Pregnancy week by week

Baby

Toddler

Antenatal care


                             

                                            Prenatal visits


At your first antenatal visit, your obstetrician will do a detailed risk assessment including genetic, medical, obstetrical history, and psychosocial factors. Your doctor will do a general physical examination, estimate your due date (EDD) and advice some blood tests. She will also advise you regarding diet, exercise, folic acid supplements and necessary precautions that need to be taken during pregnancy.

The timing of subsequent prenatal examinations is usually scheduled at intervals of 4 weeks until 28 weeks, and then every 2 weeks until 36 weeks and weekly thereafter. Women with complicated pregnancies often require return visits at 1-2 week intervals.

What to expect at each visit
  1. Doctor will listen to baby’s heart rate and baby’s  activity/movements .

  2. Maternal blood pressure, weight, urine protein and glucose

  3. Look for danger signs/symptoms such as headache, altered vision, abdominal pain, nausea and vomiting, bleeding, contractions, fluid from vagina, and dysuria.
  4. Uterine size by taking the fundal height( 24 weeks onwards)

  5. Confirmation of the presenting part and station of the presenting part (36 weeks onwards)
  6. Consistency, effacement, and dilatation of the cervix by vaginal examination (36 weeks onwards)

  7. Vaginal examination late in pregnancy provides valuable information about : confirmation of the presenting part, station of the presenting part, clinical estimation of pelvic capacity.

Recommended blood tests during your pregnancy
  • Haemoglobin level: done at first visit and then repeated at 28-30 weeks.

  • Syphilis screen

  • Hepatitis B: this is a viral infection that affects your liver and is transmitted to the baby. If you test positive, your baby will be treated with a course of immunisations starting at birth.

  • Rubella statues (German measles): if you are not immune, you are advised to avoid contact with anyone who may have rubella; you will be offered an immunisation injection after your baby is born.

  • Blood sugar: screen for gestational diabetes if indicated (24-28 week).

  • Screening tests: according to your medical and family history, you may also be offered other screening tests, e.g. cystic fibrosis, sickle cell disorder, thalassemia
     
  • HIV: you will be offered a confidential HIV test that you may decline if you wish. If your HIV status is known to be positive, there are treatments to reduce the risk of passing this on to your baby. You will be cared for by a specialist team and offered counselling before and after the test.
     
  • Blood group and rhesus factor

    Rhesus status: your rhesus statues matters when you are pregnant because if you are rhesus- negative and the baby’s father is rhesus-positive, your baby could be rhesus-positive. During pregnancy, a few of your baby’s RBCs will pass into your circulation. Your immune system recognises these cells as different from yours and forms antibodies against them. When these pass back into your baby’s circulation, they can destroy his red blood cells.

    If you are rhesus-negative, you will be told, and you will need extra care. You may be offered an injection of rhesus immunoglobulin (anti- D) at the 28th and 34th weeks of your pregnancy. This will coat any of the baby’s cells that may be in your bloodstream and destroy these invaders before your immune system responds to them. You will also have some extra blood tests to see if you have developed any rhesus antibodies (28 weeks). If you have any trauma, such as an accident, amniocentesis or CVS, you will need an injection of anti- D immunoglobulin.

Urine tests:

You will be asked for a sample of urine at each hospital visit. It is tested for:

  • Protein- if there is protein, it may just be from the vaginal discharge which got mixed into your urine when you passed water; this happens a lot in pregnancy. However, protein can also be a sign that you have a urinary infection such as cystitis or a kidney problem, which you have been unaware of.
     
  • In later pregnancy, if there is protein in your urine and you also have high blood pressure, this could be a first sign of pre-eclampsia, a condition which will need closer monitoring of you and your baby. You will be asked to provide another urine sample, this time from the middle of a wee ( a mid- stream specimen of urine, MSU or MSSU). If there is still protein in this urine then the sample will be sent to a laboratory for further tests.

  • Sugar- you may also be checked for sugar in the urine. If there is significant amount of sugar, you may be developing pregnancy diabetes and will be asked to have a glucose tolerance test to check.                    

                                   Screening tests during pregnancy

It is natural that you would wish to know whether your baby is okay. There are some tests which may help to put your mind at rest. Ultrasound scans and blood tests are the most common tests in pregnancy. There are some other antenatal tests that are available. Most of them are not mandatory and are offered only in special circumstances. If you want one of these tests you will have to consult your doctor. There are two types of tests: a screening test that tells you whether there might be a problem and a diagnostic test that tells you for sure if there is a problem. These tests are recommended in special circumstances.

