Tests necessary during pregnancy

All the information you need to know about pregnancy checkups

Congratulations: the test is positive. You are expecting a baby! Now you have to take great care of yourself and avoiding anything that may harm the baby that is growing inside you.

To see how the fetus is developing and the well-being of the expectant mother, various medical tests are carried out in pregnancy. Therefore, you must arrange a doctor's appointment as soon as possible to confirm the pregnancy and be sent for initial tests.

1. A visit to the gynecologist once a month

At the first appointment, the gynecologist will send you for a comprehensive blood and urine test to confirm the pregnancy, check the state of your health and rule out any infectious diseases such as: HIV, Hepatitis B or syphilis, and to check if you have ever had rubella and toxoplasmosis (a minor illness for adults but very serious for a developing fetus) and a cervical screening to rule out vaginal infections.

Through Social Security, you usually have to attend your family doctor to be referred to the gynecologist who will manage your pregnancy. To save time, the doctor usually orders the initial blood tests and the cervical screening (performed by the midwife in the medical practice).

In fact, both in the public and private healthcare channels, once the pregnancy is confirmed, the gynecologist will take an exhaustive medical history to know if there are any special conditions to take into account (diabetes, heart problems, severe illnesses, etc).

Then, they will recommend that you take the supplements that they consider necessary: folic acid (if you were not taking it already), and iron or iodine if you have any deficiencies. After this first visit, you will see your gynecologist regularly for monitoring of the pregnancy. In all visits, the specialist will take your blood pressure and weight, and will answer any questions you may have about the pregnancy and how to take care of yourself. In private healthcare, checkups are monthly.

In Social Security healthcare, they may be a little more sporadic, depending on the region in which you are located and even the hospital you are attached to, but there is usually additional contact with the midwife of your medical practice.

2. There will be at least three ultrasound scans

Ultrasound scans are very useful to check the child's development and well-being in the uterus. They are non-invasive tests that have no negative impact on the fetus, so as many can be performed as your doctor considers necessary.

The Social Security standard is a minimum of three ultrasounds (one per trimester), although more can be performed if necessary. In private healthcare, ultrasounds tend to be more frequent. Some doctors perform an ultrasound every month. An ultrasound also tends to be used to confirm the pregnancy.

In all the ultrasound scans, the size of the baby is measured, as is their movements and heartbeat, the amount of amniotic fluid and the position of the placenta, and the likely due date is calculated.

First trimester ultrasound: Around week 12

This ultrasound scan, which is usually vaginal, is to check if there is more than one baby, and to measure the nuchal fold of the fetus, to assess the risk of chromosomal abnormalities.

Second trimester ultrasound: At week 20 of gestation

This is to observe the internal organs of the fetus to check that the baby is developing well. You can usually discover the gender of the baby, if it is in the right position.

Third trimester ultrasound: Around week 34

This is to once again assess the growth of the fetus and look at its position for labor. If it is a breech position, another ultrasound is often performed to check whether the baby's head has engaged.

3. Special ultrasounds

There is another type of ultrasound scan reserved for special situations:

3D or 4D ultrasound scans

These are used in addition to traditional scans. They both show the fetus in a 3D dimension, and 4D shows movement. They can help to detect skin problems or cleft lip deformities, but they do not offer information on other anomalies that show up in normal ultrasound scans. They are very exciting for expectant parents, because they let you see your baby much more clearly.

In Social Security they are used in certain hospitals, wherever considered necessary. Some private insurance covers 3D ultrasound, but 4D comes at an additional cost.

Ultrasound scan with Doppler technology

This is performed when it is necessary to observe the circulation in the fetus, the umbilical cord and the uterus, because it can reveal heart or circulation problems.

4. Laboratory tests

During the pregnancy, at least one blood and urine test per trimester is performed.

There are also some special laboratory tests to detect possible problems:

Coombs test:

If the mother is Rh-negative and the father Rh-positive, the first blood test checks if the fetus has antibodies in the blood against Rh-positive. The test is repeated later in the pregnancy in case antibodies have been created, and as a precaution, in week 28 the expectant mother is given Rho(D) immune globulin, which is repeated after birth if the baby is Rh-positive, to protect future pregnancies.

O’Sullivan test:

At week 24 of pregnancy, a special blood test is performed to assess the concentration of sugar in blood and to promptly detect gestational diabetes that could cause problems for the fetus. If the test is positive, a glucose tolerance test (oral overload of glucose) is performed to confirm the diagnosis.

All these test are included in public healthcare and private health insurance.

In the public healthcare, the standard is a minimum of three ultrasound scans, one per trimester. In private healthcare, ultrasounds tend to be more frequent.

5. Prenatal diagnosis

One of the things that most worries expectant parents is the possibility of their baby suffering from a genetic disorder. Between week 10 and week 14, prenatal diagnostic tests are performed to calculate if there is any risk, and whether it would be appropriate to perform other invasive tests (such as amniocentesis).

The first trimester blood test measures the amount of certain hormones and proteins related to certain chromosomal abnormalities such as Down's syndrome.

The results se evaluated together with the ultrasound scan of the nuchal fold and the personal circumstances of the mother, such as age. If the risk is high, the doctor may recommend an amniocentesis (between weeks 14 and 18).

Before making that decision, through private insurance an additional, non-invasive test can be carried out at an additional cost: a non-invasive prenatal test, through a blood test, detects Down's syndrome and other anomalies such as Patau syndrome or Edwards's syndrome. This fetal DNA blood test is now offered in certain public hospitals.

6. Postpartum tests

About four weeks before the expected due date, around week 36 of pregnancy, a vaginal and rectal swap is taken from the mother to rule out the presence of a bacterium called streptococcus agalactiae. If there is, the mother is given antibiotics during labor to avoid the baby catching an infection.

Towards week 40 (for Social Security) or from week 37 (for private insurance), weekly monitoring begins of contractions and the baby's heartbeat.

The pregnancy usually lasts 40 weeks, but it is also normal for the baby to be born between week 37 and week 42. Ideally, the baby arrives naturally, but if by week 42 there are no signs of it wanting to come out, an induction is planned.

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