Ob/Gyn

Midsouth Wellness Guide

You and your Baby: Prenatal visits and tests

By Riad Homsi, M.D., FACOG
Just For Women

Pregnancy and birth are a natural part of life, but problems can arise. This is why all pregnant women should receive prenatal care as early as possible. This can include regular care visits and prenatal tests.

3-Urinalysis: Checking your urine will be done at each visit because it provides valuable information about how your body is functioning. Diabetes and other problems can be detected by testing your urine. Kidney and bladder infection can occur more frequently in pregnancy and be detected by checking your urine.

3-Syphilis: Syphilis is an STD.It can be treated. If you have syphilis and are not treated, you can pass it to your baby. Babies with syphilis have major problems. 4-Rubella: Your blood will be tested for Rubella or German measles. If you have this condition before, you are not likely to get it again. If you have not had it, you should avoid anyone who has the disease during pregnancy. Vaccines for the disease are available, but it is best not to be given during pregnancy. If you have never had German measles, you should get the vaccine after the baby is born. 5-Hepatitis B virus: Hepatitis infects the liver and can be transmitted to your baby. Hepatitis B immunoglobulin and Vaccine are available for the baby after birth. 6-Human Immunodeciency Virus (HIV): HIV is the virus that causes AIDS. Pregnant women need to be tested even if they do not have special risk factors. If the HIV test is positive, there are further tests that need to be done to conrm the result. If the test is positive, there is chance you can pass it to your baby. You can be given medication during pregnancy to reduce this risk. 7-Glucose screening test: You will be given a sugar mixture to drink to challenge your liver, and your blood is tested after an hour for the glucose (sugar) level. If the test is positive, another sugar test is done to conrm the diagnosis of gestational diabetes. Gestational diabetes is controlled by diet and sometimes Insulin. If left untreated, it has major consequences on the mother and the baby.

Prenatal Tests
A number of lab tests are recommended for all women in pregnancy. Some of these tests are done to diagnose certain problems during your pregnancy. They are called diagnostic tests. These tests are offered based on your medical history, family background or previous test results. Sometimes your ethnic background may create a need for you to be tested for problems that occur more often in your ethnic group (e.g. sickle test). Other tests do not diagnose problems. They are done to see if you or your baby is at risk of certain problems or birth defects. They are called screening tests. Lab tests done in pregnancy include samples from your blood, urine, cervix and vagina. No test is perfect. There may be a problem even if the test does not show it. Also, the problem may not exist even if the test does show it. Your fetus may also have a problem that the test was not designed to nd.

Prenatal visits
Prenatal visits allow your doctor to closely watch your health and your babys progress. During these visits, you will be examined and the growth of the baby will be checked. During your rst prenatal visit which is usually long, included are a detailed health history, a physical exam, and some lab tests, calculation of your date of delivery, and a schedule for your prenatal care visits. These visits provide a good chance to discuss any question or concerns and to learn about your pregnancy. These visits are usually spread initially and as the pregnancy progresses they will get closer. During each visit, the followings are routine: 1- Blood pressure: An abnormal increase may be a sign of problem that can affect you and your baby. Low blood pressure is rarely a reason for concern. It can occur temporarily when you lie on your back. It is preferable that you lie on your side in pregnancy. 2-Weight: A gain of 25-35 pounds in pregnancy is normal. Women who are underweight should gain about 28-40 pounds. Women who are overweight should gain 1525 pounds. Women carrying twins should gain as much as 45 pounds. Your body may also store some extra water in the tissues, and you may notice some ankle swelling. However, not everybody will follow this weight gain. Some people may add less and some may add more. Your doctor may advice how much is good for you.

Blood tests
1-Blood type and antibody screen: Your blood type could be A, B, AB or O. It can be Rh-positive or Rh negative. If your blood lacks the Rh antigen, it is Rh negative. If it has the antigen, it is called Rh positive. Problems can arise when the fetuss blood type has the Rh factor and the mother does not. The mother body may react as if it were allergic to the fetus. It will make antibodies that attack the fetuss blood. This will require special care during the pregnancy. 2-Hematocrit and Hemoglobin: The levels of Hematocrit and hemoglobin in your blood are measured to check anemia.

Cervical Tests
1- Pap smear: A pap smear may be done to check for changes of the cervix that could lead to cervical cancer. 2-Culture: A sample is also taken from your cervix to check for certain STDs, such as

June 2007 Midsouth Wellness Guide

Midsouth Wellness Guide

Gonorrhea and Chlamydia. Luckily, these conditions are treatable.

