Necessary Tests During Pregnancy
Pregnancy is a miraculous condition and a process in which the expectant mother should be well-informed.
Various analyses and tests should be performed at different stages from the beginning to the end of pregnancy. In fact, some tests should be done before pregnancy, when couples decide to conceive; that is, it is more appropriate for couples to receive preconception counseling, and most importantly, to make a firm decision to become parents. Some tests must also be performed during specific weeks of pregnancy. Therefore, these tests should be carefully followed and their timing should not be missed. Some tests performed during pregnancy are routine for every pregnant woman, while others are only performed in certain situations.
In addition, ultrasound and physician examinations are required every month in the first 32 weeks, every 15 days between weeks 32–36, and at least once a week after the 36th week.
Tests performed at the first examination:
These tests are performed when the couple first consults a doctor. The most appropriate approach is for couples to consult a doctor before pregnancy occurs, when they decide to conceive, and to have these tests done during that visit. Because some abnormalities that may be detected in these tests can be managed before pregnancy even begins. However, most couples apply to the doctor after pregnancy has already occurred (after a missed period). During this first visit, the female genital organs are evaluated through gynecological examination and ultrasonography. If it has not been done within the last year, a PAP smear test should be performed. A general systemic examination may also be carried out, and if systemic diseases (such as diabetes, hypertension, etc.) are present, consultation with the relevant specialist may be required. Tests performed at the first examination:
v Complete blood count (Hemogram)
v Blood groups of the mother and father: to take precautions if blood incompatibility is detected.
v Indirect Coombs test if there is blood incompatibility
v Complete urinalysis (Urine culture if necessary)
v TSH: If the mother has goiter or thyroid hormone disorders, it may affect the baby; if detected, treatment by an endocrinology specialist is required.
v Toxoplasma IgM and IgG: A screening test for a parasitic infection transmitted through cat and dog feces, raw meat, and unwashed vegetables.
v Rubella IgM - IgG: Tests that indicate whether the rubella vaccine is effective and whether there is an acute infection
v HBsAg for Hepatitis B: If hepatitis is detected in the mother, Hepatitis B Ig serum is administered to the baby after birth to prevent transmission.
v HCV test
v HIV (AIDS) test
v VDRL test for syphilis is not routinely required but may be performed.
v In patients at risk for diabetes, fasting blood glucose or HbA1C test showing the average blood sugar level over the last 3 months
v Biochemistry tests (cholesterol, kidney and liver, etc.)
Between 11-14 weeks:
After the 11th week of pregnancy, during ultrasound examination, the baby’s nuchal translucency (NT), CRL (crown-rump length), and nasal bone (NB) are measured, and the double screening test (blood test) is performed. It is called a double screening test because two parameters are evaluated. Since it is a probability test, if the risk is above the threshold value, more comprehensive tests such as amniocentesis should be performed. This test can be done between 11–14 weeks and cannot be performed after the 14th week.
With the Prenatal Pregnancy test, which has been used for approximately the last 10–12 months, chromosomal abnormalities can also be detected. Since it can be performed using only maternal blood from the 9th week of pregnancy, it is completely safe. In this test, fragments of DNA from the baby’s cells present in the mother’s blood are analyzed, and chromosomes can be examined in terms of number and structure. The results of this diagnostic test are accurate at a rate of 98–99%. The only drawback and the reason it is not yet widely used is its cost.
Between 16-20 weeks:
During these weeks, the triple test or quadruple test is performed.
If the results of the double, triple, or quadruple tests are risky, further examination can be performed by amniocentesis (inserting a needle into the womb under ultrasound guidance and taking fluid from around the baby). The reason amniocentesis is not performed on everyone is that it carries risks and may lead to pregnancy loss.
Between 24-28 weeks:
The 75 g glucose tolerance test is performed between 24–28 weeks. In patients who miss these weeks and present later, fasting and postprandial blood glucose levels can also be evaluated to determine the patient’s predisposition to diabetes.
If there is blood incompatibility between the parents, IDC (indirect Coombs test) is performed at the 28th week, and if this test is negative, it indicates that there is no effect due to blood incompatibility between the mother and baby. If there is an effect (if the indirect Coombs test is positive), further tests are performed to determine the extent of the effect on the baby.
The tests described above are routine tests performed in almost every pregnancy. In some conditions and diseases that develop during pregnancy, additional tests beyond those mentioned above may also be required.
Between 34-36 weeks:
Blood count and complete urinalysis should be repeated.
After the 32nd week of pregnancy, especially in the last weeks, if it is suspected that the baby is in distress in the uterus or for routine monitoring, a biophysical profile assessment should be performed. This consists of five parameters, four evaluated by ultrasound and the fifth being NST (Non-stress test, fetal monitor). Thus, the stress factors of the baby in the uterus near delivery are evaluated. Doppler ultrasound can also be used additionally. In this multidisciplinary follow-up, monitoring the baby’s movements by the mother is also a part of the process. Regular follow-up, general routines, and individualized monitoring are very important for a healthy pregnancy.
Wishing you a stress-free but attentive pregnancy.
Remember that serious problems related to the mother and baby occur in pregnancies that are not properly monitored
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Op. Dr. A. Refik KELEŞ Obstetrics and Gynecology Specialist / İRENBE