Tests of Pregnancy
Fetal Anatomy Scan
This is an ultrasound exam that is performed between 20 and 22 weeks of pregnancy. This is the time when you often find out the sex! But there are many other important things we look at during this ultrasound. In this ultrasound we look at the baby’s head, face, heart, stomach, abdomen, spine and extremities. Additionally, we look at where the placenta is located and the fluid surrounding the baby. This is a screening ultrasound. Meaning sometimes things are seen that may need to be examined more closely. If this is the case we will refer you to a maternal fetal medicine specialist for further evaluation.
1 Hour Glucose Tolerance Test (GTT)
This is a test that screens for gestational diabetes of pregnancy.
It is performed between 24 and 28 weeks of pregnancy.
You will be given a small glass of a very sugary drink and then have your blood glucose level checked an hour later
You can eat a normal diet and do not need to fast prior to the test.
If your blood sugar level is higher than normal then you will be asked to perform a 3 hour glucose tolerance test. This test will diagnose diabetes if you have the condition. For this test you must be fasting (nothing to eat or drink for 8 hours). A fasting blood level will be checked. You will then be given 8 ounces of a glucose solution. Blood sugar levels will then be checked one, two and three hours after you drink the solution. If two or more of the blood sugar levels are abnormal you have gestational diabetes.
Be aware - you must stay seated in the waiting room for the three hours of testing – so bring something to read or help you pass the time.
*** If you have high glucose levels in your urine or risk factors for gestational diabetes you may need to be screened for gestational diabetes prior to 24 weeks. If this test is normal, you will then be checked again between 24 and 28 weeks.
Group B Streptococcus (GBS)
Group B strep is one of the many bacteria that live on our bodies. In women, it can be found in the vagina and rectum. It is NOT a sexually transmitted disease (or infection). Some patients have it while others do not. Most patients who test positive for GBS have no symptoms and do not know they have it. You can carry the infection at one point in time and not at another. Approximately 30% of women carry GBS.
How does GBS affect pregnancy?
Patients who are colonized with GBS (have no symptoms but test positive for the bacteria) are at risk of developing a urinary tract infection or a uterine infection during labor. Additionally, if a patient is GBS positive there is a risk of passing the infection to the baby when the baby moves through the birth canal during delivery.
What are the risks to the baby if exposed to GBS?
The baby can develop a lung infection, blood infection and meningitis.
How is GBS tested for?
To test for GBS a sample from the vagina and rectum is obtained using a Q-tip. This is a quick and painless test that is usually done between the 35th-37th weeks of pregnancy. The results are usually available within 1 week.
What if I test positive for GBS?
If you test positive for GBS you will receive intravenous antibiotics when you go into labor and this helps prevent GBS infection in the newborn. Penicillin is the antibiotic most commonly used but if you have a penicillin allergy a different antibiotic will be used. The antibiotics only work if given during labor – if given earlier the bacteria can regrow and be present during labor.
Who else should be treated for GBS?
There are two situations when you will be given antibiotics in labor to prevent newborn infection regardless of your GBS culture results.
If you have had a previous baby who had a GBS infection.
If you have had GBS identified in your urine at any time during your pregnancy.
Prenatal Testing
Prenatal testing includes testing for inherited genetic disorders before or during pregnancy. As well as testing in early pregnancy that evaluates elevated risk of having a child with a chromosomal abnormality or neural tube defect. This testing is optional. There are risks and benefits of performing testing and it is a very individual choice for families.
Genetic Carrier Screening
Genetic disorders include conditions such as sickle cell disease, cystic fibrosis, spinal muscular atrophy, fragile X syndrome, Tay-Sachs disease among others. In these disorders, there is an abnormal gene that gets passed from parents to their children. With genetic disorders, you may carry one copy of an abnormal gene and not have the disorder. This is termed being a carrier. If you are a carrier, you have the potential to pass the abnormal gene onto your child. Often times, people who are carriers have no idea they carry the mutation and there is no family history of a genetic condition.
To find out if you are a carrier for a genetic condition, we can perform a blood test. This blood test can be done at any time, but if you are considering carrier screening, a good time to perform the test is before you start trying to conceive. Please speak with your doctor to discuss your risks for various genetic disorders and if carrier screening is right for you.
Screening Tests for Birth Defects
Previously, we offered prenatal genetic screening only to women over the age of 35. This is no longer true, and the American Congress of Obstetrics and Gynecology recommends all women be offered genetic testing before 20 weeks regardless of the mother’s age. We offer testing to everyone; however, it is important to clarify that this is optional testing. Performing this testing is a very personal choice and we support your decision to opt for or against testing.
Genetic testing is testing that is done during pregnancy to determine if you are at elevated risk for having a baby with conditions including Trisomy 13, 18 and 21 (Down syndrome) as well as open neural tube defects like spina bifida. The options include combined first-trimester screening, non-invasive prenatal testing, the AFP screen and the fetal anatomy survey.
