Lab tests, ultrasounds, and more
*Please note that before we can provide any care for you, including ordering ultrasounds or laboratory work, we are legally bound to have established care.
Most women will start prenatal care sometime between 8 and 12 weeks. Some like to start even earlier. Beginning early in the pregnancy does have some advantages. Here, we share with you what to expect during your prenatal care visits.
Your First Visit
The first prenatal care visit is usually the longest and sometimes extends to two visits. To make it less overwhelming, beforehand, please visit Preparing for Your Appointment on the Gifford website, gather insurance information, and download and complete a Health History Form. Knowing your medical history will help us provide you with the best information and personalized care.
First we will review your medical history. If you have completed it online, we will be able to focus our discussion on the most pertinent parts.
A basic physical exam is next and provides an important baseline for measuring changes in your pregnancy. We recommend that you wear loose-fitting garments. Many parts of the exam are specially targeted at identifying problems common to women of childbearing years, or problems that have special consequences for pregnancy. We generally do not include a pelvic exam at this time unless there are specific concerns or you wish to have certain tests, such as a pap smear or cultures.
Blood specimens and a urine specimen are generally collected either at this visit or the next. Recommended tests include a minimum of a prenatal panel and a urine culture.
The longest part of the visit is reviewing important pregnancy information and discussing your specific concerns. We will review warning signs, and give you our cell phone numbers.
If you are at least 10 weeks pregnant, we are usually able to hear the baby’s heartbeat with a device known as a doppler. It is common not to be able to hear a heartbeat even at 10 or 11 weeks, but by 12 weeks we can hear it about 95 percent of the time. If we are not able to hear the heartbeat, early ultrasound is available to confirm viability and dates.
Early ultrasound is offered to every client and can be done during the first visit or scheduled around 10 to 14 weeks. This is currently the best way we know to prevent overdue babies, especially if you are uncertain of your last period date. Like any other test, ultrasound is offered but not required.
After your first visit, appointments are generally scheduled every four weeks until 28 weeks, then every two weeks until 36 weeks, and finally every week until you give birth. You may be seen more frequently if there are any concerns or if your pregnancy progresses beyond 41 weeks.
Visits generally begin with a weight check and collection of a urine sample to check for protein and glucose. Baby growth is followed by measuring your uterus and feeling the baby’s size. After about 28-30 weeks, we can start to feel the baby’s position. If you are interested, we are happy to show you how to do this, too. Many women get very good at it!
We also generally discuss diet and nutrition as well as upcoming tests you need to know about. We have a list of topics that we bring up at the appropriate time if you haven’t asked about them already. Most visits are focused on discussing your questions and concerns. As the pregnancy progresses, we talk about labor, understanding your birthing plans and desires, and working through any fears you may have.
During the last couple of weeks, we discuss postpartum plans and newborn care.
You are encouraged to bring family or support persons with you to visits, as well as your children, if you wish.
Early Pregnancy Laboratory Tests
Several blood tests are generally recommended in early pregnancy. Some of these are required by law. Tests screen for conditions that could cause problems during pregnancy or with the baby, and provide information that may help you make decisions during your pregnancy.
A urine culture and prenatal panel are generally suggested at your first or second visit and are best done before about 16 weeks of pregnancy.
Urine culture: About 5 percent of women will have large amounts of bacteria in their urine that don’t cause uncomfortable symptoms. Normally this is not a problem, but pregnant women who have this condition have a 40 percent chance of developing a kidney infection. Research shows that if this condition is treated early, the chance of developing a kidney infection is greatly reduced to about 3 percent. Kidney infections are never fun, but during pregnancy they can be quite dangerous.
The prenatal panel includes several different tests:
Blood type and rhesus (Rh) factor: This test tells you the type of proteins on the surface of your red blood cells. Because your baby has different genetics, it may have a different blood type. Sometimes a little blood from the baby can get into your system and cause your body to make antibodies against the baby’s red blood cells. One of these antibodies can be prevented with a medication, while others may cause a significant, but treatable, severe jaundice in the baby once it is born. Knowing this beforehand will allow prevention or early treatment that will prevent serious problems.
Antibody screen: This is a test that checks to see if the mother’s immune system has reacted to a foreign blood type. This particular test only checks for antibodies that can cause a mother’s system to destroy a baby’s blood. The Rh factor is the most well-known of these, but there are several others that can do similar damage. If the test is positive, the actual number of antibodies will be measured. Although this situation is quite rare, it can be very serious and newer treatments are available that can enable a baby to survive.
