In addition to the monitoring your LMC midwife or doctor does during your pregnancy check-up appointments, there are a number of other tests available that can provide you with more information about your baby’s growth and development and how your body is coping with the physical changes and demands of pregnancy.
Some women/parents feel that they need the additional information and (hopefully) the reassurance that these tests can provide. Others prefer to trust that their bodies and their babies will cope with the normal process of pregnancy and find these tests intrusive and anxiety producing.……
Before you choose to have any test you should consider the following questions:-
- Will it provide any information that I want or need?
- Will the information it provides lead to changes in my self care, my
maternity care or my decision-making that will improve my wellbeing
and/or that of my baby?
- Can I/we cope with the possibility that the test will raise concerns about
- the wellbeing of my baby or would I/we cope with the pregnancy better if
- I/we assume that our baby is growing and developing normally unless or
until, there are obvious signs that this is not the case?
- What does the test or procedure involve?
- Does it carry any risks for me or my baby?
- Will I need to pay for the test?
- How accurate is the test? What is the margin of error or rate of false
positive or false negative results for this test?
- How long will it take for me receive the test results and who will report
these to me?
- What would a positive result mean for me and my baby? What treatment
would be recommended and how would it affect the care I receive from
- What is the likely outcome if you choose not to have the test?
Blood and Urine Testing
At one of your first pregnancy check-up visits, your LMC will give you a form to take to your local medical laboratory so you can have your blood and urine tested. Sometimes women are referred for blood testing by their family doctors before they have found/chosen an LMC. If you have already had your blood tested before you Register with an LMC, you and your LMC can request that your doctor forwards a copy of the results instead of having these tests done again.
Your urine is tested to check for bacterial or fungal infection.
Your blood can be tested to check for any of following:-
- Blood Group – your blood is tested to discover or confirm your blood group i.e. A, B, O or AB.
- Rhesus Factor – to discover whether the Rhesus factor is present in your blood. If you have the Rhesus factor (most people do) you are Rhesus positive. If you do not have the Rhesus factor you are rhesus negative.
- White blood cell count – to check for infections.
- Full Blood Count, Folates and B12 – The levels of iron, folates and B12 in your blood are measured because deficiencies in any of these can lead to anaemia.
- Hepatitis B – to check whether you have antibodies to this virus, or are a carrier. If you are a carrier you may pass this infection on to your baby.
- Rubella (German measles) – to check whether you have antibodies to this virus. If you have no rubella antibodies you need to be careful to stay away from people with this virus during the first 16 weeks of your pregnancy. If you catch Rubella at this time it can cause miscarriage or severe congenital abnormalities in your baby.
- VDRL – to check for sexually transmitted infections e.g.syphilis that can cause serious health problems for you and your baby.
- HIV-AIDS – to check whether you have the virus that can cause AIDS.
Many tests that can be performed during pregnancy, including listening to your baby’s heartbeat, use ultrasound. Ultrasound is a form of non-ionising radiation. It has not been shown to be harmful to pregnant women or their growing babies, but neither has it been proven to be safe. Some people are concerned that exposure to ultrasound, especially during the first 12-14 weeks of pregnancy when the baby’s major organ systems are being formed, could cause subtle changes or damage. Others worry that the effects of ultrasound exposure may not show up until later in the child’s life or even in the next generation, particularly when female fetuses are scanned, because they already carry all their ova/eggs for the next generation.
Pregnancy tests that use ultrasound
- Doptone/Doppler – a hand-held device that your midwife can use to listen to your baby’s heartbeat during pregnancy and labour. Women who are concerned about ultrasound exposure can ask their midwives to use either the completely manual, trumpet-like pinard/fundoscope or a regular stethoscope.
- Ultrasound Scanning – this procedure produces a moving picture of your baby on a television-like screen and should only be performed by a radiologist or sonographer. In New Zealand there are no laws covering the use of ultrasound during pregnancy etc. Monitoring the safety and accuracy of machines and those operating them is the responsibility of the owners of the equipment/scanning facility.
Many women/couples expect that regular ultrasound scans are a routine part of pregnancy care. However, ultrasound scanning should only be performed if it will provide information that will improve the outcome of your pregnancy for you and/or your baby. Many research studies have shown that routine scanning of women whose pregnancies are progressing normally does not lead to healthier babies or fewer problems during labour and birth. Ultrasound scanning is not 100% accurate for any condition or measurement.
Many parents find ultrasound scans reassuring and entertaining – however if you choose to have a scan you need to be prepared for the possibility that the information it reveals about your baby that may not be so reassuring.
Procedures that use ultrasound scanning.
- Confirmation of pregnancy – Increasing numbers of women are being referred for an ultrasound scan to confirm their pregnancies. (Most ultrasound scans are performed abdominally, but in the early stages of pregnancy because the baby is so small and low down in the mother’s pelvis, it can be necessary to do a transvaginal scan to be able to see the tiny fetal sac.) If you have had a positive pregnancy test you are pregnant there is no need to expose your rapidly growing baby to ultrasound just to confirm that you are pregnant.
- Prediction of due date – Sometimes women are totally unsure of when they became pregnant. An ultrasound scan during the first 12-14 weeks of pregnancy can reasonably accurately assess the age of your growing baby. (If you really have no idea of when you last had a menstrual period or when you might have conceived and are planning to have a nuchal translucency screening scan you can combine these two scans and reduce your baby’s exposure to ultrasound.)
- **Nuchal Translucency (NT) scans – are performed between 11-14 weeks of pregnancy and use ultrasound measurements/imaging as part of a procedure that assesses the risk of your baby having Down Syndrome or some major heart abnormalities.
- Chorionic Villus Sampling and Amniocentesis – use ultrasound as a guide to minimise the risk of harm to your baby during these procedures that check for congenital abnormalities in the growing baby.
- Anatomy Scan – is performed between 18 – 20 weeks of pregnancy to check for growth and physical development abnormalities. During this scan various parts of your baby’s body is measured to check that s/he is growing normally and is within the size range for her/his gestational age. This scan can also detect about half of all genetic syndromes that include physical abnormalities.
- Third trimester ultrasound scans – are mostly performed to follow-up potential problems that were picked up during the 18-20 week anatomy scan or to monitor the growth of a baby who appears to be too small or too large for gestational age.
- Cardiotocography – is a method of continuous fetal heart rate monitoring using an electronic fetal heart monitor that is strapped to your abdomen. This picks up the fetal heart rate using pulsed ultrasound and electronically records it for a period of about 15- 20 minutes. This form of ultrasound can be used during pregnancy and labour to assess fetal wellbeing.
- Fetal biophysical profile – uses both continuous electronic fetal heart monitoring and ultrasound scanning to assess fetal wellbeing and placental functioning and is usually recommended if your pregnancy continues for more than 7 -10days after your estimated due date or if there are concerns about a baby’s growth and wellbeing at any stage during pregnancy.
** The Ministry of Health currently funds First Trimester Combined Screening. This involves a blood test that is taken when you are between 9 – 13 weeks pregnant that measures a couple of blood proteins and a Nuchal Translucency ultrasound scan when you are 11 – 14 weeks pregnant. (You may be asked to pay a surcharge for this scan.) The results of these test are combined with information about your age and weight to calculate the risk of your baby having Down Syndrome.