Prenatal Testing and Monitoring

Your First Prenatal Visit

During your first prenatal visit, you and your care provider will talk about what you can expect during your pregnancy. This will be an opportunity for you to ask questions and for you and your caregiver to make a schedule for future visits.

Your caregiver will suggest some tests to assess your health and to help identify any possible risks for you and your baby. These tests will require taking three or four vials of blood to test for the following:

• Blood type, including your Rh factor
  If your blood type, particularly your Rh factor, is different than your baby's, your immune system may react to your baby's blood. Although this is rarely a problem during a first pregnancy, antibodies created during the first pregnancy can threaten subsequent pregnancies. This was a major risk in the past, but these problems can now be easily prevented.

• Rubella (German measles)
  Most Canadian women are either vaccinated for German measles during childhood or have had this illness early in life. This makes them immune to further infection. This test is done to determine if the woman is immune. If a woman gets rubella during the early months of her pregnancy, it can cause birth defects.

• Anemia
  Anemia means you have too few red blood cells. This is usually caused by an iron deficiency. Since your red blood cells carry oxygen to your body and to your fetus, it is important to have anemia treated as soon as possible. For anemia, most doctors will simply recommend an iron supplement.

• Hepatitis
  Hepatitis B is an infectious disease that can damage your liver. Although it can cause serious damage, many women are infected without having any symptoms at all. Children that contract this infection from their mother during the birth are at high risk of liver disease. This test checks to see if you are infected. If so, your baby can be vaccinated just after birth and have followup vaccinations to protect against infection.
  

• The VDRL
  This blood test checks for syphilis. Untreated syphilis can cause a stillbirth or neurological damage to your child.

• Genetic Disorders
  Certain genetic conditions are more common among people from specific ethnic groups. For example, Ashkenazi Jews and French Canadians are at higher risk for Tay-Sachs disease. People of African, Mediterranean and Hispanic backgrounds are at higher risk for sickle-cell disease. People of Mediterranean and Southeast Asian background are at increased risk for Thalassemia.
  

  If you are at a higher risk for certain disorders, a blood test can be done, either before or while you are pregnant, to determine if you are a carrier. People who are carriers usually have no symptoms themselves. If both parents are carriers of one of these disorders, there is a 25 percent chance that they will have a baby with the disease, and a 50 percent chance they will have a child who, like them, is a carrier but has no symptoms.

Your caregiver will answer any questions you have about these tests. He or she will also ask about your relationships, the social support available to you and the relationship between you and your partner. Pregnancy is an opportunity for some women to confide in their caregivers about issues like domestic violence and to get help in dealing with these issues.

Your caregiver will also ask about your sexual history and your risk of sexually transmitted diseases. In some parts of Canada, a doctor is now legally required to offer you an HIV test (to test for the virus that causes AIDS). You can refuse this test if you wish. However, if the test is positive, treatment can markedly reduce the risk to your baby, if it is started promptly. Your doctor may also suggest taking swabs to test for other sexually transmitted infections like chlamydia and gonorrhea.

Subsequent Visits

During each prenatal visit, your caregiver will do a routine physical exam. In addition to listening to your heart and breathing, you caregiver will also be able to listen to the fetal heartbeat as your pregnancy advances. Your blood pressure will be monitored regularly. Some pregnant women (6 to 8 percent) develop pregnancy-induced hypertension (PIH) or a more serious condition called preeclampsia, midway through pregnancy. If this condition is severe, the baby may have to be delivered early, usually in the last few weeks of pregnancy.

There are several screening tests, which are often used to monitor a pregnancy. Screening tests like an ultrasound are offered to all pregnant women, to detect pregnancies at higher risk. There are also diagnostic tests that can be done, if problems are suspected.

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