Antenatal Testing

Antenatal Testing

 

Definition

Antenatal testing includes any diagnostic procedures performed before the birth of a baby.

Purpose

These tests and exams are essential for protecting the health of a pregnant woman and her developing child.

Precautions

Some tests, such as amniocentisis, carry a small risk of a miscarriage or other complications that could harm the mother or baby.

Description

Women who become pregnant undergo a wide variety of tests throughout the nine months before delivery. In the early stages, physicians order blood tests to screen for possible disorders or infections, such as human immunodeficiency virus (HIV), which can pass from the mother to the fetus. Later, the focus shifts to checking on fetal well-being with a variety of technological tools such as ultrasound scans. Descriptions of the most common tests and procedures used during pregnancy are listed below.
When a woman first learns she is pregnant, her physician will run a series of routine urine and blood tests to determine her blood type, check for anemia and gestational diabetes, make sure she is immune to rubella (German measles) and check for infectious diseases like HIV, hepatitis, chlamydia or syphilis. Physicians also usually do pelvic exam to screen for cervical cancer and check the patient's blood pressure. As the pregnancy progresses, more tests will follow.

Ultrasound

Ultrasound is a device that records sound waves as they bounce off the developing fetus to create an image, which is projected onto a large computer screen. Physicians order an ultrasound scan to listen for a fetal heartbeat, determine a woman's precise due date and check for twins, among other uses. An ultrasound scan also is known as a sonogram. The procedure takes a few minutes, is painless and usually is covered by health insurance.

Key terms

Alpha fetoprotein screen — A test that measures the level of alpha fetoprotein, a substance produced by a fetus with birth defects, in the mother's blood.
Amniocentesis — An invasive procedure that allows physicians to check for birth defects by collecting a sample of fetal cells from inside the amniotic sac.
Breech position — When a child is oriented feet first in the mother's uterus just before delivery.
GBS — Group B streptococci are a type of bacteria that, if passed to a can cause inflammation of the brain, spinal cord, blood or lungs. In some cases, it can result in infant death
Ultrasound — A device that records sound waves as they bounce off a developing fetus to create an image, which is projected onto a large computer screen
The ultrasound technician will ask the pregnant woman to remove her clothes and change into a gown. The technician may rub some gel on the woman's stomach, which helps the hand-held device pick up sound waves better. In certain cases, the technician may insert a plastic probe into the woman's vaginal canal to get a clearer picture of the fetus. Early in pregnancy, the test may need to be done with a full bladder.
Unlike x rays, ultrasound is safe to use during pregnancy. It does not cause any known side-effects that would harm the mother or baby.
Pregnant women usually will have their first ultrasound anytime between 8 and 12 weeks of gestation. In normal cases, the technician is able to identify a fetal heartbeat, which appears as a flashing light on the screen. Closer to the due date, physicians use ultrasound to make sure the fetus is in the correct position to exit the birth canal head first.
Sometimes an ultrasound will show that a fetus has stopped growing, or a gestational sac has formed without a fetus, and a miscarriage has occurred. Later in pregnancy, it also may show that the child is in a breech position, oriented feet first, which can cause a difficult labor.

Tests for birth defects

Most obstetricians offer parents a variety of ways to find out if their developing child might have birth defects such as spina bifida and Down Syndrome. An alpha fetoprotein screen can be done through a simple blood test in the doctor's office between the 16th and 18th week of gestation. It tells the odds that their child will have a severe congenital anomaly. The test works by measuring the level of alpha fetoprotein, a substance produced by a fetus with birth defects. Low levels of alpha fetoprotein in the mother's blood may indicate Down's Syndrome. In that case, the next step for most couples is amniocentesis because the alpha fetoprotein test can give false-positive results. Amniocentesis is a more accurate test, but it also has higher risks of complications.
This procedure typically is used to diagnose Down syndrome while a developing child is still in the womb, at 15-28 weeks.
During amniocentesis, a doctor inserts a needle through a woman's vaginal canal and inside her cervix. Using ultrasound as a guide, the doctor pierces the uterus to withdraw a sample of fluid from the amniotic sac. Afterwards, tiny cells shed by the fetus can be studied in the laboratory. Scientists can analyze DNA samples to determine if the fetus has Down syndrome or other genetic conditions. Amniocentesis also can determine the sex of the fetus.
Women who have a history of recurring miscarriages may not want to have this procedure.
Amniocentesis is usually performed in a doctor's office on an outpatient basis.
Common side effects include cramping and bleeding.
In about one out of every 1,000 cases, amniocentesis causes a needle to puncture the uterine wall, which could result in miscarriage.
In most cases, couples find out their baby does not have a birth defect.
If the results come back positive for Down's Syndrome or other serious conditions, the couple must decide if they want to end the pregnancy. Others use the knowledge to plan and prepare any special care needed for their future child.

