PREGNANCY EXAM SCHEDULE

At 7-8 weeks a woman should have an ultrasound to determine the location of the pregnancy sac,
size and vitality (heartbeat) of the fetus.
At 10 weeks your doctor will give you a follow-up card to track your pregnancy.
Routine Tests: Blood count, fasting glucose, urine culture, blood type (and RH antibodies level if
negative), rubella antibodies, VDRL, CMV, antibodies, toxoplasma and HBsAG and if necessary an
HIV test. Some physicians add a general urine culture and TSH test or other subrule of thyroid
activity
Week 11-12: early chromosomal genetic diagnostic testing, placental structure (chorionic placenta)
Around week 12 (10-14): ultrasound, nuchal translucency or fetal development test performed by the
physician or technician
Week 15-16: early ultrasound screening exam
Week 17: triple screen test, fetoprotein or amniocentesis and blood count
Week 22-25: late ultrasound anomaly scan
Week 26: glucose tolerance test, 50-100 grams (based on risk factors), blood count and RH antibody
levels for those with negative blood type and urine culture
Week 28: a visit to the physician to discuss glucose test results and talk about receiving RH immune
globulin if RH negative
Week 28-30: review of fetal growth
Week 32: follow-up visit
Week 34-39: weekly tracking of fetal growth weight
Week 40: follow-up with doctor, ultrasound, monitoring biophysical profile every 2-4 days
Week 41-42: referral to the delivery room to perform a stress test or induce labor
Up until week 32, the pregnancy will be tracked once a month, then every 2-3 weeks until week 36,
finally every 1-2 weeks until week 40. After this stage the pregnancy will be passed over to another
department which specializes overdue pregnancies (in certain cases it will be passed over to the
hospital delivery room)

WHAT TESTS ARE PERFORMED DURING PREGNANCY?

Women planning to conceive or in the early stages of pregnancy should know what tests are available
to them during pregnancy. Tests may greatly reduce the risk of birth defects however, there isn't a
100% guarantee of accuracy.
There are many factors that are out of our control which can influence the health and development of
your baby. Some tests are performed routinely by your healthcare provider or privately. Your health
insurance may reimburse you for some of the tests or your service provider may give you a discount
through a payment plan.
Consult your healthcare provider on your rights, so you receive all necessary tests to monitor your
pregnancy.
Prior to Pregnancy
Blood tests can be performed to diagnose carriers of genetic diseases in both partners prior to
conceiving. Tests are performed privately by a genetics laboratory at the request of the mother. These
tests are not necessarily cpvered by your healthcare provider. Contact your healthcare provider to find
out if they will cover part of the test or in some cases reimburse you for it.
You should check to make sure that neither parent is a Tay-Sachs carrier and check that you're
vaccinated against rubella prior to conceiving. Consult a genetic counselor if there are any known
genetic diseases in either family.
Women who suffer from chronic illnesses such as diabetes, hyperlipidemia, obesity, epilepsy,
hypertension, thyroid function disorders, FMF, etc, should inform their doctors and check their blood
sugar, blood pressure, etc. and modify drug therapy as needed.
Inform Your Doctor

About any inflammatory conditions such as herpes outbreaks or genital warts. Any chemical
treatments either parent received within the year preceding the pregnancy in case it is
necessary to perform a chromosomal test on the fetus.

If you have recently undergone surgery, particularly gynecologic surgery such as cervical
surgery, in utero surgery, hysteroscopy or ovarian or fallopian tube surgery.

About the course of previous pregnancies, complications such as recurrent miscarriages, fetal
death in utero, termination of pregnancy due to defects and any other disorders that occurred
during previous pregnancies.

About any surgery in a previous birth or if there were previous complications with pregnancy
or birth. Women with a history of recurrent miscarriages should clarification as to why and if
necessary receive preventative treatment.

Alcohol, smoking or drug use should be avoided in the months before and during pregnancy.
However, if these habits can not be controlled your doctor should be informed.

