Tests in Pregnancy

During your pregnancy, you'll be offered a range of tests, Which include simple things like Weight and Height , Blood Pressure , a set of blood tests and few ultrasound baby scans. These tests can help find conditions that can increase the risk of complications for you and your fetus during the pregnancy .

You don't have to have any of the tests – it's your choice. However, it's important to understand the purpose of all tests so you can make an informed decision about whether to have them.

You should discuss this with your doctor.

USG in Pregnancy

What is pre-natal diagnosis?

Many babies are born with major and less severe congenital abnormalities. These may be associated with chromosomal and genetic problems. Today, such conditions can easily be EITHER predicted before the pregnancy OR detected inside the mothers’ uterus by using advanced ultrasound based techniques and running tests on fetal cells taken out of pregnant mother’s uterus.

Why prenatal diagnosis is important?

Individuals with congenital abnormalities suffer from many problems, which limit them from living a fulfilling life. Also, they often come with many problems for their respective families and society as a whole. So, with prenatal diagnosis, the incidence of these conditions can significantly be reduced. This is good for that person, the family, as well as the whole society.

During pregnancy, a range of tests and screenings are recommended to ensure optimum prenatal care and development, as well as the well-being of the mother. Some of these tests are routine like , haemoglobin , sugar , thyroid etc. However, there are some special USG and Blood-based tests recommended at different stages of pregnancy

There are two types of ultrasounds: Abdominal Ultrasound and Transvaginal Ultrasound. Following, there exist different types of ultrasound imaging techniques: 2D, 3D, and 4D. The 4D ultrasound is a modern technique that visualizes the unborn baby move in real time. Ultrasounds may be done at different phases (trimesters) of pregnancy to identify the location and estimate the due date (Early Pregnancy TVS ), to identify structural abnormalities in the baby ( anomaly Scan), measure fetal growth , water around baby and blood flow to it ( Fetal wellbeing and Doppler study )

Here are some of the common tests during pregnancy:

First trimester screening

This is done between 11 and 14 weeks of pregnancy to determine the risks of the fetus of having Downs syndrome and related conditions. It includes ultrasound scans for fetal neck skin thickness ( NT ) and nasal bone determination. Also, added with this a maternal blood test called double Marker to assess the probability of those conditions.

It's a first trimester screening, done between 11 and 13 weeks of pregnancy. The screening is done to diagnose and assess the risks of chromosomal abnormalities and down syndrome. The women get an estimate of individual risk for this pregnancy, which is calculated based on various factors, including the age and weight of the mother, measurement of pregnancy hormones, the length pf fetus and thickness of fetal neck (nuchal translucency), This screening also helps estimate the due date, as well as assess multiple pregnancies and identifying early fetal anatomical problems.

Second trimeste screening

Principally similar to First Trimester Screening. Done between 15 and 20 weeks of pregnancy who presents late. it includes a blood test called Quadruple Marker, apart from blood Test

In the second trimester, you would go for quadruple test. It would be done anywhere between 15 and 20 weeks of your pregnancy. It is done to diagnose Down Syndrome, as well as to find defects in the spinal cord.

Fetal Anatomy Scan

Fetal anomaly scan, also called level-2 ultrasound or anatomy scan, is an essential part of prenatal care. The pregnancy ultrasound is usually done about 20 weeks into pregnancy to measure the growth abnormalities of the fetus.

The Aim

Fetal anatomy scan helps doctors evaluate the physical structures of the fetus in the mid-second trimester, with a focus on the brain, stomach kidneys, bowel, face, heart, and limbs of the baby. More specifically, the test helps doctors assess fetal cardiac activity, weight estimation, amnionic fluid volume, location of the placenta, and more that enables them to detect any abnormality in the growth of the fetus.

The Interpretation

In the fetal anatomy scan, 2-4 percent of the babies may have their physical abnormalities visible. Some of these problems could be minor and require no intervention. Your doctor would closely monitor them and provide you with certain measures in terms of what you can do in your capacity to fix or minimize the problem. There could also be some serious abnormalities in the fetus, which can or can’t be curable. Depending on its nature, your doctor would suggest you the right course of action.

Preparation and After

Fetal anatomy scan doesn’t require any specific preparation, unless advised by your doctor. So, you can eat normally before the test. However, you will require to have an empty bladder for better interpretation. After the scan, you will be given a printed report within 15 minutes. The doctor would go through the report and reassure you if the baby is normal and healthy or not. In case of abnormality, the doctor will lay out the available options for you, and even recommend you to a specialist.

