Throughout pregnancy, you will be offered a number of routine tests and checks to keep a close eye on your health and the development and wellbeing of the little life growing inside you. These tests are not compulsory, so you can choose to refuse them if you wish. They are, however incredibly useful to help identify problems and to monitor and treat any complications as promptly as possible. Your doctor should talk through the reasons for any tests, so you can assess the pros and cons and make an informed and intelligent choice.
At each antenatal appointment, you'll have a blood pressure measurement to check for pre-eclampsia, and a urine test to look for blood, protein and glucose. These can be an indication of infection, pre-eclampsia and gestational diabetes. You'll also be offered a number of blood tests to monitor your wellbeing throughout your pregnancy.
Monitoring your baby's health
Checking your baby's growth
As your baby grows, your bump will expand too. Your doctor or midwife can keep a close eye on their healthy development by measuring the size of your bump. By 20 weeks the womb will have reached your tummy button. That's a convenient 20 centimetres from your pubic bone. It will continue to swell by a centimetre a week, so these measurements can be plotted on a graph to show a safe and steady pattern of growth, or to quickly identify any problems so your baby can have further investigations.
Doppler Scans
Whenever we spot growth problems, it's important to keep a close eye on the baby, especially towards the end of pregnancy. A scan may be arranged to repeat the measurements. If there are concerns, a Doppler scan may also be offered. That's a special type of ultrasound that measures blood flow in different parts of the baby, including the umbilical cord, the brain, and the heart.
A scan can give us a much better idea of how well the placenta is functioning. The placenta is the baby's life-support machine. If blood flow is decreased, the baby won't be getting the nutrition they need. That can significantly affect their growth, so we have to consider whether they are still safe within the womb and balance that against the risks of a premature birth. Sometimes the baby may be better off if they are delivered early.
Abdominal examination
The experienced hands of your pregnancy doctor or midwife can provide an enormous amount of information about the baby growing in your womb. They can identify movements, check position and see whether their head has started to move down into the pelvis ready for birth. They will also listen to the magical thump of your baby's heartbeat using a stethoscope or hand-held Doppler device.
In addition to these routine checks and measures you will also be offered a number of other screening tests and scans, or if you are thought to be at risk due to your age, your family or your medical history, diagnostic tests to identify certain genetic or chromosomal conditions may be suggested.
Ultrasound Scans
Your pregnancy ultrasound scans
The monochrome ultrasound images of your baby's dating scan usually offer the first picture of your beautiful baby. I say beautiful, but try to remember that ultrasound uses sound waves to develop an image of your baby. The waves bounce back from solid objects like bone and pass through liquids, so the scan sees all the way through your baby's skin to show the internal organs and structures. Believe me, all babies look a little like extras from Lord of the Rings!
Scans provide fantastic information; I can check the chambers of the heart, look for cleft lip and palate and examine the fold of fluid behind the neck. But it's not useful if you'd like to see a picture of your baby looking like... well, a baby.
"Sometimes silence is scary during a scan, but it is mostly concentration on their part. One doctor thought my baby was measuring quite small and made me have more appointments than usual, but I asked plenty of questions to get reassurance that all was OK. That would be my piece of advice — if you feel unsettled, or have a question, ask it. Don't feel silly or whatever — your baby is the most important thing and it's important you understand what is happening to it and to you!"—Lindsey, Kilkeel
In the UK, pregnant women are offered at least two ultrasound scans during their pregnancy:
1. The dating scan - This ultrasound is carried out between 8 and 14 weeks. Your doctor or sonographer will check your pregnancy is progressing well, take a look to see if more than one baby is nestling in your womb and carefully measure the baby so the estimated date of delivery can be calculated. At this stage, a fold of fluid at the back of the neck called the nuchal fold may also be measured as part of the combined screening test for Down's syndrome.
2. The anomaly scan - This is a more detailed scan offered to every pregnant woman between 18 and 21 weeks. The sonographer will check that your baby has continued to grow at a healthy rate and will also check for any structural abnormalities. They will examine the chambers of the heart, the organs, the spine and the limbs and they'll also look at the face to check for cleft lip and palate. The scan will also show the position your baby is lying in and the location of the placenta.
"At my second scan at twenty weeks they picked up potential placenta praevia. It was frightening because I didn't know what this was, and the sonographer didn't give me much information. I was booked in for an extra scan for this at thirty-two weeks and then thirty-six weeks, when the placenta finally moved enough to have a natural birth."—Sam, Northfield
Boy or girl?
To know, or not to know, that is the question. Your doctor or scanner will check your baby's genitals but actually discovering the sex of your baby isn't part of the screening programme. However, different hospitals have different policies. If you'd like to know, ask the sonographer at the beginning of the scan.
But, be warned, even if they're happy to look it's not always possible to tell. Your baby may be demurely crossing their legs; they may be in an awkward position or it may be tricky to tell. Take my advice and don't splash out too much on pink or blue baby-grows unless they're really confident.
