Keep in check
As soon as you've discovered you're pregnant and found an LMC, the tests and check-ups begin. Here's the lowdown on what to expect and why they're part of the process.
Booking antenatal visit
You will have your booking antenatal visit during the first 12 weeks of your pregnancy, when a full medical and family history of you and your family will be performed to identify any factors that put your pregnancy at risk of complications. Your LMC will perform a cardiorespiratory examination to check for any underlying conditions and if you haven't already, they will organise you to have all your routine antenatal booking blood and urine tests.
They will organise a dating ultrasound scan to confirm your estimated due date (EDD) for when your baby is likely to be born. Your LMC will also discuss the optional first trimester screening tests for chromosomal abnormalities, such as Down syndrome, which are more common in babies born to older women. They will ensure you have sufficient folic acid (0.8mg daily in most women, 5mg daily in some groups of women such as having had a previous baby with spina bifida, those on anticonvulsants, diabetics) for the rest of the first trimester as well as iodine for the duration of pregnancy and while breast feeding. They will discuss antenatal classes, give advice about safe eating and exercise in pregnancy, advise whooping cough vaccination by your GP from 28 weeks as well as the flu vaccination during the flu season.
At this booking visit you will also discuss with your LMC how often you visit. After 12 weeks, checks are usually monthly until 28 weeks, fortnightly till 36 weeks, then weekly thereafter.
Your first blood test helps give your LMC a picture of your health. It includes a full blood count and iron studies, to test for anaemia and iron deficiency. It also identifies your blood group to see whether your red blood cells are negative for the rhesus factor. If you are rhesus negative, we would test your partner to see if they were rhesus positive or negative. If you are rhesus negative and your partner is positive, your baby could also be positive. In this scenario, during your pregnancy, anytime when babies blood could leak into your bloodstream (such as after any vaginal bleeding, a falls or trauma), your immune system could identify babies blood as foreign and start to make antibodies against it. To prevent this, women that are rhesus negative (and their husband is either rhesus positive or his status is unknown) have Anti-D injections when they have any fresh vaginal bleeding, any falls or trauma and also at 28 and 34 weeks. If you are Rhesus negative and so is your partner, then your child will only be rhesus negative as well and you don't need to have Anti-D.
Rubella (German Measles) antibodies are checked to see if you are immune to this as if not and you are exposed to rubella during pregnancy, this can cause serious problems for yourself and baby such as miscarriage and fetal abnormalities. Some women lose their immunity as they get older, which is why we check for this every pregnancy. Hepatitis B, a virus causing liver disease, is also tested for and if found in the mother, means the baby must be immunised at birth to prevent it from being passed onto your baby. Varicella (Chickenpox) immunity is also checked. Syphilis, Hepatitis C and HIV are also tested for as if present, these can be treated to reduce the risk of passing onto your baby. The full blood count and testing for blood group antibodies may be repeated at around 28 and 36 weeks. At 28 weeks the polycose test, a screening test for diabetes, is usually offered. A high polycose result will require further testing for diabetes in pregnancy.
Downs syndrome screening
As women, we are only born with our eggs, we never make any in our lifetime and so our eggs are the same age that we are. This means as we get older, our eggs age as well and become more genetically fragile and more likely to make babies with chromosomal abnormalities such as Downs syndrome. There are two optional screening tests available. The traditional nuchal translucency test combines a blood test from you at 10 to 11 weeks and a scan of the fat pad behind babies neck at 11-14 weeks and gives a low or high risk of your baby having Downs Syndrome (trisomy 21) as well as Edwards' (trisomy 18) and Patau Syndrome (trisomy 13). It can pick up 70-80% babies with Downs Syndrome. The new test available is Non-Invasive Prenatal Testing or NIPT. Already from 10 weeks there is placental tissue floating around in your blood stream which is fetal DNA in origin. We can take a blood test only from you and send it to one of the units performing this test, either in Melbourne or the USA. They extract the fetal DNA and examine chromosomes 21, 18, 13 as well as the sex chromosomes and can detect with 99% accuracy Downs Syndrome as well as the sex of your baby. The result is usually back in 5 days and the cost is coming down very quickly as more local units get the technology to perform this test. Your LMC will discuss these options with you and organise one of them if you wish.
We routinely check the urine with a mid-stream urine during your booking antenatal tests, looking for urinary infections in pregnancy, which often don't have any symptoms for the pregnant woman. If found, a course of antibiotics can be given to avoid a bladder infection spreading further to cause a kidney infection and the potential serious effects on kidney function if left untreated. We only need to check the urine again in pregnancy if you have high blood pressure or symptoms of a urinary infection.
Your LMC will organise a 12 week scan to check for any problems than can be detected early and then a detailed top-to-toe scan of baby, called a morphology scan, at 20 weeks. This is the most detailed scan of baby and a good one for your partner to come along to as well. The sex of baby maybe seen at this scan if you wish and depending on babies position.
At every visit, we measure your blood pressure. It normally decreases in the second trimester, then gradually returns to normal pre-pregnancy levels in the late third trimester. If it increases above a certain threshold, your LMC will do urine and blood tests to look for causes such as pre-eclampsia or gestational hypertension.
Your weight and height will be checked at your booking visit to calculate your Body Mass Index (BMI). This is so your LMC can check whether you are in the normal range or are underweight (low BMI) or overweight (high BMI). Being under or overweight increases the risk of complications during your pregnancy. There is a good guide to healthy weight gain in pregnancy at Health.govt.nz
Baby’s heart beat
Baby's heartbeat is monitored at every visit with a sonicaid, which amplifies the sound so you can hear it. A baby's heart rate is normally much faster than an adult, normally between 110 and 160 beats a minute.
After 12 weeks, the womb grows out of the pelvis and can be felt by the LMC to estimate fetal growth. Measuring from the pelvic bone to the top of the uterus (fundus) gives an estimate of the baby’s growth. This is known as the fundal height. By 28 weeks, the head and bottom can be distinguished, revealing how the baby is lying.
By 28 weeks, you will recognise the normal pattern for your baby’s movements. If your baby moves less than usual, contact your caregiver. Reduced movements can be a sign that your baby is no longer thriving in the womb.
Checking for Oedema
Swelling and retention of fluid in your feet and hands (oedema) occurs in 90% pregnant women and is normal in pregnancy, especially in warm weather and by the end of the day. If one leg is swollen and the other isn't, you should notify your LMC, as this can be a sign of blood clots in the deep veins of the leg called deep venous thrombosis (DVT), a condition more common in pregnant women.
Presentation, Engagement and Position
Presentation describes which part of your baby is closest to your cervix and will come out first during your delivery. This is important near the end of pregnancy, to make sure your baby is in the best position for delivery. The most common presentation is head first or cephalic. Breech presenting babies have their bottom coming first and only occur in 5% of pregnancies at term. If this happens, your LMC will discuss whether trying to turn baby is an option for you or whether a caesarean is the best way to deliver baby. Engagement is the relationship of the baby’s presenting part to the pelvis. It's descent into the pelvis is documented as the number of fifths of the babies head palpable above the pelvic brim, with 5/5 being all of babies head still felt in the abdomen and 2/5 or
3/5 meaning babies head is engaged and has descended into the pelvis. A babies head starts to engage after 36 weeks in a women having her first child. Engagement does not necessarily happen until labour in a woman who has already had a baby before, as her uterus and pelvic muscles are much more efficient at doing this during labour.
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