Fetal Echocardiography

It is a detailed sonographic evaluation that helps identify fetal heart anomalies in the baby before delivery. Done after 18 weeks of pregnancy, usually between 22 and 24 weeks, fetal echocardiography is highly recommended for women with a high-risk pregnancy. Remember, congenital heart disease is a top cause of infant morbidity and mortality with about 6-9 incidences per 1000 live births.

The assessment of fetal heart report major and minor problems. It is done through maternal abdomen; rarely is trans-vaginal route is selected as a method of evaluation. The report comes

In case of abnormal result, the parents will receive thorough counseling from the doctor. They will receive an appropriate action plan, which would also include opting for an invasive diagnostic test for accurate confirmation of the problem in baby and consulting a qualified pediatric cardiologist.

Also note, negative screening or normal interpretation doesn’t entirely rule out every heart problem. There are many reasons for that. For example, the small holes between the lower chambers of the heart are difficult to spot and may miss out in the final report. Also, circulation in the fetus is relatively different than after birth. But that said, a normal fetal consideration is a good news and you need not worry about what else could go wrong.

In terms of preparation for fetal echocardiography, it's quite regular and you don’t need to do anything extra.

Fetal wellbeing assessment and Doppler’s study

The assessment is done to confirm the growth and well being of the baby between 24 weeks and the delivery. It helps check the estimated fetal weight of the baby, water around the baby, the sufficiency of blood flow to the baby, the position of the placenta, and the position of the fetal head. All these provide adequate information about how healthily and well the baby is developing.

The assessment can identify any problem with the growth of the baby; if it's too small or too large. In case of abnormal growth, as well as an abnormality of the fetal position, the report will be assessed further and proper action plan will be laid out by the doctors on monitoring and delivery. The parents will receive thorough counseling.

The preparation is quite regular and you don’t need to do anything extra. Eat normally before the test. You don’t need a full bladder. The printed report usually comes in same day.

Weight and Height checks in pregnancy

You'll be weighed at your first visit to your doctor and regularly in subsequent visits during your pregnancy. Your height and weight are used to calculate your body mass index (BMI).

All together there is a gain of upto 13 kilos during the pregnancy.

Women who are overweight for their height are at increased risk of problems during pregnancy.

Blood pressure tests in pregnancy

Your blood pressure will be checked at every antenatal visit. A rise in blood pressure later in pregnancy could be a sign of pre-eclampsia.

It's very common for your blood pressure to be lower in the middle of your pregnancy than at other times. This isn't a problem, but it may make you feel lightheaded if you get up quickly. Tell to your doctor if you're concerned about it.

Antenatal urine tests

Your urine should be checked few times mainly to see leakage of protein or signs of any Leakage of protein is a sign of pre-eclampsia.

Pre-eclampsia affects 5% of pregnancies and can lead to a variety of problems, including fits (seizures). If left untreated, it can be life-threatening.

Pre-eclampsia can also affect the growth and health of the baby. Women with the condition may feel perfectly well before serious complications develop..

Leakage of protein ( along with blood and Pus cells ) may also mean an infection that needs to be treated.

Blood tests in pregnancy

As part of your antenatal care, you'll be offered several blood tests. Some are offered to all women while others are only offered if you might be at risk of a condition.

The following lab tests are done early in pregnancy:

  • Complete blood count (CBC) – To check haemoglobin and other blood cells
  • Blood Group and Type - If your fetus is Rh positive and you are Rh negative, your body can make antibodies against the Rh factor. In a future pregnancy, these antibodies can damage the fetus’s red blood cells to make it anaemic. Certain action need to be taken in this situation.
  • Blood Sugar – usually Fasting to detect pre-existing diabetes which can have significant consequences for pregnancy.
  • Thalassemia Carrier Status - 1:25 couple will be carriers of Thalassemia in our country. If both partners are carrier , there will be 25% risk of baby developing Thalassemia, which is a severe anaemia that can result death in early childhood.
  • Rubella Immunity status - Rubella is a flu like virus which can cause birth defects if a woman is infected during pregnancy. Some women may already have immunity through vaccinations ( Childhood). Your blood test will show whether you are already immune against this disease. If you are not , you should avoid anyone who has the disease while you are pregnant. You should not be vaccinated against rubella during pregnancy. But, you should get it after the baby is born, even if you are breastfeeding.
  • Blood test for screening of three infectious diseases - HIV, Syphilis and Hepatitis B and C. The tests are recommended to protect your health and reduce any risk of passing on an infection to your baby. Usually offered at your first or second appointment with your doctor.

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