Group b strep

This test is for Group B streptococci (GBS) infection.
By testing for GBS, physicians can determine if a woman is at risk of passing this infection along to her child.
Women who have had a prior child with GBS, or who have a fever or prolonged or premature rupture of the amniotic sac may be at higher risk for this type of infection.
GBS is a type of bacteria commonly found in the vagina and rectum. Unlike regular strep throat, GBS can be present in a person's body without causing any symptoms, so many women do not realize they are infected with it.
To test for the presence of GBS, doctors may take a urine sample. They also may collect samples from the vagina or rectum, which are then analyzed in a lab. This test is usually performed late in pregnancy, at 35-37 weeks of gestation.
This is a routine urine test or pelvic exam with no side effects.
In many cases, doctors do not find any evidence of this type of infection.
If a woman is found to be infected with Group B strep, physicians usually wait to treat it until just before labor begins. At that time, they may give the mother antibiotics so the baby is not born with the infection. Newborns who are exposed to Group B strep can have inflammation of the brain, spinal cord, blood or lungs. In some cases, this serious complication can result in infant death.

Resources

Books

Planning your Pregnancy and Birth. Washington, DC: The American College of Obstetricians and Gynecologists, 2000.

Periodicals

Parkey, Paula. "Birth Defects: Is Prenatal Screening Advisable?" CBS HealthWatch April, 2000. 〈http://www.cbshealthwatch.com/cx/viewarticle/214798〉.

Organizations

American College of Obstetricians and Gynecologists. 409 12th St., S.W., P.O. Box 96920, Washington, DC 20090-6920. http://www.acog.org.
March of Dimes Birth Defects Foundation. 275 Mamaroneck Avenue, White Plains, NY 10605. (888) 663-4637. http://www.modimes.org.
References in periodicals archive ?
Specific recommendations for antenatal testing do not exist and should be assessed on a case-by-case basis; especially in the case of women who have had prior radiation therapy.
They hope to fund research and press for antenatal testing which could prevent future tragedies.
The most detrimental for reproductive health care access was the intensification of the political role of the Catholic church, which swiftly led to a ban on abortion and the institution of a Conscience Clause law, which restricted access to prescription drugs such as hormonal contraception and antenatal testing for fetal anomalies, as some doctors began to cite religious objection to providing these previously lawful medical services.
A delay in antenatal testing or reporting of the results.
Eighty-three percent of eligible women enrolled in the study; participants provided demographic and health data, and underwent routine antenatal testing.
Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing.
They also received antenatal testing and, if necessary, treatment for syphilis.
There is often a bit of pressure about antenatal testing, partly because there are only a few weeks to consider the pros and cons, but taking the time to think about what you and your partner want to do is very important.
An interim report from a survey on antenatal testing policy conducted as a collaborative project between the Institute of Child Health and the Communicable Disease Surveillance Centre found that substantial progress had been made on the implementation of routine antenatal testing for HIV.
Prior to coming to the Antelope Valley, Samadi was director of the antenatal testing unit at Staten Island University Hospital in New York.
Unfortunately, cholestasis of pregnancy is associated with a high rate of stillbirth between 37 and 38 weeks, and none of our antenatal testing can predict these deaths.
Of these infected children, 54 were born to undiagnosed mothers who had either declined antenatal testing or seroconverted during pregnancy [6].