Pregnancy is an exciting time for parents-to-be and their family and friends.
Pregnancy is an exciting time for parents-to-be and their family and friends. It’s also a time when you might have more questions than answers about how your baby is developing. In an effort to help you find the answers you are looking for, we have provided a link to one website we believe offers a clear and concise overview of the different stages of your baby’s development, week by week, trimester by trimester: Pregnancy.org
As each week of your pregnancy unfolds, Pregnancy.org provides detailed descriptions and pictures of real embryos and fetuses to bring the experience of fetal development to life and help you better understand your baby’s growth.
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A family physician is a licensed medical doctor with extra training in the area of basic care. This includes uncomplicated pregnancy, childbirth and postpartum. A family physician can offer care for the entire family, including infants and children. However, not all family physicians are willing to perform deliveries. In such cases, they provide the bulk of the pre- and post-natal care, and the obstetrician or midwife takes over the care at the end of pregnancy and delivers the baby.
Family physicians can admit patients to one or more hospitals. They may practice with a group of physicians or in a solo practice.
Your family physician may or may not deliver your baby. If your family physician is in a group practice, the group shares being on call at the hospital. This may mean that your family physician will not be present for your labour and delivery and one of the partners or the doctor on call at the hospital will deliver your baby. OHIP covers the family physicians’ services. Family physicians may consult with an obstetrician if a problem arises in pregnancy or labour. If the labour turns into a high risk situation, family physicians call in an obstetrician to take the lead.
Your family physician may or may not deliver your baby. If your family physician is in a group practice, the group shares being on call at the hospital. This may mean that your family physician will not be present for your labour and delivery and one of the partners or the doctor on call at the hospital will deliver your baby. OHIP covers the family physicians’ services.
Most family physicians check on mom and the baby regularly at the hospital, as this type of doctor cares for the whole family. Maternity nurses help mom through her time in the hospital after birth. Family physicians see new moms and their babies (and often dads) for a postpartum check-up in their offices during the first week after birth.
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Expectant parents are often amazed at the number of laboratory (lab) tests and screenings done by their doctor or midwife during the pregnancy. Just what do all of these routine screens and tests show?
Lab tests are routinely done to help predict risks or diagnose problems with your health and your baby's health. These lab tests are urine tests, rubella titre, Pap test, HIV test, as well as screening for gestational diabetes, which develops during pregnancy, and Group B Streptococcus (GBS), a bacteria.
There are also several screening tests for genetic abnormalities that are done early in pregnancy.
Screening tests include maternal serum screening, frequently called the Triple Screen, and ultrasound. These screens may show fetal defects and, if the screens are positive, there are diagnostic tests that can be used to show whether your baby has certain defects.
Diagnostic tests include Chorionic Villus Sampling (CVS), amniocentesis and Percutaneous Umbilical Blood Sampling (PUBS). Your age and medical, obstetrical and genetic histories are important factors used to decide whether testing for fetal abnormalities is needed early in pregnancy. Any genetic diseases or birth defects in close relatives may indicate an increased risk. If you have concerns talk with your doctor or midwife.
None of the tests available today are 100% accurate. Women may be offered some of these at their first prenatal visit or later in the pregnancy. The advice of your doctor or midwife will be based on her particular risks and on the availability of prenatal screening programs. Ultimately, the decision to go ahead with genetic testing will be up to you and your partner.
Below, are lists that include the tests or screenings that may be done during pregnancy. Use this information when talking with your doctor or midwife about tests and screening in pregnancy.
BLOOD GROUP AND ANTIBODY SCREEN
This blood test checks to see what type of blood type you have and looks for any unusual antibodies in the blood. Your blood will be one of four types: A, B, AB or O. This test also screens for Rh factor. This is an antigen that sometimes attaches to blood cells. It is called Rh factor antigen and can be present (Rh+) or absent (Rh-). Rh incompatibility can occur if mother and baby have different Rh factors.
FETAL FIBRONECTIN TEST (FFT)
This test may be done if you are at risk for preterm labor. Fetal fibronectin is a protein found in secretions from the cervix. They normally show up in the cervical canal both early in pregnancy and in the late stage of pregnancy but should not be present in the weeks in between. A swab of your cervical secretions is taken during an internal vaginal examination. The secretions are then analyzed for fetal fibronectin. If the test is negative, it is unlikely that you will go into labour in the next seven days.
FIRST TRIMESTER SCREENING (FTS)
This screening test is done in the first trimester to indicate the chance of your baby having Down Syndrome, congenital heart disease and other genetic disorders.
Two blood tests are taken between the 11 and 14th week of pregnancy with a finger prick sample. The tests are analyzed for two pregnancy proteins—pregnancy associated protein A (PAPP-A) and beta- human chorionic gondatropin (B-hGC)—normally found in pregnant women. This blood test is combined with an early ultrasound to check the fluid pocket at the back of the baby’s neck. This is called nuchal translucency (NT). The information from these two assessments is then used to determine the risk of the baby having one of the disorders stated above.
A positive screen means the baby has an increased chance of having one of these conditions. You would then need to decide if they want to have diagnostic testing, such as chorionic villus sampling (CVS) or amniocentesis.
