Tests, scans and checks

 
When you first learn that you're pregnant, get in touch with a doctor as soon as possible so that you can start your antenatal (pregnancy) care. This will also help to make sure you receive maternity healthcare that takes into account all your health needs and preferences.
 
 

What is antenatal care?

 
Antenatal care is the care you receive from healthcare professionals during your pregnancy. You'll be offered a series of appointments with a doctor who specialises in pregnancy and birth (an obstetrician).
 
They will check that you and your baby are well, give you useful information to help you have a healthy pregnancy (including healthy eating and exercise advice) and answer any questions you may have.  They should also advise you of available antenatal classes, including breastfeeding workshops.
 
 

Starting your antenatal care

 
You can book an appointment with your doctor as soon as you know that you're pregnant.
 
It's best to see them as early as possible. If you have special health needs, your doctor or other doctors may take shared responsibility for your maternity care. This means they will all see you during your pregnancy.
 
Let your doctor know if you have a disability that means you have special requirements for your antenatal appointments or for labour.
 
 

How many appointments you will have

 
If you're expecting your first child, you'll have up to 10 appointments. If you've had a baby before, you'll have around seven appointments. Under certain circumstances, for example if you develop a medical condition, you may have more. If you can't keep an antenatal appointment, let the hospital know and make another appointment.
 
 
To give you the best pregnancy care, your doctor will ask you many questions about your health, your family's health and your preferences. He or she will do some checks and tests, some of which will be done throughout your pregnancy. The results of these tests may affect your choices later in pregnancy, so it’s important not to miss them.
 
 

Your initial appointments

 
Your first visit with your doctor is the appointment when you tell them that you're pregnant. At this first visit, you may be given information about: 
  • Folic acid and vitamin D supplements
  • Nutrition, diet and food hygiene
  • Lifestyle factors that may affect your health or the health of your baby, such as smoking, recreational drug use and drinking alcohol 
  • Antenatal screening tests for abnormality 
They will give you information on keeping healthy, and ask whether you have had any previous health or pregnancy issues, such as complications in pregnancy. It's important to tell your doctor if:
  • There were any complications or infections in a previous pregnancy or delivery, such as pre-eclampsia or premature birth. 
  • You're being treated for a chronic disease, such as diabetes or high blood pressure . 
  • You or anyone in your family have previously had a baby with an abnormality, such as spina bifida. 
  • There's a family history of an inherited disease, such as sickle cell or cystic fibrosis.
An important part of antenatal care is getting information that will help you to make informed choices about your pregnancy. Your doctor will give you information in writing or some other form that you can easily use and understand.
 
 

Questions you might be asked

 
The doctor might ask about:
  • the date of the first day of your last period, to help work out when the baby is
  • your health
  • any previous illnesses and operations
  • any previous pregnancies and miscarriages 
  • your and your partner's ethnic origins, to find out whether your baby is at risk of certain inherited conditions, or other relevant factors, such as whether your family has a history of twins
  • your job or your partner's job, and what kind of accommodation you live in to see whether your circumstances might affect your pregnancy
  • how you're feeling and whether you've been feeling depressed
Your booking appointment is an opportunity to tell your doctor if you're in a vulnerable situation or if you need extra support. This could be due to domestic abuse or violence, sexual abuse or female genital mutilation.
 
 

Later visits

 
From around 20-24 weeks, your antenatal appointments will usually become more frequent. However, if your pregnancy is uncomplicated and you are in good health, you may not be seen as often as someone who has concerns.
 
Later visits are usually quite short. Your doctor will: 
  • check your urine, blood pressure and sometimes your weight
  • feel your abdomen to check the baby's position
  • measure your abdomen to check your baby's growth
  • listen to your baby's heartbeat if you want them to
You can also ask questions or talk about anything that's worrying you. Talking about your feelings is as important as all the antenatal tests and examinations. You should be given information about:
  • your birth plan 
  • preparing for labour and birth
  • how to tell if you're in active labour
  • induction of labour if your baby is late 
  • the "baby blues" and postnatal depression
  • feeding your baby
  • vitamin K prophylaxis (to prevent bleeding caused by vitamin K deficiency in your baby)
  • screening tests for newborn babies
  • looking after yourself and your new baby
 

Checking your baby's development and wellbeing

 
At each antenatal appointment from 24 weeks of pregnancy, your midwife or doctor will check your baby's growth. To do this, they'll measure the distance from the top of your womb to your pubic bone. The measurement will be recorded in your notes.
 
In the last weeks of pregnancy, you may also be asked to keep track of your baby's movements. If your baby's movements become less frequent, slow down or stop, contact your midwife or doctor immediately. You'll be offered an ultrasound scan if they have any concerns about how your baby is growing and developing.
 
 

When you'll have an ultrasound

 
 

This differs according to your own needs. Ask your doctor what your options are and what they're looking for each time.

 
 

You might be offered a scan at any of these following times:

  • About six to eight weeks to confirm/date the pregnancy, see if it's ectopic (developing in the fallopian tubes, not the uterus) and check the foetus is alive by looking for a heartbeat.
  • About ten to 14 weeks to confirm/date the pregnancy, see if you're expecting twins, or more, and when offered alongside a nuchal scan (which looks at a pad of skin at the back on your baby's neck) assess the risk of Down’s syndrome or other chromosomal conditions.
  • About 20 to 23 weeks to check for spina bifida and other possible abnormalities, look in detail at your baby's major organs and skeleton, check the health of your placenta and monitor your baby's growth.
  • Later scans monitor your baby's growth and check the position of the placenta and your baby.
 

