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Pre-Natal Check-Up


"Is this test necessary" That's a common question among mums-to-be a every pre-natal check-up. A. Alias clues you in on some of the most common tests you can expect to undergo at some point during your pregnancy. Most mums-to-be are very anxious about their unborn child's development and are bound to ask their gynaecologist the same question at every check-up, "Is my baby healthy?" Well that's where all the pre-natal tests come in.

The various tests done during pregnancy serve to monitor the health and well-being of both the mother and the baby, as well as to detect any problems that may arise. Many but not all conditions that can affect the health of your baby can be detected during pregnancy; often early enough to determine the special care your baby will need both before and after birth. There is a large variety of tests which can be done, some are routine, while others are optional, or done only when the mother or baby is at risk, or when problems are detected.

First Check-Up

Once you confirm your pregnancy, you should schedule an appointment with your gynaecologist. The first appointment usually takes place at around 10 - 13 weeks of pregnancy. During this visit, the mother's health, previous pregnancies, any medical problems and social circumstances are discussed.

An estimated date is given for when the baby is due based on your last menstrual cycle, and a brief ultrasound scan is performed to confirm that the size of the baby fits with the estimated date and also to check for multiple pregnancies. Although there may be some variations between different healthcare providers, the following are the typical tests done at the first appointment: 

Blood Count

White and red blood cells and platelets are measured to see if you're anaemic. The test also determines if your blood clots properly when you bleed and screens you for thalassemia (an inherited blood disorder.

Blood Group And Rhesus (Rh) Type

Women are either Rh positive or negative. Problems can occur if the blood type of the mother and baby are not compatible, or if the mother has antibodies in the blood that may react with the blood cells of the baby. If you're an Rh-negative and carry an Rh-positive baby, there's a danger of damage to the foetus if your Rh antibodies cross the placenta. To prevent this, doctors inject you with an Rh immune globulin at 28 weeks: Rh negative women are also usually offered an injection after delivery to protect their next baby from the risk of anaemia.

Screening For Infections

Hepatitis B infection affects the liver, and can commonly be passed to the baby. When this infection is detected, the mother needs to be closely monitored, and treatment is given to the baby at birth to minimise transmission. Syphilis is one of the common sexually transmitted diseases that may affect the growth and development of the foetus.

When an active infection is identified, antibiotic treatment can be given to reduce the risks to the baby. HIV testing is done as an HIV positive mother is at risk of passing HIV to the baby. Treatment can be given, and steps taken to decrease the likelihood of the baby acquiring AIDS.

Immunity To Rubella

Your doctor will check to see if you're still immune to rubella. If resistance has waned and you contract rubella during the first trimester, your baby is at risk for mental retardation and heart problems. Women who are found not to be immune are given advice on how to reduce the risk of catching it and what to do if they catch it.

Routine Tests

If you have a normal pregnancy, you will be scheduled for a monthly pre-natal check-up until close to your due date. During these monthly check-ups, your blood pressure is monitored and urine is tested for infection and the presence of protein and sugar. Large amounts of sugar may indicate the presence of diabetes, and large amounts of protein may indicate a urine infection or kidney problem.

Protein in the urine and raised blood pressure are also signs of pre-eclampsia a condition that can be harmful to both mother and baby and may mean that the baby needs to be delivered early. The baby's development is also monitored at every visit through ultrasound scanning.

The baby's heart beat is not routinely checked, but you may ask to listen to it for reassurance. As your pregnancy progresses, your healthcare provider will ask about the baby's movements and try to determine the position of the baby by feeling your abdomen.

Ultrasound Scanning

An ultrasound is generally performed on all pregnant women and is not hazardous to both the mother and baby. In early pregnancy, ultrasound is used to check the size of the foetus, detect for multiple pregnancies or diagnose early complications such as miscarriage. At 18 - 20 weeks of pregnancy, most pregnant women would have to undergo a more detailed ultrasound scan.

During this scan, your doctor would ensure the right amount of fluid surrounds the baby, examines the baby's head, heart, spine, limbs and internal organs in detail and checks the position of the placenta. This scan can also identify some physical abnormalities, such as cleft lip or skeletal abnormalities, and can confirm spina bifida if blood tests have shown the baby is at high risk. The genitals are usually visible at this time and your baby's gender can also be detected if you choose to know.

Blood Tests

Blood tests are offered from 11- 20 weeks. The levels of a number of chemicals can be measured in the mother's blood to help estimate the risk of the baby suffering from certain conditions, such as spina bifida or Down's Syndrome. Blood is tested again at 28 weeks for anaemia. Different tests measure different hormones or proteins, or combinations of these, including alphafetoprotein (AFP), human chorionic gonadotrophin (HCG), oestriol and inhibin A.

Optional Tests

Throughout the course of your pregnancy, your healthcare provider may advise you to take some optional tests depending on your condition. Some of these tests include:

Down's Syndrome Screening Test

This involves an ultrasound scan of the baby's neck skin thickness, and/ or a blood test done between 11 to 14 weeks to determine the risk of the baby having Down's Syndrome. If the risk is high, the mother will be advised to have an amniocentesis.

Maternal Serum Screening

Also called triple screen, this is a blood test done after 15 weeks. It detects levels of certain proteins in the mother's blood, indicating whether the baby is at risk of Down's Syndrome and spine defects. If screening suggests an elevated risk, follow-up testing, such as amniocentesis, can provide answers.

Amniocentesis

Amniocentesis is usually only offered to women when screening tests show they may be at a higher risk of having a baby with a genetic disorder, or to women 35 years of age or older. This is an accurate way of finding out whether the baby has a number of genetic or inherited disorders, such as Down's Syndrome or cystic fibrosis and is usually conducted between 15 and 19 weeks of pregnancy.

The procedure involves taking a small amount of fluid from the baby's water bag to test for gene or chromosome abnormalities. Full results can take up to four weeks. However amniocentesis carries a 0.5 -1% risk of harming the baby or causing a miscarriage thus the test is only done when the baby is determined to be at high risk of having a genetic abnormality.

Glucose Tolerance Test

About 3 to 5% of pregnant women are diagnosed with gestational diabetes, a condition characterised by high blood sugar levels. If you are found to be at risk of developing gestational diabetes during your pregnancy, your healthcare provider would advise you to take the glucose screening around 28 weeks; or earlier, where necessary.

This test involves fasting overnight before the mother is given a sweet glucose drink. An hour later a blood sample is drawn from her arm and the sample is sent to a lab for testing to see if the body is able to respond well to sugar.

Group B Streptococcus

Group B streptococcus is a bacterium that is occasionally found in the vagina. If the infection has not been treated, it may be passed to the baby at the time of delivery, causing pneumonia and other infections in the newborn. During your third trimester, a sample of your vaginal discharge is taken, and sent to the laboratory to see if there is any infection present. If the results are positive, antibiotics are administered during labor.

After all the poking and prodding, mothers often would have to wait for the results in bated breath. Rest assured that the vast majority of tests come back just fine, indicating a glowingly healthy baby. If there are any problems, knowing about them in advance can help parents and doctors plan for the baby's future and assess any special requirements for the birth and aftercare.

 

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