Prenatal Testing
In modern times, health care services have relied on good prenatal care and testing to ensure positive pregnancy outcomes. In general, women who receive good prenatal care, starting with their first trimester, have better pregnancy outcomes than women who have little or no care. In the past, prenatal care focused on the prevention of eclampsia and problems associated with maternal toxemia. In recent years, prenatal care has become more concerned with the identification and management of high-risk conditions for the fetus and newborn. A healthy pregnancy depends greatly on a woman's general health before pregnancy; therefore, preconception care is encouraged. Often, conditions such as diabetes, high blood pressure, thyroid, and certain sexually transmitted diseases can be identified and treated more aggressively before a woman becomes pregnant. Unhealthy behaviors such as smoking, drinking, or using illicit drugs may be identified, modified, or even eliminated prior to pregnancy.
The initial prenatal visit should be within the first twelve weeks of pregnancy. The following tests are usually performed at this time if they were not done at a preconception visit:
Hemoglobin and Hematocrit - Used to identify whether anemia is present. If these values are low, further tests may be ordered, and an Iron supplement may be added to prenatal vitamins.
Blood type and Rh Factor - Used to identify antibodies and Rh factors that may have adverse effects on the fetus. The results may require further tests and close monitoring throughout the pregnancy.
Rubella Titer - This test will identify whether a woman is immune to the measles virus. If she is non-immune and the test is done preconceptionally, she can receive the Rubella vaccination. She would be advised to avoid pregnancy for three months thereafter. This test would not need to be repeated during pregnancy.
Urinalysis and Urine Culture _ To identify sugar, protein, and infection. These tests are done initially, and then periodically, throughout the pregnancy.
Gonococcal Cultures and Hepatitis B Antigen Screening - These tests are recommended for all women because of the prevalence of these diseases in the general population. For women at high risk, non-immunity for hepatitis B antigen may indicate the need for vaccination. Gonococcal cultures are repeated later in pregnancy for some women.
Screening for infections such as toxoplasmosis and CMV are more effective when done preconceptionally.
Screening for tuberculosis is restricted to women at risk.
Screening for HIV and illicit drugs should be offered to all women.
A complete physical exam, including a pelvic exam, Pap smear, and complete health history, is done during this first visit.
Prenatal visits will be scheduled every four weeks up to the twenty-eighth week of pregnancy. At each visit, blood pressure, weight, fundal height, fetal heart rate, and urine dipstick for protein and sugar are monitored and compared to the previous visits. From twenty-eight to thirty-six weeks, the visits should be every two to three weeks, and the addition of edema assessment is added to the routine exam. From thirty-six weeks until delivery, the pregnant woman should be seen weekly, and fetal presentation should be evaluated. The following screenings and tests are done during the second and third trimesters of pregnancy:
Pregnancy Ultrasound,at 16-18 weeks, provides the most accurate information regarding Estimated Date of Confinement and fetal growth and development data.
Blood Tests such as AFP and screens for anatomic and chromosomal abnormalities are also recommended at this time.
Between weeks 24-28, the Gestational Diabetic Screen should be due. A repeat hematocrit and hemoglobin is also done at this time. A repeat Rh titer should be done for Rh-negative women, and RhoGam will be administered.
At 36 weeks, your physician may perform a Culture for Group B Streptococcus if clinically indicated. Women at risk will be rescreened for sexually transmitted diseases.
Non-stress Fetal Monitor test and Biophysical Ultrasound examination may be ordered any time to determine fetal well-being, especially if fetal movement decreases, or if risk factors such as diabetes or high blood pressure are present.
Choose an obstetrician or CNM with whom you feel comfortable. Developing a good rapport with open communication between you, your healthcare provider and the office staff is very important. All aspects of pregnancy, from preconception to postpartum are special events in a woman's life and must be treated as such. Keeping your appointments and having the tests and screenings ordered by your caregiver show your concern and commitment to your pregnancy. It is very important during your routine visits that you tell your doctor of any problems you may be having, no matter how insignificant you may think they are. Often, medical, genetic, or nutritional risk factors go undetected if the pregnant woman is unwilling to discuss past histories or adverse health behaviors with her obstetrician.
Good prenatal care correlates positively with the prevention of poor pregnancy outcome; therefore, it is imperative that every pregnant woman takes advantage of the opportunity to receive prenatal care. Several special programs and services are available to uninsured pregnant women to help them receive the care they need. Information and assistance may be obtained from the local hospital, WIC office, or Medical Assistance Office. If you are pregnant or think you might be pregnant, don't wait - call for your prenatal appointment today!