Testing throughout pregnancy Blood test: a sample of blood is taken from a vein in your arm and sent to a lab for analysis. Risk: no risks to the mother or developing baby What can be found? Many different diagnosis can be made by a simple blood test. These results will better equip your physician to care for you and your un-born child throughout the pregnancy. These results may also help to predict potential complications with you or your baby at birth. Blood type Rh Factor: this may show a need for an additional medication to keep your blood and the babys blood from interacting during the birthing process Glucose level: can indicate diabetes Iron level: susceptibility to anemia Hemoglobin Level: anemia if counts are too low Sexually Transmitted Diseases: syphilis, hepatitis B or HIV which may require treatment to keep you and the baby safe Rubella (German Measles): antibodies showing immunity Toxoplasmosis: this is harmless to you but may cross the placenta and harm the baby Urine sampling: done by obtaining a small sample of urine (midstream) into a sterile cup. This will occur many times throughout the pregnancy. Risk: no risk to mom or baby Simple testing will determine presence of: Sugar: too much may indicate need for further testing for gestational diabetes Ketones: indicate nutrition and hydration level Protein: indicate a potential problem with the kidneys (infection) or a need for pre-eclampsia workup Bacteria: indicates a possible urinary tract infection requiring treatment Vaginal exams Pelvic exam: a manual exam (the doctor uses his fingers) to determine Your gestational age by the shape of the pelvis, uterus, pelvic bones Presence of any masses, ovarian cysts or fibroids Cervical exam: a manual exam to check if your cervix is open/closed PAP smear: a speculum exam where the doctor uses a swab to remove a few cervical cells to test for abnormal cells (pre- cancerous) Vaginal culture: a speculum exam where the doctor swabs the cervix to determine the presence of chlamydia and gonorrhea. Risk: low/no risk to mom and baby Pre-natal (before birth) Pre-natal testing does present an increased risk to mother and fetus when compared to post-natal testing. Amniocentesis: a DNA test is done on the amniotic fluid surrounding your unborn baby. Chorionic Villus Sampling: a DNA test is done on a sample of tissue attached to the uterus is taken via the vagina and cervix. This is done to determine the father of the child. May cost $400-$2000 depending on the lab performing and type of testing done. Post-natal (after birth) Blood testing Cheek swab Umbilical cord testing
Transvaginal: probe is inserted into the vagina to obtain images EARLY in pregnancy. Standard Ultrasound: probe place on the abdomen and generates a 2D image of the baby. Advanced Ultrasound: probe still placed on the abdomen but is targeting a suspected problem using more sophisticated equipment. Doppler Ultrasound: detects blood flow and movement using ultrasound waves. 3D-ultrasound: generate 3D images of the baby in the uterus. 4D or dynamic 3D ultrasound: looks at the face of the baby and detects movements prior to delivery. Fetal echocardiography: examines the babys heart anatomy and function in the uterus. First Trimester: Confirming viability Confirming heartbeat Measuring gestational age Confirming molar or ectopic pregnancy Assessing for abnormal gestation Second Trimester: Fetal malformation Wks 13-14 potential Down Syndrome characteristics Wks 18-20 congenital anomalies Structural abnormalities Multiples in pregnancy Verification of dates and growth Confirming intrauterine death Identifying excessive or reduced levels of amniotic fluid Evaluation of fetal well-being Third Trimester: Identifying placental location Confirming intrauterine death Fetal presentation Fetal movements Identification of uterine and pelvic abnormalities in the mother. Ultrasound may be encouraged by your doctor if there is medical concern for mom or baby. Questions?? Heartbeat: early in the pregnancy (6-7 wks) it is OK to not find the heartbeat initially Gender of the baby may be determined at 18-20 wks. Ultrasounds are done according to patient needs, baby needs, and physician discretion. Screening Procedures for the First 3 months of Pregnancy First Trimester Screen Determines risk for potential chromosomal abnormalities Done according to MD recommendation Chorionic Villus Sampling Determines chromosomal abnormalities. Done when mom and dad medical history supports need. First Trimester Screen Performed at 11-13 wks at the recommendation of your doctor Simple blood test: hCG and PAPP-A (pregnancy hormones) Ultrasound: measure nuchal translucency Combines the two results Assesses for potential risk for: Downs Syndrome Trisomy-21 and Trisomy-18 Cardiac disorders Abnormal results may suggest need for additional testing
