Even though women, for centuries, have been having babies, modern medicine utilizes many medical tests to ensure that you and your baby are in the best health possible. It can be very overwhelming thinking about the tests but don’t worry. The chances of you turning into a pinprick cushion or feeling like a guinea pig are pretty small. Only the tests that need to be done will be ordered for you.
The life and health of the mother are reflected in the blood, and because of this, many blood screenings are completed to ensure that the doctor has a complete view of the health of the mother.
First Trimester Blood Testing
A pregnancy test is often the first test that is done to confirm positive pregnancy (HCG) hormones and to ensure they are increasing at proper levels. If this test is positive, more testing is typically ordered at the first visit. These tests can include:
- Complete Blood Count
- Iron levels
- Thyroid Levels
- Sexually Transmitted Disease (STD) Screening
- Rh (D) incompatibility
- Blood typing
- Hormone levels of estrogen and progesterone
Rh (D), also called Rhesus factor, is not well known but it is vital. Because most people are RH positive, this inherited protein is not an issue. Unfortunately, if the baby inherits an Rh-negative blood factor from either parent, it can be hazardous for the baby and the mother.
Some mothers who previously experienced infertility issues in the past may have estrogen and progesterone levels monitored in the first trimester of pregnancy. The placenta is the leading supplier of progesterone in the pregnancy, but it can take several weeks for it to produce enough progesterone. Mothers who are naturally low in the hormone may benefit from supplementation.
Second Trimester Blood Testing
Early in the second trimester, specifically between the 16th and 18th weeks, a "Triple Screen" or "Quad Screening" may be done. Women who have a family history of birth defects, over the age of 35, are diabetic, work in areas of high radiation levels, or used potentially dangerous medications and drugs during pregnancy should be screened.
Triple Screen measures proteins and hormones levels produced by the baby and the placenta to assess for risks of spina bifida or Down Syndrome. However, it is important to note that these tests are merely screenings. They are not definitive diagnoses of conditions; if a positive result is found, your doctor will typically order additional testing to confirm the presence of the disease. These tests may include a high-level ultrasound or amniocentesis.
Quad Screen is almost identical to the Triple Screening, but it adds a test for Inhibin-A. Inhibin-A looks at the possibility of Down Syndrome, and it has a lower false-positive rate.
Glucose Monitoring, measured at 24-28 weeks gestation, is done to ensure that the mother is not at risk for gestational diabetes. This test involves drinking a sugary flavored drink and then testing the blood sugar level one hour later. If this test’s results are too high, a four-hour test (with one-hour blood sugar check intervals) may be done as well.
Third trimester Blood Testing
For healthy low-risk pregnancies, third-trimester mothers do not have a lot of additional blood screenings done. Some physicians may repeat the STD screening, but this depends on the physician's preferences. Of course, any previous lab results that were concerning to the physician are repeated in the third trimester.
Little chin bones and feet! Thumb-sucking and hiccups. Wiggles and Waves!
These are just some of the things that can be observed through an ultrasound. The most popular (and exciting) medical test that pregnant women look forward to is the ultrasound. This amazing technology can be used many different ways to provide doctors the best way to observe the health of the mother, baby, and placenta.
- Transvaginal Scans - The ultrasound device is inserted through the vagina, typically in the early first trimester, to confirm a positive pregnancy test and heart rate of the baby. It also can possibly diagnose an ectopic pregnancy in early gestation.
- Standard Ultrasound - Often done at 20 weeks gestation, the standard ultrasound allows the physician to measure the growth of the baby, amount of amniotic fluid, placental health, and even the gender of the baby. For low-risk pregnancies, this ultrasound may be the only ultrasound that is performed (besides the initial transvaginal ultrasound)
- High-Resolution Ultrasound - More advanced than a standard ultrasound, this type of ultrasound is used when there is a suspected difficult pregnancy or fetal concerns. One specific high-resolution ultrasound is the Ultrasound Screening Test. This screening is done in the first trimester to assess genetic disorders such as Down Syndrome Trisomy-21 and Trisomy-18.
- 3-D and 4-D Ultrasound - This advanced software allows for a complete view of the growing fetus’s face and movements. Some people are able to see specific facial features on the baby with the 3-D and 4-D that resemble other family members.
- Fetal Echocardiography - This ultrasound technology can measure the heart function and anatomy of the baby and is very helpful if there is a risk of congenital heart defects.
- Combination Ultrasound - While not explicitly used for diagnostics, the ultrasound machine can assist with other tests to ensure safety. Amniocentesis and Chorionic Villus Sampling uses a needle to withdraw samples, and the ultrasound allows the physician to see exactly where to place the needle for the procedure.
- Fetal Heart Tones - A small hand-held ultrasound device allows a doctor or nurse to quickly listen and measure the baby’s heart rate. These devices are so small, they are typically carried in the pocket of your medical provider.
