Jeannet E.

Canda, RN, MAeD

College of Health and Sciences
NDDU

Testing throughout pregnancy
Blood test: a sample of blood is taken from a vein
in your arm and sent to a lab for analysis.
Risk: no risks to the mother or developing baby
What can be found?
Many different diagnosis can be made by a simple
blood test.
These results will better equip your physician to care
for you and your un-born child throughout the
pregnancy.
These results may also help to predict potential
complications with you or your baby at birth.
Blood type
Rh Factor: this may show a need for an additional
medication to keep your blood and the babys blood
from interacting during the birthing process
Glucose level: can indicate diabetes
Iron level: susceptibility to anemia
Hemoglobin Level: anemia if counts are too low
Sexually Transmitted Diseases: syphilis, hepatitis B or
HIV which may require treatment to keep you and the
baby safe
Rubella (German Measles): antibodies showing immunity
Toxoplasmosis: this is harmless to you but may cross the
placenta and harm the baby
Urine sampling: done by obtaining a small sample of
urine (midstream) into a sterile cup.
This will occur many times throughout the pregnancy.
Risk: no risk to mom or baby
Simple testing will determine presence of:
Sugar: too much may indicate need for further testing for
gestational diabetes
Ketones: indicate nutrition and hydration level
Protein: indicate a potential problem with the kidneys
(infection) or a need for pre-eclampsia workup
Bacteria: indicates a possible urinary tract infection requiring
treatment
Vaginal exams
Pelvic exam: a manual exam (the doctor uses his fingers) to
determine
Your gestational age by the shape of the pelvis, uterus, pelvic
bones
Presence of any masses, ovarian cysts or fibroids
Cervical exam: a manual exam to check if your cervix is
open/closed
PAP smear: a speculum exam where the doctor uses a swab
to remove a few cervical cells to test for abnormal cells (pre-
cancerous)
Vaginal culture: a speculum exam where the doctor swabs
the cervix to determine the presence of chlamydia and
gonorrhea.
Risk: low/no risk to mom and baby
Pre-natal (before birth)
Pre-natal testing does
present an increased risk
to mother and fetus when
compared to post-natal
testing.
Amniocentesis: a DNA test
is done on the amniotic
fluid surrounding your
unborn baby.
Chorionic Villus Sampling: a
DNA test is done on a
sample of tissue attached
to the uterus is taken via
the vagina and cervix.
This is done to determine
the father of the child.
May cost $400-$2000
depending on the lab
performing and type of
testing done.
Post-natal (after birth)
Blood testing
Cheek swab
Umbilical cord testing

Transvaginal: probe is
inserted into the vagina to
obtain images EARLY in
pregnancy.
Standard Ultrasound: probe
place on the abdomen and
generates a 2D image of the
baby.
Advanced Ultrasound: probe
still placed on the abdomen
but is targeting a suspected
problem using more
sophisticated equipment.
Doppler Ultrasound: detects
blood flow and movement
using ultrasound waves.
3D-ultrasound: generate 3D
images of the baby in the
uterus.
4D or dynamic 3D ultrasound:
looks at the face of the baby
and detects movements prior
to delivery.
Fetal echocardiography:
examines the babys heart
anatomy and function in the
uterus.
First Trimester:
Confirming viability
Confirming heartbeat
Measuring gestational age
Confirming molar or ectopic
pregnancy
Assessing for abnormal
gestation
Second Trimester:
Fetal malformation
Wks 13-14 potential Down
Syndrome characteristics
Wks 18-20 congenital anomalies
Structural abnormalities
Multiples in pregnancy
Verification of dates and
growth
Confirming intrauterine death
Identifying excessive or
reduced levels of amniotic
fluid
Evaluation of fetal well-being
Third Trimester:
Identifying placental location
Confirming intrauterine death
Fetal presentation
Fetal movements
Identification of uterine and
pelvic abnormalities in the
mother.
Ultrasound may be
encouraged by your doctor
if there is medical concern
for mom or baby.
Questions??
Heartbeat: early in the
pregnancy (6-7 wks) it is
OK to not find the
heartbeat initially
Gender of the baby may
be determined at 18-20
wks.
Ultrasounds are done
according to patient
needs, baby needs, and
physician discretion.
Screening Procedures for the First 3 months of Pregnancy
First Trimester Screen
Determines risk for potential
chromosomal abnormalities
Done according to MD
recommendation
Chorionic Villus Sampling
Determines chromosomal
abnormalities.
Done when mom and dad
medical history supports
need.
First Trimester Screen
Performed at 11-13 wks at the
recommendation of your doctor
Simple blood test: hCG and
PAPP-A (pregnancy hormones)
Ultrasound: measure nuchal
translucency
Combines the two results
Assesses for potential risk for:
Downs Syndrome Trisomy-21 and
Trisomy-18
Cardiac disorders
Abnormal results may suggest
need for additional testing