Complete blood count: This test measures the size, shape and color of your blood cells. It will tell us if you have anemia and what kind of anemia. That helps us know the best way to treat it. It will tell us if you have a normal amount of platelets which are essential in helping your blood to clot normally. It also tells us about the numbers and kinds of white blood cells that you have.
Syphilis screening / rapid plasma regain (RPR): This test is required by law. Syphilis is a sexually transmitted infection that can cause serious problems in a baby. Treatment drastically improves outcomes for the baby.
Hepatitis B: This test is required by law. Hepatitis is a blood-borne and sexually transmitted infection that affects the liver. This sometimes does not cause obvious disease in the mother but can still be passed on to the baby. There are medications that can be given to the baby at birth that can prevent infection.
Rubella or German Measles immunity: This test is required by law and tests to see if childhood vaccinations are still working. Most people who have been vaccinated are still immune into adulthood, but since the virus can cause such serious damage to a developing fetus, it is considered a public health measure to test all women just to make sure. If you are not immune, vaccination is recommended after the baby is born.
Other Tests You May Want to Consider
HIV screening: Because HIV transmission from mother to child can be largely prevented, the major obstetric organizations recommend that every pregnant woman is screened for this disease. This screening is evidence-based.
Gonorrhea and Chlamydia screening: These are sexually transmitted infections that may not cause symptoms in the mother but can cause serious infections both in baby and mother after the birth. Because of this, they are routinely offered in a medical setting. Yearly screening is recommended for women younger than 25 and all women who are at increased risk of contracting a sexually transmitted disease. The samples are collected from the cervix using a speculum, or can be collected from a urine sample. This screening is evidence-based.
Pap smear: Pap smears are the current best way to screen for cervical cancer. While not part of routine pregnancy testing, if you are due for a pap smear it can be done during pregnancy. The current guidelines say to start pap tests at age 21 and continue every three years until age 30. Starting at age thirty, co-testing is recommended with both a pap test and HPV test every five years until age 65. Women with a history of abnormal tests or certain risk factors should follow different recommendations. Many women will get a pap test at their six-week postpartum visit. This screening is evidence-based.
Thyroid testing: Since most women do not get regular health screenings outside of pregnancy, many providers recommend having your thyroid tested. Appropriately balanced thyroid levels are essential to a developing baby and slightly low levels may not be readily detected without testing. Severely low or high levels will cause noticeable symptoms. Based on your physical exam or history, we may specifically recommend a thyroid test. Routine screening is not evidence-based.
Diabetes testing: If you are significantly overweight, are over 35, have parents or siblings who have Type 2 diabetes or have previously been diagnosed with gestational diabetes, you might want to consider diabetes testing earlier than usual in pregnancy. This is specifically to detect Type 2 diabetes that existed before the pregnancy. The early stages of this disease often have no symptoms and earlier treatment may lead to healthier outcomes for both mother and baby. Screening based on these risk factors is evidence-based.
Most people choose to have at least one ultrasound during their pregnancy. Of course, you may just want to know if you are having a boy or a girl—or if there are maybe two babies in there! However, there are many other good reasons you may want to have an ultrasound.
Many women are unsure of their last menstrual period or have had irregular cycles. Ultrasounds done before 14 weeks are very good at determining an accurate due date. In fact, most babies that are “overdue” actually just had an inaccurate due date. Lots of research shows that an early ultrasound is the best way to prevent an overdue baby.
If you are having early pregnancy bleeding or we are unable to hear a fetal heartbeat with a doppler, ultrasound can provide immediate reassurance or clear answers about viability.
Between 19 and 22 weeks is the ideal time to look at the different body structures of the developing baby. The sonographer is able to view brain structures; look for a cleft lip or palate; examine the heart and major blood vessels; look at abdominal contents, including the appropriate closure of the abdominal wall and spine; and check to make sure all the arms and legs are there and the kidneys are present and functioning.
Another very important thing that is looked at is the placement of the placenta and measurement of the baby. Although this is not the best time to use baby size to determine a due date, it will still help us know if we are far off. Ultrasound is not perfect, but it is a fairly accurate, noninvasive way to rule out many major problems.
Later in pregnancy, a biophysical profile can be done to confirm fetal well-being. This test is a combination of ultrasound measurement of amniotic fluid levels, fetal movements and a non-stress test.
Limited ultrasounds are performed by either a midwife or a certified technician and then evaluated by the midwife. All of the fetal anatomic surveys (20-week ultrasounds) are performed by the technician and then interpreted by a radiologist. You are not charged a separate fee for the radiologist services. Our technician has been performing medical ultrasounds both in the hospital and clinic setting for more than 25 years. He is very skilled and knowledgeable with extensive experience in obstetric ultrasound.