Having a baby in the UK is safer than it's ever been. This is partly due to the regular monitoring and tests carried out throughout your pregnancy - designed to ensure all is well with you and your baby's health.
Many tests, such as urine and blood tests, are carried out routinely as part of your regular antenatal appointments. Others are optional and may carry a small risk of miscarriage - such as the amniocentesis test for Down's syndrome. That's why the decision as to whether to take certain tests is not always straightforward.
This guide is designed to arm you with the key information you need to know about antenatal tests. That way you will be able to feel fully involved in your antenatal care and make informed decisions about testing, should you need to.
Routine check-ups and tests
Most tests take place as part of your regular antenatal
appointments with your midwife or doctor. Antenatal care arrangements differ
depending on where you live. You may be asked to attend your local surgery for
your antenatal visits, alternatively you may need to go to hospital - or both.
Who will look after me?
Increasingly, midwives are taking on more antenatal care.
However, a midwife will automatically refer a mother-to-be to her doctor or a
consultant if she feels there is a need, or if the woman requests it.
How often will I see someone?
Midwife Sue Jacob, a Royal College of Midwives spokeswoman, says
women usually have an antenatal appointment once every four weeks until 28
weeks into pregnancy, then every fortnight until 36 weeks, and then weekly
until delivery.
However, she added that recent medical research has concluded that women don't need that many checks - about six to eight visits in total. But midwives feel that extra sessions are necessary to provide social support, health education, reassurance and advice on any aspect of pregnancy, birth and parenting.
What are the routine tests?
Blood tests
The initial blood sample will also be tested for syphilis and
to check your immunity to rubella since the rubella virus can cause severe
abnormalities in unborn babies. All women should now be offered an HIV test.
Much can now be done to reduce the risk of a mother transmitting HIV to her
unborn baby.
Urine tests
Glucose may indicate diabetes, in which case further tests
will be required. High levels of protein may indicate a condition called
pre-eclampsia. This is a form of high blood pressure that affects 10 per cent
of first pregnancies. If untreated, it can lead to serious complications.
Blood pressure
Ultrasound
Ultrasounds are also used to detect foetal age, position,
expected date of delivery, as well as some major abnormalities.
Some women may be offered an ultrasound scan at their first
appointment, but most have one at 14 to 16 weeks to confirm the baby is
developing normally and again at 28 weeks. There are no known side effects of
ultrasound scans.
Foetal heartbeat
What non-routine or optional tests may be performed?
Amniocentesis
What are the risks?
After the test you will be advised to spend a couple of days
at home taking it easy to minimise the danger of miscarriage.
When do you get the results?
Chorionic villus sampling (CVS)
What does it involve?
What are the risks?
When do you get the results?
What are the risks of Down's syndrome?
Support groups
Antenatal Results and Choices (ARC), 73 Charlotte Street,
London, W1P 1LB. Helpline: 020-7631 0285. Email: arcsatfa@aol.com.
A blood sample will be taken at your first appointment to
establish your blood group and haemoglobin (red blood cell) level to check for
anaemia. If the test shows that your haemoglobin levels are low, you may be
prescribed iron tablets to correct this. You may also need further blood tests
to check that the tablets are being absorbed properly, which can be a problem
for some women.
Your urine will be tested regularly for the presence of
glucose and protein at every routine antenatal appointment.
Your blood pressure will be taken at your first appointment
and at every check-up from then on. In the case of an abnormally high or low
blood pressure, you will need to be closely monitored.
Ultrasound not only allows you to see your baby on screen but
also enables your midwife or doctor to pick up a problem with the pregnancy, eg
if your baby is not growing at a normal rate, or if the placenta is in an
abnormal position. In such cases you may be asked to return for a follow-up
scan.
Your baby's heartbeat will be monitored at each visit to check
it is alive and that the heartbeat is normal. This is done using an instrument
called a doppler, which is placed against your abdomen, or as part of an
ultrasound scan.
Amniocentesis is normally carried out at 16 to 19 weeks. It is
used to diagnose Down's syndrome, other genetic abnormalities, and spina
bifida. Because the risk of having a Down's baby is higher in older women, the
test is generally offered to mothers-to-be in their late 30s. Amniocentesis is
also available if the triple test has shown a high risk factor, or if the
doctor recommends it.
There is a small risk (up to 1 per cent) of triggering
miscarriage, and a further 1 per cent risk that the test may be inconclusive.
Some women believe the risks associated with the tests outweigh the risk of the
baby being abnormal - and for that reason decline the test.
The results can take up to three to four weeks. This means
that in the case of a positive result, some women may face a decision on
termination halfway or even further through their pregnancy, which naturally
can be very traumatic.
Using an ultrasound as a guide, a fine needle is passed
through the woman's abdomen, or vagina and cervix, into the developing placenta
and a tiny piece is removed. The procedure tends to be uncomfortable rather
than painful and the results are ready in 7 to 10 days.
CVS is used less often than amniocentesis as it carries a
higher risk (up to 2 per cent) of miscarriage, plus a further 2 per cent risk
that the results may be wrong.
The results are processed within 10 days. The one major
advantage CVS has over amniocentesis is that it is performed much earlier in
pregnancy, so a decision at this stage over termination may be less traumatic.
On average, one in every 1,000 babies born in the UK will have
Down's syndrome. The risk increases with the mother's age, particularly after
35, as shown in the list below.
Down's Syndrome Association, 155 Mitcham Road, London, SW17 9PG.
Tel. 020-8682 4001. Website:
www.dsa-uk.com. Email: info@downs-syndrome.org.uk.
The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use
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