Chorionic Villus Sampling
Used to identify
chromosomal
abnormalities or other
inherited disorders
Only indicated if you or
your partner has a medical
history that reveals a
potential risk.
Abnormalities detected:
Down syndrome
Cystic fibrosis
Also can be used for
paternity testing
Risks: invasive
procedure, risk to mom
and fetus.
1 out of every 100 tested
experience miscarriage.
Side effects:
Infection
Spotting
Cramping
Pain at puncture site
(abdomen or cervix)
Screening Procedures for the Next 3 months of Pregnancy

These may be recommended
by your physician during your
second trimester or simply
offered as a screening method
Quad Screen
Same as triple screen with addition
of Inhibin-A (more sensitive to
Down Syndrome)
Triple Screen Test: multiple
marker screen
Amniocentesis
Maternal Serum Alpha-
Fetoprotein Screen
Cordocentesis (percutanteous
umbilical blood sampling)

Quad screen is
recommended for
women who:
Have family history of birth
defects
Are 35 yrs or older
Used harmful medications
or drugs during pregnancy
Have diabetes and use
insulin
Had a viral infection during
pregnancy
Have been exposed to high
levels of radiation
Blood testing:
Quad screen:
Alpha-fetoprotein level
hCG level
Estriol level
Inhibin-A level
Based on the levels
found, combined with
maternal age and race
the lab determines a
probability of
chromosomal anomaly
like Downs syndrome or
cystic fibrosis.
Amniocentesis
Follow up to abnormal Triple or
Quad Screen
Performed usually between 14-20
wks
Ultrasound guided
Needle aspiration of fluid from the
amniotic sac through the stomach
Detects:
Chromosomal abnormalities
Neural tube deficits
Genetic disorders
Does not measure severity of
deficits or abnormalities
Cordocentesis
Umbilical cord sampling
Ultrasound guided
Needle inserted into the
umbilical cord where it meets
the placenta for a blood
sample
Typically done when
information cannot be
obtained through amnio, CVS
or ultrasound
Assessing for:
Malformations of the fetus
Fetal infection
Fetal platelet count
Fetal anemia
Isoimmunisation: mom develops
antibodies against babys blood
cells (rH incompatibility)
Does NOT test for neural tube
deficits
Highly accurate
Risks to mom and baby
Miscarriage (1-2 out of 100)
Blood loss from puncture site
Infection
Drop in FETAL heart rate
Premature rupture of membranes

Screening Procedures for the final months of Pregnancy

Testing in this trimester
may aid the physician in
planning your delivery and
any potential complications
Testing includes:
Biophysical Profile
Glucose Tolerance Test
1 hour
3 hour
Fetal Non-Stress Test (NST)
Group B Strep
Fetal Non-Stress Test (NST)
Two belts are placed on moms
abdomen
Fetal heart rate
Contractions
Measurement of heart rate and
movement for 20-30 minutes
Indicated for pregnancy over
28 weeks if:
Baby is not moving as usual
Past due date
Suspicion placenta is not
functioning appropriately
High risk pregnancy
Risk: no risk to mom or baby
Biophysical Profile
NST with ultrasound
5 specific attributes scored
Biophysical attribute
Breathing
Movement
Muscle tone
Heart rate
Amniotic fluid
Total score determines
overall health and well being
of the baby
Risk: no known risk to mom
or baby
Test may be requested if:
Doctor questions the fetal
health and well being:
Examination
Maternal/fetal symptoms
High risk pregnancy
Typically performed after
32 wks
Glucose Screening: to test for
gestational diabetes or glucose
intolerance and asses s the need
for intervention (diet and meds)
Two part screening
1 hour mom drinks a sweet drink
then one hour later has a simple
blood draw.
If abnormal then
3 hour baseline fasting blood sugar
is drawn on arrival then mom drinks a
larger sweet drink then one hour, two
hours and three hours later has a
simple blood draw.

Group B Strep Infection Screening
Group B Strep is a bacterial infection found in the vagina or rectum
Found in 25% of all healthy, adult women
Test performed by swabbing the vaginal and rectal areas of the pregnant
women between 35 and 37 wks
Positive test: simply means you are a carrier, not necessarily
actively infected.
This positive result may pass on an infection to the baby during delivery.
Prophylactic antibiotics are typically administered when:
Labor or rupture of membrane is before 37 wks
Rupture of membrane is 18 hours or more before delivery
Fever occurs during labor
Urinary tract infection (caused by GBS) during pregnancy
A previous delivery resulted in a baby with GBS
Risk: no risk to mom or baby
Amniocentesis
Ultrasound guided
Needle is advanced
through the abdomen into
the amniotic sac to remove
a small amount of fluid for
testing.
Why amnio so late?
Test for infection in
premature rupture of
membrane
Severity of fetal anemia
Assess fetal lung maturity
Thank you
All that testing? As easy as a day at the beach