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Pregnancy

Stork’s visiting? (The Times of India:2 June 2010)

We get experts to reveal the tests during pregnancy that are a must for moms-to-be

While a pregnancy may be planned or sudden, you have to prepare yourself not only for the numerous
changes that will occur in your body but, also find out about all the tests you need to take to ensure a
smooth and uneventful pregnancy. Gynaecologist Dr Rishma Dhillon Pai says that while pregnancy can
be a beautiful experience, a woman goes through a changing body and the baby she is nurturing, need to
be cared for and checked for problems.

―Right from the pre-pregnancy state, pre-existing problems need to be looked for and solved. Pre-
pregnancy, a woman is advised to undergo routine tests like haemoglobin, blood sugar, thyroid tests,
blood group, rubella, thallasemia profile, HIV, hepatitis B and hepatitis C tests and urine examination,
which give basic information about any medical or hormonal problems that can be rectified before a
pregnancy. A sonography will rule out problems like fibroids or endometriosis that may be needed to be
treated prior to the pregnancy,‖ she says.

Once pregnant, remember to get an early sonography done so as to determine that the pregnancy is in
the womb and not in the tube (ectopic pregnancy). ―This is usually a transvaginal scan (an internal
sonography), which gives an accurate picture compared to a transabdominal scan. Between 11 and 12
weeks of pregnancy, most doctors recommend a sonography to check the baby especially for nuchal
translucency. This is a screening test for Down’s Syndrome,‖ says Dr Pai.

A first trimester serum screening — a blood test, which includes checking for PAPP- A and Beta HCG
is also recommended at this stage. This determines the risk that the baby has for Down’s syndrome and
Edwards’s syndrome, as well as neural tube defects. ―These are serious genetic and developmental defects
in the baby and if suspected, a conclusive diagnosis can be made by doing a chorion villus biopsy where a
small biopsy from the placenta is taken and analysed for genetic problems. As a pregnancy advances, a
detailed anomaly scan, which nowadays is often a three or four dimensional sonography, should be done
at 18 weeks. This picks up abnormalities in the baby,‖ she says.

As a pregnancy progresses, it is important to keep a watch on the haemoglobin, blood sugars and urine.
Later in pregnancy a sonography with a colour doppler is often recommended. In this the baby is studied
in detail and the colour doppler analyses the blood flow to the uterus and to the baby. If the blood going to
the baby reduces or stops, it is a sign of fetal distress or leads to IUGR (Intra Uterine Growth Retardation)
where there may be a need to deliver the baby urgently, probably by caesarean section. The Doppler can
also pick up if the umbilical cord is wound around the baby’s neck. This may be dangerous if there are
multiple tight loops of cord as the baby can get strangulated.

Non stress test (NST) is another useful test in later pregnancy. This is a simple, non-invasive test in
which a transducer is placed on the mothers abdomen and an ECG type tracing of the baby’s heart beat is
made. This indicates if the baby is healthy or having distress, as it picks up the changes in baby’s
heartbeat with movements.
 Gynaecologist Dr Nandita Palshetkar says that the Triple Test is a maternal blood screening test that
looks for three specific substances and is performed between the 15th and 20th week of pregnancy,
although, results obtained in the 16th-18th week are said to be the most accurate. The test is done to
assess probabilities of potential genetic disorders and neural tube defects. ―While all pregnant women
should undergo this test, it is highly recommended for women who have a family history of birth defects,
are over 35 years or older, have used harmful medications or drugs during pregnancy, have diabetes and
use insulin, had a viral infection during pregnancy or have been exposed to high levels of radiation,‖ says
Dr Palshetkar.

Dr Nilesh Shah says, ―An important imaging modality used during pregnancy is the Ultrasound, which
works on a principle of sound waves and is extremely safe without side effects. It is the best modality for
dating the duration of a pregnancy and is extremely accurate during the early stages of pregnancy. This is
important since in later stages there can be a lack of foetal growth and the baseline ultrasound accurate
dating becomes an extremely important tool to evaluate growth retardation.‖

During the nine months of pregnancy, you have:

1st trimester: up to 12 weeks

2nd trimester: up to 24 weeks

3rd trimester: 24 weeks – full term