A variety of standard tests are performed during pregnancy. These comprise the Antenatal Screen, Diabetes Screen and Ultrasounds.
- Blood group & blood group antibodies
- Haemoglobin (to exclude anaemia)
- Rubella (German Measles) serology
- Hepatitis B & Syphilis serology
- Hepatitis C & HIV serology
- Varicella (Chicken Pox) serology
- Toxoplasmosis & CMV (Cytomegalovirus) serology
- A urine culture is checked as 5% of pregnant women will have an asymptomatic infection
- Pap smear performed if necessary.
This is performed around 28 weeks in an effort to identify women who develop diabetes due to the hormones of pregnancy.
If you have the older Glucose Screen you are not required to fast. The pathology lab will give you a sweet drink containing either 50g or 75g of glucose. 1 hour later your blood is taken and checked to see if your blood sugar level is abnormal (> 7.8 or 8.0 respectively).
If this is abnormal or if you are to have the, now recommended full Glucose Tolerance Test (GTT) then the following will apply:
Glucose Tolerance Test (GTT): This diagnostic test will determine if you have developed diabetes during your pregnancy. You are required to fast and a baseline blood sugar level will be taken by the pathologist at the start of the test. You will then drink a sweet drink and blood will be taken from you 1 hour and 2 hours later. Urine will also be tested for signs of glucose at these times. The whole test takes about 3 hours. If the test results are abnormal then Gestational Diabetes is confirmed.
Blood Group Antibodies:
These are checked at 28 and around 36 weeks and is important for those with a NEGATIVE blood group.
Anti D is routinely given to Rh Neg mothers at 28 and 34 weeks in the pregnancy and is done here in the practice.
Nuchal Translucency Ultrasound (NT):
This test replaced the Triple Test at 15 weeks as it is more reliable.
The advantage of tests like the NT and Triple test is that they are non-invasive. But, because they are occasionally wrong, we need Diagnostic tests. These are often invasive and therefore may place the baby at risk. The Diagnostic test will determine if the baby truly has abnormal chromosomes and is invasive.This is performed by insertion of a needle, either into the placenta [Chorionic Villus Sample – CVS] or into the sac of fluid around the baby [Amniocentesis]. The problem with these tests is that there is a risk of miscarriage after the procedure. That risk is about 1 in 50-100 for CVS and 1 in 300 for Amniocentesis. Some couples may accept this small risk anyway so that they “know for sure”. We refer to this as needing a YES / NO answer.On some occasions, the result of the NT scan may suggest that the couple should consider having a diagnostic test, even though their ultimate risk was low. This does not necessarily mean that the baby has a chromosome defect because the screening tests can be wrong. If the chromosome result comes back as normal, a careful scan will be recommended at 18-19 weeks. If there is nothing found on the scan, almost all of these pregnancies will result in completely healthy live births.Non-Invasive Prenatal Test (NIPT):
This blood test became routinely available in Australia in 2013. It is a blood test taken from the mother between 10 and 24 weeks looking for DNA from the baby which circulates in the mother’s blood stream as cell free DNA (cfDNA).
The DNA is ‘magnified’ in the lab and searches for:
- Chromosome 21 (Down Syndrome),
- Chromosome 18 & 13
- Chromosome X & Y to sort out the girls from the boys
Some companies test for additional chromosomal abnormalities, at a cost.
There are 5 different companies performing the test and as yet there is no clear superior test.
Cost: $400 + depending on the company and it takes 7-10 days for the result to become available.
There is no rebate.
You cannot end a pregnancy based on the test and would be offered either an Amniocentesis or CVS if the NIPT is abnormal.
Testing can be done through:
Amniocentesis and CVS
An amniocentesis is an invasive test during pregnancy and is most commonly performed between 15 and 17 weeks. It can be performed anywhere between 14 weeks and delivery, but is most commonly used to determine the chromosomal make up of the baby or babies.
Under ultrasound control, a needle is passed through the abdominal wall of the mother into the uterus and into the fluid which surrounds the baby. Approximately 20ml of fluid is removed from the uterus and sent for examination. This fluid contains cells from the baby’s skin and these cells can be grown in a culture. Once a sufficient number of cells have been cultured they can then be examined and the baby’s chromosome number and structure can be determined.
Fish (Flourescent In-Situ Hybridisation):
It has been generally reported that the risk of losing the baby from this test is approximately 1 in 300. A study of just under 4000 consecutive amniocenteses performed in Western Australia gave an overall pregnancy loss rate of 0.74 percent, which is quite favourable when compared to the calculated background normal pregnancy loss rate of 1 percent (i.e. the number of babies that would be lost between 15 and 17 weeks gestation due to other unexpected or unexplained events in pregnancy).