No woman likes standing on the scale, but pregnant women need to have their weight monitored for many reasons. The doctors need to know from a numerical standpoint that the baby is growing, and that weight is typically measured by the mother’s weight gain. Also, in early pregnancy, morning sickness and Hyperemesis Gravidarum can lead to weight loss. Too much weight gain is also a problem; mothers who have Gestational Diabetes may gain many additional pounds - and the baby grows too! In some rare instances, there have babies weighing over ten pounds at birth due to maternal Gestational Diabetes.
Blood Pressure Assessment
High blood pressure is not just a concern for elderly patients; it is a severe condition for pregnant women. Pregnant women can suffer from Gestational Hypertension, Preeclampsia, and Eclampsia from uncontrolled high blood pressure. These conditions are life-threatening for the mother and the baby.
Focused Urinalysis Checks
This quick urinalysis is typically done at every visit in the first, second, and third trimester. This dipstick-based test checks for ketones, protein, and sugar in the urine, which can indicate gestational diabetes. The focused urinalysis is different than a urine test done at a doctor’s office; those tests look at many more factors including the presence of blood cells, epithelial cells, bacteria and the concentration of the urine.
Fundal Height Measurement
A very quick way to measure a mother’s growing stomach is the Fundal Height Measurement. This test is an easy way to see if gestation is at the right level of growth. To measure this a tape measure with centimeter markers is used. The measurement begins at of top of the pubic bone and stops at the top of the growing uterus.
After about 20 weeks of pregnancy, each centimeter should reflect the weeks of pregnancy that the mother is at that week. For example, for a 25-week gestation, the measurement should be 25 centimeters. Mothers who measure large or small-for-gestation may have additional testing to ensure that the baby is growing well.
Chorionic Villus Sampling
A procedure that is not usually done, but may be requested by your physician if there is a risk for genetic issues, is the Chorionic Villus sampling. This test is performed by removing a small sample from the placenta. It is typically done early in the pregnancy - usually between 11 and 14 weeks of pregnancy. Those who have had positive results from blood screening tests or have had chromosomal disorders in a previous pregnancy may elect to have this done.
The sac of fluid that surrounds the baby is rich in information for doctors who are concerned about the development and condition of the baby. With the assistance of an ultrasound doppler to guide the needle, the doctor removes a small amount of amniotic fluid and test it.
Birth defects, like Spina Bifida and Anencephaly, can be assessed through the amniocentesis. It also can look at other genetic disorders such as Sickle Cell Disease and Cystic Fibrosis.
Similar to a blood pressure cuff, the tocometer is a device that measures the contractions of the uterus. It is placed around the mother’s stomach, typically attached by elastic bands, and it will give a readout of the frequency and strength of the contractions. This measurement is beneficial if there are concerns of pre-term labor, and it can help your doctor see the prevalence of contractions which may determine a beginning of labor.
Non-Stress Test and Stress Test
With the use of the tocometer, a doctor may order stress tests to assess whether a mother is going into labor and how the baby is responding to possible contractions. A Non-Stress Test merely involves wearing the tocometer with the fetal heart monitor to “observe” if there are contractions present and the heart rate of the baby. Typically, it is done for about twenty minutes to give a good sample for a proper evaluation.
The Stress Test, also called Contraction Stress Test, observes contractions and the heart rate of the baby, but there may be a small dose of Pitocin ( a synthetic hormone, similar to oxytocin, that induces uterine contractions) given. Some doctors may encourage the mother to rub their breast nipples to release natural oxytocin to stimulate contractions as well. The test is done to ensure that the baby is can potentially handle the stress of labor contractions and if the uterus is able to contract.
Fetal Heart Monitor
Just like the ultrasound devices that a mother may have experienced in the earlier stages of pregnancy, the fetal heart monitor measures the baby’s heart rate and continually graphs the results. The monitor can audibly project the sounds as well. The monitor is worn similar to the tocometer, but a small amount of ultrasound gel needs to be added to have the most accurate results.
The “ferning” test, to measure fetal fibronectin, is critical to assess whether amniotic sac has broken or is leaking amniotic fluid. The appearance of fibronectin looks similar to forest fern plant under a microscope. The fibronectin is comparable to glue that keeps the sac wholly closed. If the glue leaks out and shows up in the test, then premature delivery is possible. To assess for this, doctors swab the vaginal fluids and look at it under a microscope.
Pelvic Exam - Cervix Dilation
Two centimeters dilated. Five centimeters. Just a rim left - it’s almost time to push!
When assessing for cervical dilation, a physician or nurse may perform a bedside pelvic exam. Similar to a yearly pap, but without the speculum, one or two fingers are inserted into the mother’s vagina to feel the opening of the cervix. It has been said the measurements feel like a 2-Liter soda bottle; it is small at the top and gradually widening until it is completely expanded to 10 centimeters. The measurement of 10 centimeters indicates the cervix has completely opened and only the baby’s head is felt. If the baby has descended far enough into the pelvis, and the doctor is ready, the pushing process begins for delivery.
Whew! That is quite a list. The number of tests that a pregnant woman may have can be overwhelming, but it is important to remember that most pregnancies will not require all these tests. Your healthcare provider wants to ensure that you have the best and safest pregnancy possible before any difficulties arise, and doing these tests is the best way to discover them.