Can I have someone with me?
Having a scan can be an exciting but also a frightening time. You may be able to see your little one waving at you or sucking their thumb. Sadly, some people discover that there are problems with the baby, so it's a good idea to have a friend, partner or family member with you when you attend to provide support. There's not usually any childcare available, so it's important to arrange for someone to babysit any other children.
When will I get the results?
The results are immediate and the sonographer is usually able to tell you everything on the day. However, if they are struggling to see some details clearly or are concerned there may be a problem, they may ask for a second opinion. Sometimes you will be offered further tests, scans or a referral to a specialist fetal medicine consultant, like myself, to find out more.
Say cheese!
At most hospitals, you can get a printed picture of your scan, although there is often a small charge. Check with your unit for their policy and you'll have the first picture for your new family album.
Can I say no?
Ultrasound scans are considered safe for both mum and baby and can provide useful information. However, you don't have to have a scan, and if you refuse your choice will be respected.
If you are uncertain about scans because you know you will proceed with the pregnancy, no matter what anomalies and problems are shown, it is worth chatting through your concerns with your midwife or doctor. Scans are about much more than looking for abnormalities. They can also provide accurate information about the position of the placenta, whether you're having twins and your baby's growth. Put simply, they will help increase the chance of you delivering your baby safely.
Testing for chromosomal abnormalities
Chromosomes are long, thread-like structures made up of DNA and proteins. They store the genetic information that controls everything from the colour of our eyes, to our sex and our tendency to develop disease. Sometimes there can be problems with the chromosomes, leading to babies being born with syndromes that can affect their appearance, health and intelligence.
Screening can provide you with early information about your specific risk of having a baby with damaged or extra chromosomes. Knowledge gleaned from scans and blood-tests can be used to determine your risk of carrying a baby with the more common of these conditions, these include:
- Down's syndrome, where there is an extra copy of chromosome 21, known as trisomy 21
- Edward's syndrome, where there is an extra copy of chromosome 18, or trisomy 21
- Patau's syndrome, which is trisomy 13
Screening
In the UK, screening tests are offered at around 12 weeks. However, if you book a little later, there are alternative options.
The combined test
The combined test is done when you are between 11 and 14 weeks pregnant. You will have a blood test to check for specific proteins in your blood, and an ultrasound scan, in which a specific fold of fluid that's found behind your baby's neck is measured. The blood test results, together with the information from the nuchal translucency scan are combined with your risk factors and your age to calculate your statistical risk of having a baby with a chromosomal condition.
The quadruple test
The quadruple test can be performed later than the combined test, so it can be used if you have booked late. It is ideally done between 16 and 19 weeks, although it can sometimes be carried out as late as 22 weeks if necessary. The clue is in the name; it's a blood test that tests for four different proteins. The results are fed into a computer programme, together with your age and other risk-factors, to work out the likelihood of your baby being affected by a chromosomal abnormality.
Non-invasive prenatal testing
NIPT is a new, simple blood test that can detect fetal cells in the maternal circulation. These cells can be tested to find out the baby's sex and to check for chromosomal abnormalities like Down's syndrome. Although it is a screening test, it can accurately identify Down's in 99.9% of cases.
A matter of choice
Remember, you don't have to have these tests. And if you do get a positive result, it doesn't mean that there will be any pressure to have further investigations or to terminate. Instead, it can be an opportunity to think, talk to your partner and make a considered choice that's right for your family.
Frequently Asked Questions
No. These tests are not compulsory, so you can choose to refuse them if you wish. They are, however, incredibly useful to help identify problems and to monitor and treat any complications as promptly as possible. Your choice will always be respected.
Your doctor or midwife will measure the size of your bump. By 20 weeks the womb will have reached your tummy button - that's a convenient 20 centimetres from your pubic bone. It will continue to swell by a centimetre a week, so these measurements can be plotted on a graph to show a safe and steady pattern of growth, or to quickly identify any problems.
A Doppler scan is a special type of ultrasound that measures blood flow in different parts of the baby, including the umbilical cord, the brain, and the heart. It may be offered if there are concerns about your baby's growth, as it gives a much better idea of how well the placenta is functioning.
Discovering the sex of your baby isn't part of the screening programme, and different hospitals have different policies. If you'd like to know, ask the sonographer at the beginning of the scan - but be warned, it's not always possible to tell if your baby is in an awkward position.
The combined test is done between 11 and 14 weeks and uses both a blood test and a nuchal translucency scan. The quadruple test can be performed later - ideally between 16 and 19 weeks - and is a blood test that checks for four different proteins. It is useful if you have booked your antenatal care a little later.
A positive result doesn't mean that there will be any pressure to have further investigations or to terminate. Instead, it can be an opportunity to think, talk to your partner and make a considered choice that's right for your family.
This post is adapted from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.