Pregnancy checkups and tests... What to expect? Dr Harita Kothia
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Pregnancy is a roller coaster ride for many to be moms and dads. A knowledge of what's in store is important to ease the fears a little. In this article we will know what are the routine checkups and tests to expect in pregnancy..
How many Antenatal visits or pregnancy check ups are required?
In a normal or low risk pregnancy you may see your doctor for check up as stated below.
Once a month till 28 weeks
Every 15 days till 36 weeks
Weekly till term
As complications like high blood pressure, baby growth restriction etc usually develop in the third trimester, more frequent visits are required.
If you have crossed your due date, your doctor may want to see you every 2-3 days as chances of complications increase.
High risk pregnancy like twins, previous preterm, previous high blood pressure or diabetes, bad obstetric history like stillbirth or abortions or intrauterine deaths or fetal growth restriction in previous pregnancy or any complications in this pregnancy or elderly mom need more close monitoring and doctor may schedule visits likewise.
What to expect during each doctor visit?
Your doctor will record your weight. He will ask you about baby movements and any specific complaints. Then he/she will examine you.
He will record your blood pressure and pulse. Do a quick general examination and cardiovascular, respiratory examination as needed.
Check your feet for swelling.
Then he will examine your abdomen for uterus size to see if it's corresponding to your dates. He will hear baby heart beats. He will also note the position of baby, liquor around baby and in later months fixing of baby's head, activity of uterus etc. If indicated from your complaints he may do a internal examination.
Then he will discuss the findings and give you instructions regarding medications, tests, Immunization etc.
Don't be afraid to ask too many questions. It's a good practice to note down your minor doubts and clear them on each visit. It's important to give all detailed history and information to your doctor and not take things for granted. Always discuss your worries and doubts openly with your doctor.
What tests to expect in pregnancy?
In a normal or low risk pregnancy, you may expect the following tests.
The first test is to be done when you miss your periods by a few days that is the urine pregnancy test. It can be done anytime after you miss your period or to be sure after 4-5 days of missed period. It can be done at home, better with morning first urine sample. If it shows two red lines it's positive.
Congratulations! Your journey to parenthood starts here.
The next step is to choose a doctor. Choose a good Obstetrician and gynecologist whom you trust and with whom you can discuss your problems openly and without fear.
Start folic acid tablets immediately on knowing that you are pregnant. Infact folic acid should be started few months before planning as it's proved that it decreases brain defects in the baby.
If no other issues or bad previous history, folic acid is the only thing required for the first three months. Your doctor may prescribe you some extra medication for positive history or other complaints in pregnancy.
We usually do a Dating sonography around 8 weeks to confirm the pregnancy, it's location, number of babies, whether it's matching your dates and baby heart beat etc. You may require an early sonography if you have any complications like bleeding.
Next comes the NT SCAN and dual marker at 12 to 13 weeks. Here alongwith the routine sonography we also look for markers for any genetic abnormalities in the baby like Down's syndrome. Dual marker is a blood test done along with it for the same reason.
Antenatal profile is also usually ordered in the first three months of pregnancy which includes routine blood tests like hemoglobin, sugar, urine,thyroid, viral markers, blood group etc.
You need to start iron and calcium tablets from the 4th month as requirements increase now. You need to continue these till delivery and even a few months after that.
Immunization in pregnancy include mainly a tetanus vaccination. You may opt for any of the vaccine choices like Dt or Tdap given by your doctor. We usually give two doses at 6 weeks interval.
At 18 to 20 weeks or 4.5 months we do a Anomaly scan, the single most important scan in pregnancy. It is a detailed structural scan of the baby to rule out any major anomalies. It's important to do it at specific dates given by your doctor as different governments allow termination of pregnancy till 20 or 24 weeks if any major anomalies are found in the baby.
If you are a first time mom, you will start feeling some baby movements around 20 weeks. If you are carrying your second or subsequent pregnancy you may feel them earlier around 16 to 18 weeks. It's called Quickening.
An important blood test to rule out gestational diabetes called the oral glucose challenge test needs to be done around 26 to 28 weeks. Asian population is at risk for gestational diabetes so all patients should be screened. We give a 75 g glucose load and test blood sugar 2 hours later.
No fasting is required for this test. You can do it after normal breakfast. No food or beverage should be taken after taking glucose till 2 hours upto testing. You may take plain water if thirsty.
You can combine glucose testing with other tests like Cbc or urine, thyroid if you are on medication and ICT if you have a negative blood group.
Next sonography is the Growth scan around 32 weeks of pregnancy. It's done to see the growth of the baby, baby weight, fluid around baby, placenta, baby position etc.
Your doctor may or may not order a repeat scan later in the pregnancy depending on clinical examination findings.
You may be called by your doctor for a non stress test or cardiotocography to study your baby's heart beat pattern and movements depending on the case.
Some high risk or complicated pregnancies may require special tests like NIPT, quadruple marker, fetal 2 D echo, obstetric Doppler etc. It's a exhaustive list, out of scope of this article.
Hope this article helps you in becoming a confident mom or dad to be.
Enjoy your pregnancy!!
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DISCLAIMER - These are the views of a qualified doctor and author. These are general suggestions and do not replace actual check up with the doctor. Any resemblance to anybody is coincidental.
AUTHOR INFORMATION - Dr Harita Kothia, Obstetrician and Gynecologist, Mumbai.