You may consider taking an early test if:

  • You are over 35 years, as the chance of abnormalities in the baby increases as age increases
     
  • You have a family history of genetic problems

  • If you had an earlier pregnancy which resulted in some abnormality or birth defects

1)  Nuchal translucency screening:

It is a screening test which is combined with a blood test, for Down’s syndrome carried out at 11-14 weeks of pregnancy. A detailed ultrasound measures the thickness of the skin at the back of the baby’s neck. When this measurement is combined with other factors like your age and weeks of pregnancy, an estimate of the risk of your baby having Down’s syndrome can be made. It is not a confirmative test; it can only say whether the risk seems to be high or low. If you are estimated to be at high risk, you can choose to have CVS ( chorionic villus sampling) to find out for sure.

2) CVS (Chorionic villus sampling)

It is a diagnostic test for Down’s syndrome best carried out at around 11 weeks. It involves taking a tiny piece of the chorion (part of the placenta) to check the chromosomes of the baby. It takes 7-10 days to get the result. As it examines the baby’s chromosomes, it is confirmatory. There is a small risk of miscarriage (0.5-2%).

2) Maternal serum AFP( alpha-fetoprotein) screening

Determination of maternal serum alpha-fetoprotein concentration at 16 to 18 weeks is recommended to screen for open neural tube defects and some chromosomal anomalies.

3) Double/Triple/Triple Plus test

Blood tests that screen for Down’s syndrome. If you haven’t had a nuchal translucency scan, then a screening blood test is carried out between 15 and 20 weeks of pregnancy. Most hospitals test for two or three markers; this is why the tests are called the Double or Triple Test. Some hospitals will test for four markers. The more markers, the more accurate the test:

  • Double test: tests for AFP and hCG
     
  • Triple test: tests for AFP, hCG, unconjugated oestriols

  • Triple plus: tests for AFP, hCG, oestriols and other markers.

 4) Amniocentesis

Amniocentesis is a test usually carried out from 16 weeks of pregnancy. You may be offered a test if:

  • Results from earlier screening tests show a high risk of your baby having a problem
     
  • If you have a family history of genetic problems

Amniocentesis is a diagnostic test done mainly for Down’s syndrome but can also detect other rare chromosome conditions. It involves taking a sample of the amniotic fluid that surrounds your baby. If you have the test, a needle will be inserted through the wall of your abdomen. The needle is guided by direct ultrasound control, to make sure it does not harm the baby. A small amount of amniotic fluid is taken using a syringe. After the test, a doctor will check your baby’s heartbeat, using the ultrasound machine, to make sure all is well. You should rest for 24 hours.

The amniotic fluid contain cells that come from the baby, these cells can be cultured for some of your baby’s chromosomes, so the test can tell you for certain whether your baby has a chromosome problem, such as Down’s syndrome. The results for Down’s syndrome can come through in a couple of days, but results for other genetic abnormalities will take about 17 days. There is a small risk that the procedure could cause miscarriage.

If your baby has Down’s syndrome, you can choose to have a termination, or to continue with the pregnancy and prepare for the arrival of this special baby.

 

5) Anamoly scan for birth defects

This is the main scan done at around 19 weeks to acertain whether the foetus has any anamolies.


What to do when you get the results?

Remember- these tests cannot tell you if your baby definitely does or doesn’t have a problem. They simply tell you whether there is a high or low chance of a problem. About 1 in 20 mothers having these tests is given a result that the baby is “at higher risk”. Most of them will go on to have healthy babies free from problems. But a “low risk” result means the chances of problems are very small. If you are given a “high risk” result: you could do nothing or go on to have further tests.

An explaination on abbreviations on your maternity notes:

Alb: Albumin, a protein in your urine could mark a potential problem, or an infection like cystitis

BP: Blood Pressure- you will see two figures in this reading; the top one is the systolic measurement (when your heart pushes the blood through the body) and the lower one is the diastolic pressure ( in the pause between the heart beats); a sudden rise in blood pressure could indicate a problem.

EDD: Expected Date of Delivery- worked out using the first day of your last period or the ultrasound dating scan.

Eng: Engagement: when your baby’s head moves down into your pelvis later in pregnancy

FH: Foetal Heart: FHH means the foetal heart was heard!

FMF: Foetal Movement Felt: your baby may mange a good kick during a check up

Fundus: the top of the uterus- the height the fundus has reached in your abdomen is a sign of how many weeks pregnant you are.

Hb: Haemoglobin: the iron containing part of your red blood cells that carries oxygen around your body. Levels below 10 may mean you need extra iron.

LMP: Last Menstrual Period- this date is used to work out when your baby is due.

NAD: No Abnormality detected- it means everything’s fine.

NE: Not Engaged- towards the end of pregnancy, you may see numbers such as 3/5 or 4/5, which show how much of the baby’s head is felt in the abdomen. These figures are only an estimate.

Oedema: this means swelling. It may be measured by +/++/+++ or nil (which means none)

Presentation: the way the baby is lying- head up or down, or sideways.

Sugar: it’s common to find a trace of sugar in your urine, but a high level could mean further tests to see if you are developing diabetes.

Tr: Trace- you may see “Tr blood” or “+ blood” if there is a small amount of blood in the urine.

 

 



We are Discussing...

Recent Posts