Chorionic Villus Sampling Used to identify chromosomal abnormalities or other inherited disorders Only indicated if you or your partner has a medical history that reveals a potential risk. Abnormalities detected: Down syndrome Cystic fibrosis Also can be used for paternity testing Risks: invasive procedure, risk to mom and fetus. 1 out of every 100 tested experience miscarriage. Side effects: Infection Spotting Cramping Pain at puncture site (abdomen or cervix) Screening Procedures for the Next 3 months of Pregnancy
These may be recommended by your physician during your second trimester or simply offered as a screening method Quad Screen Same as triple screen with addition of Inhibin-A (more sensitive to Down Syndrome) Triple Screen Test: multiple marker screen Amniocentesis Maternal Serum Alpha- Fetoprotein Screen Cordocentesis (percutanteous umbilical blood sampling)
Quad screen is recommended for women who: Have family history of birth defects Are 35 yrs or older Used harmful medications or drugs during pregnancy Have diabetes and use insulin Had a viral infection during pregnancy Have been exposed to high levels of radiation Blood testing: Quad screen: Alpha-fetoprotein level hCG level Estriol level Inhibin-A level Based on the levels found, combined with maternal age and race the lab determines a probability of chromosomal anomaly like Downs syndrome or cystic fibrosis. Amniocentesis Follow up to abnormal Triple or Quad Screen Performed usually between 14-20 wks Ultrasound guided Needle aspiration of fluid from the amniotic sac through the stomach Detects: Chromosomal abnormalities Neural tube deficits Genetic disorders Does not measure severity of deficits or abnormalities Cordocentesis Umbilical cord sampling Ultrasound guided Needle inserted into the umbilical cord where it meets the placenta for a blood sample Typically done when information cannot be obtained through amnio, CVS or ultrasound Assessing for: Malformations of the fetus Fetal infection Fetal platelet count Fetal anemia Isoimmunisation: mom develops antibodies against babys blood cells (rH incompatibility) Does NOT test for neural tube deficits Highly accurate Risks to mom and baby Miscarriage (1-2 out of 100) Blood loss from puncture site Infection Drop in FETAL heart rate Premature rupture of membranes
Screening Procedures for the final months of Pregnancy
Testing in this trimester may aid the physician in planning your delivery and any potential complications Testing includes: Biophysical Profile Glucose Tolerance Test 1 hour 3 hour Fetal Non-Stress Test (NST) Group B Strep Fetal Non-Stress Test (NST) Two belts are placed on moms abdomen Fetal heart rate Contractions Measurement of heart rate and movement for 20-30 minutes Indicated for pregnancy over 28 weeks if: Baby is not moving as usual Past due date Suspicion placenta is not functioning appropriately High risk pregnancy Risk: no risk to mom or baby Biophysical Profile NST with ultrasound 5 specific attributes scored Biophysical attribute Breathing Movement Muscle tone Heart rate Amniotic fluid Total score determines overall health and well being of the baby Risk: no known risk to mom or baby Test may be requested if: Doctor questions the fetal health and well being: Examination Maternal/fetal symptoms High risk pregnancy Typically performed after 32 wks Glucose Screening: to test for gestational diabetes or glucose intolerance and asses s the need for intervention (diet and meds) Two part screening 1 hour mom drinks a sweet drink then one hour later has a simple blood draw. If abnormal then 3 hour baseline fasting blood sugar is drawn on arrival then mom drinks a larger sweet drink then one hour, two hours and three hours later has a simple blood draw.
Group B Strep Infection Screening Group B Strep is a bacterial infection found in the vagina or rectum Found in 25% of all healthy, adult women Test performed by swabbing the vaginal and rectal areas of the pregnant women between 35 and 37 wks Positive test: simply means you are a carrier, not necessarily actively infected. This positive result may pass on an infection to the baby during delivery. Prophylactic antibiotics are typically administered when: Labor or rupture of membrane is before 37 wks Rupture of membrane is 18 hours or more before delivery Fever occurs during labor Urinary tract infection (caused by GBS) during pregnancy A previous delivery resulted in a baby with GBS Risk: no risk to mom or baby Amniocentesis Ultrasound guided Needle is advanced through the abdomen into the amniotic sac to remove a small amount of fluid for testing. Why amnio so late? Test for infection in premature rupture of membrane Severity of fetal anemia Assess fetal lung maturity Thank you All that testing? As easy as a day at the beach