How ultrasound scans work

 
 

An ultrasound scan uses high-frequency sound waves, which bounce off solid objects. This creates a screen image of your uterus and nearby organs, as well as your baby, the baby's organs and the placenta.

 
 

Scans can be two-dimensional, three-dimensional (for better clarity, to allow easier diagnosis of anomalies such as a cleft palate) or four-dimensional (mostly available privately).

 
 

While you're lying down, the operator (usually a sonographer or radiographer) spreads gel over your tummy and rolls a hand-held transducer across the area. The images are transmitted to a screen. These may be printed out and a copy kept with your notes. You may also be given a print, although you may have to pay for this. Some scans can be put on to a CD.

 
 

For external scans in early pregnancy you'll be asked to drink lots of water so your bladder pushes the uterus upwards for a better picture.

 
 

Early dating scans can also be done internally, via a probe inserted into the vagina. If this is the case, you won't need to drink water first as the internal scan-head rests against the uterus itself.

 
 

Blood tests during pregnancy

 
 

Normally, a small sample of your blood is taken at your first antenatal appointment. You may also be asked to give a sample in later pregnancy. The first test can:

  • identify your blood group
  • see whether your blood is rhesus positive or negative
  • check for conditions that could affect your health or your baby's (this may or may not include HIV)
  • check your immunity to rubella (German measles)
  • check for anaemia          
 

The blood test shouldn't be painful and should only take a minute or so. There may be slight bruising for a couple of days.

 
 

Blood tests can also be used to estimate the risk of Down's syndrome. A blood sample is taken at about 16 weeks to measure three substances: alpha-fetoprotein (AFP), unconjugated oestriol and human chorionic gonadotrophin. Together with the mother's age, these give an estimate of risk.

 
 

The level of AFP can also be used to assess the risk of a neural tube defect, such as spina bifida.

 
 

Blood pressure during pregnancy

 
 

Your blood pressure will be monitored at your antenatal appointments to look for signs of pre-eclampsia, or pregnancy-induced hypertension.

 
 

Your weight during pregnancy

 
 

You'll probably be weighed near the beginning of your pregnancy. Some, but not all, antenatal clinics weigh you at every appointment.

 
 

Urine tests during pregnancy

 
 

You'll be asked to bring, or produce, a urine sample to your antenatal appointments. Usually, a testing stick will be dipped into this to see whether protein or sugar is present. Protein can be a sign of pre-eclampsia, while sugar in urine is a symptom of gestational diabetes.

 
 

Palpation

 
 

This is a manual feel of your abdomen to gauge the height of your uterus and how the baby is lying.

 
 

Doppler test

 
 

This is a test to listen to your baby's heartbeat and can be done throughout pregnancy by a doctor or midwife.

 
 

Less routine tests

  • Chorionic villus sampling (CVS) - tests a sample of the placenta, taken with a needle inserted through the abdomen or via the cervix. It's done at about 11 to 14 weeks and looks for chromosomal abnormalities.
  • Amniocentesis - a sample of the amniotic fluid surrounding the baby is taken by syringe. Cells from the baby found in the fluid are tested for chromosomal abnormalities such as Down's syndrome. This is done from about 18 weeks and is offered to women who are at high risk.
  • Nuchal fold test - this uses ultrasound scanning to measure the nape of the foetus's neck. The measurement can help to estimate the risk of Down's syndrome. You may also be offered a blood test to check for past or present infection with the cytomegalo virus (CMG virus) and for toxoplasmosis.
 

Are tests during pregnancy risky?

 
 

Invasive tests such as CVS and amniocentesis do carry a risk of miscarriage, which you should discuss with your doctor.

 
 

Other risks are more difficult to quantify. Will the test mean you're unable to enjoy your pregnancy, or would you prefer to know everything you possibly can? Will the test give a false sense that everything's guaranteed to be OK, or will knowing that everything's fine help to reduce your anxiety?

 
 

Talk it over with your partner, other parents-to-be, and doctor.

 
 

What's rhesus negative blood?

 
 

Most people (80 per cent) have rhesus positive blood; the remainder have rhesus negative. Being rhesus positive means that the person has a substance called D-antigen on the surface of their red blood cells (this characteristic is inherited).

 
 

When both partners have the same rhesus factor, there's no problem, and neither is there a problem if the mother is rhesus positive and the father is rhesus negative. But if the mother is rhesus negative and the father is rhesus positive, and they have a baby who inherits rhesus positive status from the father, this can result in harm to the baby.

 
 

During the pregnancy or birth, small amounts of the baby’s rhesus positive blood may cross over into the mothers bloodstream. The D-antigen on the blood cells can then trigger an immune response in the mother, causing her to produce antibodies against D-antigen. The mother is then said to be “sensitised” to rhesus factor.

 
 

During a first pregnancy this may have no obvious effect, as sensitization don't usually happen until late in the pregnancy or at the birth. But if she becomes pregnant again with a rhesus positive baby, these antibodies can cross the placenta and attack the developing baby causing haemolytic disease of the newborn, anaemia and jaundice, which can be fatal for the unborn child.

 
But these deaths can be prevented. Treatment (also known as routine antenatal anti-D prophylaxis or RAADP) consists of injections of an immunoglobulin (or antibody) against D-antigen, which prevents the immune reaction to the baby’s rhesus positive