If you have a positive screening test that means you are at elevated risk for having a child with a trisomy or neural tube defect. You will be offered genetic counseling and additional testing that will help diagnosis if the child does, in fact, have one of these conditions. Diagnostic testing includes chorionic villus sampling (CVS) or amniocentesis. These tests are more accurate and provide a diagnosis. However, both are invasive procedures – meaning cells from the placenta or fetal cells from the amniotic fluid are obtained and there is a risk of miscarriage.
Screening for inherited genetic disorders can alert you to potential disorders you carry. If one is found prior to pregnancy you may choose to meet with a genetic counselor and consider in vitro fertilization with pre-implantation genetic testing. However, if you carry a genetic disorder you may face tough decisions regarding future pregnancies as well as if and how you disperse this family information. Prenatal screening can provide reassurance or alert you to a potential medical condition. This allows you time for preparation, optimal medical care or termination of pregnancy. If you have an abnormal screening test and then decline a diagnostic test because of risks it may lead to additional worry.
This is a very personal choice. If you have questions talk with your doctor and we will be happy to further discuss your option. If you are considering any genetic testing – you should check with your insurance company ahead of time to confirm coverage. Additionally, both the nuchal translucency and the anatomy scan require a separate ultrasound appointment. Talk with the scheduler to make sure your appointments are scheduled correctly.
Recommended Vaccinations for Pregnant Women
Tdap Vaccination
This is a vaccine that protects against tetanus, diphtheria and pertussis. Pertussis is also known as whooping cough. Mothers are vaccinated in pregnancy because they develop antibodies that protect the baby for the first few months of life until they are able to be vaccinated. There has been a dramatic rise in the number of cases of whooping cough in the US and the babies that catch this illness can get very sick. By giving the mom the vaccine, she develops antibodies that helps prevent the disease in vulnerable newborns.
It is recommended you get the vaccine between 27 and 36 weeks of pregnancy. We typically give it at your 28-week visit.
It is recommended you get the vaccine with each pregnancy.
If you decline the vaccine in pregnancy, it is recommended that you get vaccinated postpartum.
Also, it is important that all family members and caregivers of the infant are up to date with their pertussis vaccines (DTaP or Tdap depending on the age).
Influenza Vaccination
The flu season in the US is generally between October and May and it is recommended that all pregnant patients receive the flu vaccination as soon as it is available. There are two reasons pregnant patients should get the flu shot.
First, being pregnant changes your body’s immune response. You do not fight infections as well. Pregnant patients who get the flu often get a more serious illness that can lead to hospitalization, pneumonia, preterm labor and other complications.
Second, when patients gets vaccinated it helps protect the baby. The baby cannot get vaccinated until 6 months of age. Some of the antibodies the patient produces cross the placenta and this helps keep the baby protected.
The flu shot is safe in pregnancy and as explained above recommended. However, if you get your flu vaccine at a location other than our office make sure you avoid the intranasal spray. This is a live attenuated version of the flu vaccine and is not safe in pregnancy
Safe Medications for Pregnant Women
Over-the-counter medications safe to use in pregnancy include:
NAUSEA AND MOTION SICKNESS
Vitamin C 500 mg, once a day with food
Vitamin B6 50 mg, one three times a day
Unisom tablets (not gel tabs) – 1/2 to 1 tab at bedtime; may also take 1/2 tab in the morning and mid-afternoon
Dramamine
Sea Bands
Ginger tablets
CONGESTION AND COLDS
Robitussin and Robitussin DM
Chlortrimeton
Benadryl
Vicks Vapor Rub
Cough Drops
Mucinex
ALLERGIES
Alavert
Claritin
Tavist
Benadryl
Zyrtec
HEADACHES
Tylenol 325 mg 2-3 four times a day
Tylenol 500 mg 1-2 four times a day
DO NOT EXCEED 4,000 MG A DAY
DO NOT TAKE IBUPROFEN, MOTRIN, ADVIL, ASPIRIN, OR ALEVE UNLESS ADVISED BY A PROVIDER
VAGINAL YEAST INFECTION
Monistat 3 or 7
Gyne-Lotrimin
HEMORRHOIDS
Preparation-H
Anusol
Anusol HC
HEARTBURN
Tums
Zantac
Maalox (tablets or liquid)
Rolaids
Mylanta
Gaviscon
Pepcid AC
NO PEPTOBISMOL (contains aspirin)
NO ALKASELTZER (contains aspirin)
DIARRHEA (do not treat for the first 24-48 hrs)
Kaopectate
Imodium AD
CONSTIPATION
Colace (Docusate Sodium) – stool softener
Peri-Colace (Colace + mild stimulant)
Any fiber supplement (Metamucil, Fibercon ,etc.)
GAS
Gas-X
Mylanta II with Simethicone
Mylicon
ACNE
Azealic acid
Benzoyl peroxide
INSECT BITES
Lotions: Calamine, Caladryl, Benedryl
Oral: Benedryl tabs 25-50mg (every 6-8hrs)