Vaginal Tests
Group B Streptococcus (GBS) testing: Group B streptococcus (GBS) is a type of bacteria that can cause serious illness and death in newborns. It is the most common cause of sepsis (blood infection) and meningitis (infection of the layer lining the brain) in newborns. Most newborn infections happen within the rst week of life. Anyone can be a carrier for GBS.The bacteria are found in the gastrointestinal tract (guts) and may move into the vagina and/or bladder. It is not a sexually transmitted disease (STD).About 1 in 4 women carry these bacteria. Most women would never have symptoms or know that they had these bacteria without a test in pregnancy. That is why toward the end of the pregnancy (35-37 weeks), your doctor will swab the vagina and rectum and send the test to the lab. For women who are GBS carriers, antibiotics before labor are not a good way to get rid of GBS.Because they naturally live in the guts, the bacteria can often come back after antibiotic treatment. However, antibiotics during labor are effective at protecting your baby because they greatly reduce the amount of bacteria the baby is exposed to during labor. The carrier status will change with every pregnancy and that is why you should be tested in every pregnancy.

Edward syndrome (Trisomy 18) is caused by an extra chromosome #18 and results in serious mental retardation and physical deformities, including major heart defects. Approximately 1 in 8000 babies is born with Edwards syndrome. Only 1 out of 10 babies affected with trisomy 18 lives past the rst year of life. The risk of having an affected child gradually increases with the age of the mother. An open neural tube defect is an abnormality of the spinal cord or brain. This occurs in 1 or 2 of every 1000 births. If there is an abnormal test screen, the baby has a 4% to 7% risk of having an open neural type defect.

Other tests
Ultrasound: It is a diagnostic test that uses sound waves to create a picture of the fetus. Early on, it cab be used to conrm pregnancy and to determine the age and location of the fetus and the number of the fetuses. During the later stages, it will show the fetus size, organs, and growth. It can detect some, but not all, birth defects. Amniocentesis: a procedure in which a small amount of amniotic uid and cells are taken from the sac surrounding the fetus and tested. Chorionic Villus Sampling (CVS) a procedure in which a small sample of cells is taken from the placenta and tested.

Genetic tests
Cystic brosis: It is an inherited genetic disease that affects the lungs and the digestive system of about 30.000 children and adults in the USA.A defective gene causes the body to produce unusually thick, sticky mucus that clogs the lungs and leads to life threatening infections, and stops the release of natural enzymes in the gut that help the body break down and absorb the food. This disease affects both males and females. It affects people from all racial and ethnic groups but is most common among Caucasians whose ancestors came from northern Europe. It is also common in Latinos and Native Americans. It is less common in African Americans and Asian American. About 1 in every 3000 babies born in the USA has CF.About 12 millions Americans are carriers of the abnormal gene. Many of them do not know that they are CF carriers. A blood test is done to detect your carrier state. If it is positive, it is recommended that you have your partner tested. If your partner is negative, your baby has 50% chance of being a carrier only. If your partner is positive, the baby has 25 % chance of having CF. Maternal analyte screen (Triple or Quad or Integrated screen) it is a blood test to check if you are at increased risk of having a baby with certain birth defects or genetic defects. It is a screening test only. It does not provide a diagnosis. It is not 100% accurate. Some defects may be missed or the results may be abnormal when the baby actually does not have one of these conditions. If there are abnormal results, further testing are needed to know more about the baby condition. This test shows if you are at increased risk of having a baby with Down syndrome, Edward syndrome, or an open neural tube defect. Down syndrome (Trisomy 21) is caused by an extra chromosome#21 and results in both mental and physical abnormalities. It is the most common cause of mental retardation. Approximately 1 in 800 babies is born with Down syndrome. The risk of having a baby with Down syndrome gradually increases with age of the mother, but can occur at any age. If the test is abnormal, the baby has a 1% to 2% risk of having Down syndrome.

About the Author

Riad Homsi, MD, FACOG is a Board certied Obstetrician/Gynecologist and Menopause Practitioner. He is the director of the practice Just For Women, located at 6025 Walnut Grove, suite 400, Memphis,TN 38120.For more information, please call (901) 50-STORK or visit www. justforwomendoc.com

June 2007 Midsouth Wellness Guide