Vitamins
During pregnancy an increase in vitamins, food and oxygen is needed for the fetus. Therefore it is
important to ensure a proper and sufficient supply of vitamins. It is recommended that you take folic
acid or prenatal vitamins 3 months prior to conceiving and throughout the pregnancy. It is important
to take vitamin supplements if there is not an adequate food supply. Iron is one of the components
necessary for fetal development, (enzymatic function, brain development and blood production), and
also necessary for the women since there is a decrease in hemoglobin (anemia) during pregnancy. It
is very important to take iron supplements during pregnancy. Some recommendations say to begin
taking iron at the pregnancy's half-way mark until 6 weeks after birth.
Taking medications or various drugs during pregnancy may adversely affect fetal development,
therefore it is advisable to consult a teratology institute when the influence of a drug is unclear.
Chromosomal Testing (Karyotype Investigation)
The health of the fetal chromosomes can be determined with almost complete certainty through an
amniocentesis and placental chorionic test (CVS). However these test do not account for all possible
genetic disorders. On rare occasions these tests can cause miscarriage, and therefore they are not
recommended unless specifically advised by your doctor or genetic counselor. Miscarriage rate after
an amniotic test ranged from 0.5 to 0.1 % of the time. If a risk for chromosomal abnormality is
suspected, it is recommended to consult a genetic counselor, or healthcare provider about further
testing.
Chorionic villus sampling test (weeks 11-12) or amniocentesis (weeks 16-20) are the two most
common exams performed along with the more recent genome array (CGH). The first two tests are
funded by the Ministry of Health for women aged 35 and over, women who've previously given birth
to a Down's Syndrome's child or if a genetic counselor recommended the procedure. Obtaining
authorization from your health insurance depends on the medical indications and approval from a
genetic counselor covered by your health insurance.
Women who are not high risk but would still like to receive the Karyotype test can have it done
privately and pay for it.
Women expected to undergo cervical stitching should consider having the nuchal translucency test
and or early diagnostic ultrasound before suturing the cervix. Women at risk for chromosomal
problems who must undergo cervical stitching should consult with their doctor about having the
chorionic villus sampling before undergoing the procedure.
Screening for Down Syndrome
There are several tests that determine the risk for Down Syndrome. These tests, unlike the Karyotype
Test mentioned previously, do not determinee whether or not the fetus is carrying a chromosomal
disorder. They only define the degree of risk of some chromosomal interface in the fetus. Most tests
calculate the risk of Down Syndrome and trisomy 13 and 18.
The tests do not give a 100% accurate result, since the results are based on a statistical overview.
Therefore, there may be cases in which all results will show low risk and the baby will still be born
with Down Syndrome. These tests do not to rule out other chromosomal or genetic problems.
The degree of risk for Down Syndrome is calculated according to different parameters tested among
women. If there is an increased risk for Down Syndrome (the value determined in this country is
1:380 or greater) it is recommended that the mother be referred to genetic counselling through her
health insurance or hospital, to determine if there is a need for a karyotype examination.
If the risk of Down Syndrome is less then 1:380, there is no referral to perform chromosomal testing
(based on the decisions of the Ministry of Health). However it is important to note that there is still a

chance of Down Syndrome. Women who would like to be sure of the chromosomal situation of the
fetus should undergo amniocentesis or CVS.
Screening Tests
Screening tests are performed during the first trimester - Fetal Nuchal Translucency test (NT) and
first trimester screening.
Nuchal Translucency is performed at week 12 (week 10 - 14). An ultrasound test performed by a
trained physician. The significant advantage of this test is that it is performed early on in the
pregnancy, and combining these results with other future results provides more accuracy. Also the
fetus itself is being tested as opposed to the components in the blood (which are affected by the
mother's liver function etc).
The Ministry of Health has recently instructed that this test be performed to screen for Down
Syndrome in pregnancies with multiples, as opposed to the accepted triple screen test. Women who
are carrying multiples are eligible to have this test covered by their health insurance.
First Trimester Exams

bHCG and PAPP-A

Nuchal Translucency (together, these two tests can provide a more accurate assessment of the
risk for down syndrome - about 85%).

Second Trimester Exam

'Fetal Protein Test' - This tests for 3 proteins (Fetal-AFP, Hcg and uE3) and is therefore also
known as the triple screen test.

