Common tests offered in pregnancy

With any test it is so important to ask the question- What is this information going to give me? Will it change any outcome or how I proceed with this pregnancy?

Using your BRAIN is the best way to talk through all the options available to you and find out what feels right for you. Remember every one interprets risk differently. This is your baby and your body, not your next door neighbours, your mothers or your best friends!

B- benefits- What are the benefits of doing this? What information will this give me?

R- risks- What are the risks involved in the test/procedure? What are the risks involved of the treatment/investigation that may be required/suggested?

A- alternatives- Is there another way to gather the information that they are trying to acquire?

I- intuition- nothing as powerful as a mothers intuition. Trust.

N- nothing- What are the consequences of doing nothing?

At face to face Checkups-

Blood pressure- every visit. The are checking for an abnormal increase in blood pressure that can sometimes occur in pregnancy (Pre-eclampsia)

Fundal check- they measure the size of your tummy from pubic bone to top of uterus, after about 25/26 weeks. Within 2cm of your gestation is NORMAL (ie- 32 weeks gestation and measuring 30 or 34 is absolutely fine)

Abdominal palpation happens anywhere from 28 weeks but definitely should happen at visits after 34 weeks. This is to check positioning and also size.

Fetal heart rate- listen to your babies heart rate via doppler

Urine- checking for protein (can be a sign of pre-eclampsia) and infection

U/S- there is no current evidence to suggest anymore ultrasounds than dating/12 week/20 week, if no signs of concern. U/S only started being using in the 1970’s after being discovered during WW2. In relative terms we are still in very early days of evidence around the safety of U/S. U/S uses high frequency sound-waves to gather the information. Always ask yourself the question-what information are we trying to gather from this scan and is there any other way to get that information.

Gestational Diabetes Test (GTT)- 

What is it? 

This is a blood test to detect how your body is reacting to a sugar load. Sometimes in pregnancy our hormones can interfere with the absorption of insulin resulting in a higher blood sugar level. 

How is it done?

You will need to fast (nothing but sips of water) overnight, then a blood test is done, straight after the first blood test you will drink a sugar drink within 5 minutes, then have 2 more blood tests at 1 hr and 2 hrs post the drink.

Why might you need this test?

Its to detect if you are having too much sugar floating around in your system, therefore your baby will be receiving a higher amount of sugar than ‘normal’ and can subsequently have a little bit more body mass.

Why does that matter?

Sometimes when we have larger babies due to a condition such as GDM (not just because we have the natural ability to make a bigger baby!!!) they can grow a little too big for your pelvis and therefore make for a tricky birth. 

Am I at risk?

Like most things there are some people that are more at risk of GDM. Family history (or personal) of either GDM or Type 2 diabetes, increased BMI, sedentary lifestyle, over 35 years old, excessive weight gain in the first 2 trimesters. Its important to note here that as gestational diabetes is more of a pregnancy hormone imbalance this can effect anyone, even those living a very healthy lifestyle.

Any concerns with the test?

Current evidence suggests that the drink is safe to have in pregnancy, and although a blood test is invasive no long term consequences. There is some discussion (not evidencel) as to whether low risk woman should be putting their bodies under the pressure of dealing with such a large sugary load. 

What if it comes back positive?

I guess this is the important part of any test. If your test is positive, you will be considered a GDM. Initially you will need to monitor your own blood sugar by finger prick testing and monitor your diet for a week or two to see what your levels are doing. Once a pattern is established you will work with your care provider and a diabetic educator to discuss ways to help you try and achieve sugar levels within normal range. Sometimes the help of medication is needed to help control the level within normal limits. Its important to remember that if sugars remain within normal range without medication then the risk factors associated with GDM (big baby and placental insufficiency) are significantly reduced.

Blood tests-

Blood tests done later in pregnancy are monitoring your iron levels and Platelet levels mostly. Iron is an important factor in your energy levels and ideally wouldn’t be too low going into birth (we have blood loss in birth which can further decreases these levels). Platelets and a few other things they are looking for, can help explain some conditions of pregnancy.

GBS swab- Group B Streptococcus, or gram B streptococcus.

What is GBS?

Group B Streptococcus or gram B streptococcus.

GBS is a normal bacteria found within the vagina and anus areas. Approximately 20% (1 in 5) of women will have GBS colonised at any given time. This is a transient bacteria and commonly has a life cycle of 5 weeks. You will most likely be asymptomatic.

How is it done?

