insurance.

If an ultrasound is done, it can be done in both 3D and 4D, providing great shots of your developing baby that warm your heart and heighten your excitement to meet the newest member of the family.

However, if another ultrasound is not performed, the excitement is not in any way lessened as you count down to the finish line of this drawn-out waiting period. 40 weeks is nothing to sniff at, as all women who have carried children to full term – and beyond – can tell you.

No-Stress Test

As your pregnancy is winding down to the moment of birth, some mothers are given regular no-stress tests to make sure the baby is not experiencing any discomfort or distress.

These tests typically involve a visit to the maternity ward of the hospital, where a fetal monitor is strapped to the abdomen and left there until a detailed printout of baby movement has been received by the attached machine. For some moms, this requires the consumption of a snack and some juice, to get the baby moving.

For others, the babies are not fans of the monitor. Once they discover the pressure and sound associated with the monitor, those babies shared their displeasure with the situation. Sometimes it seems like they are trying to dislodge the monitor with eerily accurate kicks.

This is good news, however, since that means the machine registers the required amount of movement and mom and baby get to escape the monitors and head home. Don’t worry, the baby is not harmed or caused distress by this monitoring experience.

Further Testing For At-Risk Pregnancies

For moms-to-be who are older (age 35 and above), have had multiple miscarriages, a child born with a birth defect or previous pregnancies where chromosomal abnormalities were present, or if they have a family history of medical issues like heart problems or other serious concerns like genetic disorders, the pregnancy can be considered high-risk.

If this label is applied to your pregnancy, it simply means more care and attention is taken to attempt to ensure a healthy pregnancy and the delivery of a healthy child. For this reason, additional tests may be administered.

Amniocentesis

This test is administered if the doctor feels that it is necessary to diagnose certain disorders or issues. This test not only has a risk of miscarriage (1 in 300 to 1 in 500), but it can cause uterine infection, which endangers the baby. This is because the test involves extracting amniotic fluid to be tested.

This test is one that the risks need to be weighed against the potential knowledge that can be gained from the testing of the amniotic fluid.

Percutaneous Umbilical Blood Sampling

This test involves extracting the infant’s blood from the umbilical cord in order to do further testing to diagnose chromosomal abnormalities. This test is quick, and it is usually used in conjunction with both an ultrasound and amniocentesis.

This is done to confirm when an abnormality is found via ultrasound. If the amniocentesis is inconclusive, this test may also be administered. This test is usually done after the 18th week of pregnancy.

Certain other screenings can be offered to those prospective parents who have families with complex medical histories. Other screenings for Sickle Cell Disease, spinal muscular atrophy, Tay-Sachs Disease, hepatitis c, toxoplasmosis, Fragile X Syndrome and Canavan Disease, among others, may be offered to those with a family history of these conditions.

Tests and Screening During Pregnancy

Research and Take Confidence in Your Knowledge

Not every test the OB offers is necessary to have done. This is something that not every first-time mom-to-be realizes. However, it is very true. If you have any concern about the test, any potential harm to the fetus or discomfort for yourself, simply do some research and discuss the possibilities with the doctor.

For example, if the glucose test is failed, the one-hour test involving a sugary drink becomes a three-hour test where a drink containing more sugar is consumed and must be kept down while blood is drawn every hour. No food can be consumed during this time or prior to the test after midnight of the previous day.

This can cause significant discomfort for a pregnant woman. If this is an issue, there are other tests that can be administered. Also, the glucose test is not the most accurate indication that a mother-to-be even has gestational diabetes. Therefore, it is not something that will significantly impact your health if you choose to pursue an alternate test path.

Consider this Checklist that can be used to understand the tests that may be offered to you by your OB. These tests are not all mandatory, and indeed may be something that you should consider skipping. Being informed can also cut down on potential misunderstandings that can increase stress. Stress during pregnancy is something to avoid.

Therefore, knowing all of your options and the potential alternatives can go a long way to keeping you and the growing baby healthy during your navigation of a first pregnancy – or one in a line of pregnancies when you may not have realized you had alternatives to the testing your doctor made to sound necessary.

Parenting is a tricky road to navigate, from the point of conception until your death. Because you are a parent beyond your child’s graduation from high school or their introduction to adulthood. Even as your child becomes a parent in his or her own right, you still are there to help and guide and worry – that is the gift of parenting that keeps on giving.

Being prepared by looking into the various testing and understanding the options can be very calming and helpful to you as a prospective parent.

While the medical field has come a long way, that does not mean they know everything. Nor does it mean that everything a particular doctor says or recommends means it must be done in order to have a healthy pregnancy and ensure the health of the baby.

Final Thoughts

You will spend a lot of time visiting your OB’s office, conversing with the doctor and the nurses in the office and discussing options and concerns you may have. Do not hesitate to question the doctor in order to better understand everything that is going on.

They may have done this numerous times, but this is your pregnancy and making sure you understand and are comfortable every step of the way is their job.

Also, remember that every pregnancy is different, so your opinions on your situation and the potential issues in your pregnancy are valid because this pregnancy is a once-in-a-lifetime experience.

Even your future pregnancies, should you choose to carry other children, will be different than this particular journey.

Therefore, be comfortable with the current testing and screenings. If new screenings are offered, ask why they are being offered now, if they are safe and what the doctor thinks based on the way your pregnancy is progressing. Then, weigh the options and your feelings along with the recommendations and find a decision that makes you happy.

Resources:

http://kidshealth.org/parent/system/medical/tests-first-trimester.html#

http://www.parents.com/pregnancy/stages/1st-trimester-tests/prenatal-test-checklist/

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2 Comments

  • As a woman who has had two pregnancies and birth’s, I think this article is particularly helpful. To be informed about your pregnancy, including the procedures and tests, helps you to be able to advocate for yourself effectively during your pregnancy. This article combines information about the medical tests that will be performed and reminds the reader that, as a woman, you can make choices regarding the medical care you receive during your pregnancy.

  • that sounds scary…thankfully I didnt have to do any amniocentesis test or the other one you mentioned. My sister was recommended one and she declined….her son is developmentally a little slow…i wonder what diseases they look for in an amniocentesis test? I’ve always wondered. 18 to 22 weeks must be difficult…you’ve already become attached to your baby, it would be hard to consider termination then…. i hope not too many moms out there has to go through that….

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