A third test has recently been added to the list. It is not yet routine but is performed according to
specific requirement and additional cost. It is called the quad screen and tests for the 3 proteins listed
above and an additional protein called inhibin. The combination of substances tested improve the
accuracy of the results in screening for down syndrome.
Combination Test
This is a combination of test results from the Nuchal Translucency, PAPP-A, AFP, Hcg, uE3 and
Inhibin. This test evaluates the risk of the fetus having Down Syndrome with an accuracy rate of 9095%. Most pregnancies are low risk with no medical reason to perform a karyotype test that may
endanger the pregnancy. Therefore the combination test is recommended to receive the most accurate
of all screening test results.
Anomaly Scan
This test examines all the various organs of the fetus through an ultrasound. The doctor or technician
focus on the fetal heartbeat, amount of amniotic fluid, fetal movements and size of the fetus.
Emphasis is placed on presence and location of all the organs, texture of the organ as it appears on
the ultrasound. Compared to other ultrasounds, this test requires more time and an extensively trained
and skilled examiner.
According to the Ministry of Health, women with a greater risk for birth defects are eligible for the
early anomaly screening funded by their health insurance. This scan reviews a limited number of
organs (brain chambers, 4 heart chambers, implantation of the umbilical cord to the abdominal wall,
kidney bladder, stomach and spine).
More extensive tests can be performed, usually through private clinics or supplementary insurance
coverage.

If a suspected problem is detected, the mother will be referred to an extended examination. It is not
always possible to examine everything due to factors such as positioning of the baby or extra fat on
the mother. An ultrasound screening can only detect about 60% of anomalies, therefore a "normal"
ultrasound is not a 100% guarantee that the fetus is completely healthy.
It is common to have two screenings. One between week 12-16 and the other between week 22-25,
although some women have scans performed at other times. If something requires monitoring or
special attention (such as heart defects, brain defects or other findings) more specified examinations
can be performed in week 29-30. An MRI can examine certain defects but is not a substitute for
ultrasound screening.
In special cases the mother should be referred for a fetal echocardiogram (a detailed scan of the
babies heart). This test is commonly performed on women with heart defects, or with family history
of heart defects, women with pre-gestational diabetes or if a heart defect is suspected.
Diabetic Screening During Pregnancy.
Diabetes can cause miscarriage and deformities in the fetus. Women who are at increased risk for
diabetes or diabetic women should make sure that their sugars are balanced before conceiving.
Women who are not at increased risk for diabetes are still recommended to take a fasting glucose test
during early pregnancy and a glucose challenge test between week 24-28.
How is this test done?
You will be given a drink consisting of 50 grams of sugar (glucose). This needs to be consumed
within 20 minutes. An hour after finishing the drink the technician will draw your blood and it will be
sent for testing. A result over 140 mg indicates an increased risk of diabetes. This is not a diagnosis of
diabetes, however it is recommended that another, more extensive test is performed with 100 grams
of sugar and 4 separate blood samples taken in a span of 4 hours, while fasting.
It is important to take these tests according to procedure or the result might be irregular.
Women with past gestational diabetes, obesity, or a history of large babies should take the glucose
tolerance test early in the pregnancy in order to enable early diagnosis and treatment during
pregnancy.
Monitoring Fetal Movement
Most women begin to feel fetal movements between week 16-20. Women who are pregnant for the
first time or bigger women tend to feel movements later on in the pregnancy. At around week 25
there is significant fetal movements. It is recommended that you count movements three times daily
after meals. You should lie on your left side and focus on feeling your baby move (avoid reading,
watching tv, etc). Every movement, weak or strong should be recorded. You should feel at least 5
movements per hour. Usually 5 movements are felt in a short period of time.
The amount of fetal movement varies on the nature of the fetus and the activeness of the mother. If a
woman notices a significant decline in the baby's movements compared to previous tests, she should
refer to her doctor for a check up.
In the last trimester of pregnancy it is normal to feel a decrease in fetal activity as the baby grows and
has less space to move around in.
Important!
In the event of bleeding or unexplainable pain during pregnancy, excessive vomiting, recurrent
urinary disorders, fever, rupture of membranes (water breaks), reduction or lack of fetal movements,
swelling in hands or face, headaches, blurred vision, general weakness, changes in consciousness,

numbness in the limbs or any other unexplainable complaints, please contact your family doctor,
gynecologist, womens health center or emergency room, accordingly.