By Connie Agnew, M.D. Saint John’s Health Center
To make sure that both you and your baby are as healthy as possible, it’s important that you get prenatal care throughout your pregnancy. At your regular visits, your general health and the health of your baby will be closely monitored. At these visits, there are several routine tests your health care provider will administer at specific times during your pregnancy, as well as several optional screening tests that may be recommended by your doctor.
At your first prenatal visit, you will receive a complete physical examination. Your urine will be tested for sugar, which is a sign of gestational diabetes. It also will be tested for protein, which is a symptom of preeclampsia, a potentially life-threatening condition, characterized by an extreme rise in blood pressure. Your urine also will be tested for bacteria that may indicate a urinary tract infection (UTI), which is common during pregnancy. The infection can be present without symptoms, and if untreated, may lead to kidney infection.
During this first visit, you will have a blood test that will determine your blood type and Rh factor. If you are Rh-negative and the father is Rh-positive, your fetus may have Rh-positive blood. If this is the case, the mother’s immune system may produce antibodies that can damage the fetus’ blood. The danger of Rh sensitization can usually be prevented by an Rh immunoglobulin injection.
Your blood will be screened to see if you are anemic; have had exposure to the hepatitis B virus and whether you are immune to German measles. Your doctor may recommend that your blood also be tested for the HIV virus and other sexually transmitted diseases.
In the first trimester, you will probably also receive an ultrasound that will show your baby’s heartbeat and gestational age. The ultrasound also gives the doctor an opportunity to do a nuchal fold screening, where he will look for abnormal accumulation of fluid behind the fetus’ neck, which can indicate an increased risk for chromosomal abnormalities. You may receive another ultrasound later in your pregnancy.
In the second trimester (between 15-20 weeks), you will have the option of taking the maternal serum triple screen. These three tests look for protein in the blood that may indicate an increased risk for certain birth defects. The blood is checked for alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and estriol. You will receive a glucose tolerance test (usually between the 24th and 28th weeks) to continue monitoring for gestational diabetes.
You can undergo other optional tests during your pregnancy to rule out certain genetic conditions and chromosomal abnormalities. Chorionic villus sampling (CVS) is a test done at week 11 or 12 on cells collected from the placenta. The amniocentesis, done around week 16, involves inserting a needle into the uterus to retrieve amniotic fluid. Both tests carry a small risk or miscarriage. An amniocentesis is sometimes done later in the pregnancy to provide information on fetal lung development, which can be important if you are at risk for premature delivery.
In the third trimester, near the end of your pregnancy, you will be checked for group B streptococcus, which can cause severe illness or even death to a newborn. If you test positive, you will be treated with antibiotics. If you tested positive for hepatitis B early in your pregnancy, your baby will receive the hepatitis vaccine and hepatitis B immune globulin within 12 hours of birth.
You will not need to ask specifically for any of these routine tests during pregnancy — your doctor will make sure you receive them. You should feel free to discuss the routine and optional tests in more detail with your health care provider. Since regular prenatal care, which includes the routine and optional tests outlined above, is so important, make sure you see your doctor as soon as you know you are pregnant so that potential risks or problems can be monitored and addressed. (Connie Agnew, M.D., is a medical director of maternal/fetal medicine at Saint John’s Health Center and a perina-tologist in private practice in Santa Monica. For more information on Saint John’s, contact the health center at (310) 829-5511 or visit www.stjohns.org).
Originally published in the Santa Monica Daily Press print edition on January 20, 2004. Read the original PDF.