Mostly, you will be offered a swab to do yourself. You will be instructed to insert the tip of the swab just inside the vagina and sweep out passed the anus. 

Why might you want to have this test?

GBS can cause a very serious infection in a newborn that passes through the vaginal passage. If the baby picks up some of the GBS there is a risk that the babies immune system won’t be ready for the bacteria and can get sepsis (whole body infection), resulting in a very sick baby.

What if I test positive?

The normal course of action is prophylactic antibiotics (usually penicillin) given to you once you are in established labour (or if your waters break, therefore allowing the bacteria to crawl up into the uterus). The Antibiotics cross the placenta and give the newborn antibiotic cover in those first few days of life to help fight off the bacteria.

Whats the risk of my baby getting sick?

There is a 20%/1in 5 chance of being GBS positive at birth.

Of those positive, the baby has a 1 in 200 chance or 0.5% chance of severe sepsis, if no prophylactic antibiotics are given.

There are signs of infection that we can look for in the newborn-an increase in temperature is the biggest indicator of infection. Within most hospitals babies of mothers that test positive have their temperature checked every 4 hours for 24-48 hours hours after birth. 

If a baby does become septic, intravenous antibiotics will be required and admission to the special care nursery.

Why might I decline this test?

There is some evidence that prophylactic antibiotics are an unnecessary risk to both the mother and a neonate. Some practitioners believe the relative risk of infection is not comparable to gross exposure to antibiotics. Antibiotics do change the flora of the gut. Again, antibiotics are a magnificent drug that has helped saved many lives, but with everything there are pros and cons. Some hospitals within Australia are now only testing ‘high risk’ women.

Some women, have the test and if positive have the antibiotics, have the test and if positive decline antibiotics but keep a close on on signs and symptoms of their baby once born, decline the test and monitor their baby closely in the 24-48 hours post birth. Some women believe that this is not a cause for concern.

CTG- cardiotocography-

What is a CTG?

Cardiotocography, better known as a CTG or baby monitor.

CTG is the continuous recording of the fetal heart rate and uterine contractions obtained via an ultrasound transducer placed on the mother’s abdomen.

How is it done?

Done by a midwife. There is one ultrasound circular ‘plate’ and one pressure circle ‘plate’ that attaches to the outside of the woman’s abdomen. The ultrasound toco is listening out for the baby’s heartbeat sound and the pressure toco is placed at the top of the uterus to measure the strength of the uterine contractibility. A CTG must be on for at least 10 minutes, but it is not uncommon for it to need to stay on for 30-60 minutes. 

Why would I need one?

Sometimes practitioners may wish to check the ‘health’ of the baby. CTG’s should really only be done on high risk women/pregnancies or on women reporting decreased/changed fetal movements. 

It is not recommended in pregnancy and labour ‘just because’. 

Sometimes in labour, hospitals decide to do a CTG at the beginning of labour. Discuss this with your care provider and decide if this is something you are willing to have.

The evidence?

The evidence suggests for low risk pregnancies, there is no benefit in continuous CTG monitoring in labour. In fact, the evidence suggests that it decreases the woman ability to move freely, and increases the risk of Caesarean and instrumental delivery. 

VE AND STRETCH AND SWEEP

A vaginal examination is an evasive procedure where you will be required to lay on your back, and the practitioner will insert two fingers into your vagina and reach to try and find, then feel the cervix. Often a VE is requested in labour to measure how far along the cervix is dilated.

Unless preparing for an induction of labour there is never really a reason for a vaginal examination outside of labour.

A stretch and sweep is something that maybe discussed with you towards the end of pregnancy. This is where your practitioner does a vaginal examination, but then proceeds to force their finger into the cervix and stretch while sweeping it to try and aggravate the cervix and begin the labour process. The evidence around stretch and sweeps is still very minimal. The current guidelines does not recommend a S&S until after 40 weeks. There is an increased risk of rupturing your membranes with a stretch and sweep, which will ultimately mean you will need to have your baby within a matter of days even if your body isn’t ready. Occasionally women will go into cervical shock (lots of pain at site followed by a fainting like episode) following a stretch and sweep.

With any vaginal examination there is a risk of introducing infection and causing pain to the woman. 

Used appropriately they are a great tool if decisions are needing to be made, but in practice are used far too often.

I hope this helps you to be more informed & have the confidence to start a conversation with your care provider about tests that might be offered to you.

Please feel free to reach out to me if you have any further questions, or check out the course dates page and book into a course that suits you! I would love to see you there to share more birth knowledge with you! xx