There are several limitations to this screening test. Ultrasound technicians and doctors need special training and high quality equipment to perform the NT ultrasound; so not all hospitals in Canada may offer this early screening test. This is only a screening test. Results from this test are not diagnostic; further testing would be required to determine if your baby has a problem. The results may cause needless worry until further diagnostic testing is done.
GESTATIONAL DIABETES SCREEN
This test is done between 24 and 28 weeks to show if you have trouble metabolizing glucose. You must drink 50 grams of a carbohydrate fluid. Blood and urine tests are taken one hour later. If the test is positive, further testing is done to find out if you have gestational diabetes.
If an expectant mother has gestational diabetes, the pregnancy may be identified as high risk and closer follow up will be done.
The greatest problem with this test is that the results can be incorrect if a woman has had an infectious disease or surgery prior to the test, or if she smoked prior to the test.
GROUP B STREPTOCOCCUS (GBS)
This test is done to show if an expectant mother has Group B Streptococcus (GBS), which can cause severe infection in the baby. A vaginal/rectal swab is done at 35 to 37 weeks. If the result is positive, mom would be treated with antibiotics and she will be monitored closely in labour. Re-infection can occur from your partner.
Women who are at risk for GBS:
- Are under 20 years of age.
- Have previously had a GBS infection.
- Had a previous preterm labour or a labour with a fever.
- Experience frequent bladder infections.
This blood test checks your blood to make sure it is able to carry enough iron and oxygen.
HEPATITIS B SURFACE ANTIGENS
This is a blood test to see if an expectant mother has been exposed to Hepatitis B. Hepatitis is a viral infection that affects the liver. This infection can be passed to your baby during birth or breastfeeding. Babies who develop Hepatitis B can develop long-term health problems. One of every 250 people has this disease. It is more common in people who have recently emigrated from Asia or Haiti. Many people have no symptoms and, therefore, don't realize they have it.
This blood test is done to see if an expectant mother has been exposed to Hepatitis C. Mothers can pass Hepatitis C to their babies.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
This is a blood test to check for exposure to HIV, the virus that causes AIDS. Many people with HIV don't know they have it because they have never been tested for the presence of the virus in their blood. It can take five years or more for symptoms to show up.
The virus is found in an infected person's body fluids – semen, blood, vaginal secretions, and breast milk. An infected mother can pass HIV to her baby during pregnancy, delivery or while breastfeeding. Unless treated, many babies who are infected with HIV die within three years. Every woman who is pregnant or thinking about becoming pregnant, should strongly consider being tested for HIV. If your doctor doesn't mention HIV testing, ask to be tested.
It is important to know if an expectant mother is HIV positive. There are treatments that can be taken during pregnancy and labour that will reduce the risk of the baby getting HIV. The baby can also be treated immediately after delivery, which also reduces the risk.
A woman must give consent for this test and receive counseling from her healthcare provider prior to having the test. Doctors and midwives must give an OHIP number for the lab to bill for this test. To protect privacy and the confidentiality of the test results, she can have this test performed at an anonymous clinic. Your partner should be tested, as well.
There are some disadvantages of this test:
- The results could be wrong if the screening is done immediately after unprotected intercourse. There is a time frame before the antibodies would show in the blood.
- If the results are positive and the mother has HIV, this will have an impact on her ability to obtain life insurance and mortgage insurance.
For advice and support about HIV, call Motherisk's toll-free HIV Healthline at 1-888-246-5840.
INTEGRATED PRENATAL SCREENING (IPS)
This screening test is done in the first trimester to detect Down Syndrome, Trisomy 18 and open neural tube defects. It may be offered instead of Maternal Serum Screening, which is done in the second trimester.
A blood test is taken between 11 and 14 weeks of the pregnancy to measure the blood for a pregnancy protein. A second blood test is then taken to measure for the same pregnancy protein at 15 to 20 weeks. As well, an early ultrasound is done to measure the fluid pocket at the back of the baby’s neck.
A positive screen indicates that your baby has an increased chance of having Down Syndrome, Trisomy 18 or an open neural tube defect. The couple would then need to decide if they wish diagnostic testing such as chorionic villus sampling (CVS) or amniocentesis. This may create needless worry for the couple until further diagnostic testing is done.
PAPANICOLAU TEST (PAP TEST)
Pap tests are done to check for cancer of the cervix or conditions that could lead to cancer. This test is done during an internal vaginal examination. Cells are collected from the cervix with a special brush or spatula.
This blood test checks to see if an expectant mother has immunity to rubella (German Measles). Rubella can cause birth defects in a baby.
This test checks sugar and protein levels in the urine. Sugar in the urine could show the development of gestational diabetes. Protein in the urine could be a sign of blood pressure problems. This test is also done to detect a urinary tract infections, which have been linked to an increased risk of premature labour.
VENEREAL DISEASE RESEARCH LABORATORY (VDRL) TEST
This is a blood test to screen for possible previous exposure to Syphilis, a disease that is spread by sexual contact. Babies exposed to Syphilis can develop congenital Syphilis, if the mother is not treated during pregnancy. Congenital Syphilis can affect a baby's kidneys, bones, skin, liver and other body systems.
Amniocentesis is done between the 14th and 16th week and it takes two to three weeks before the results are ready. A fine needle is inserted through the abdomen and into the uterus. Ultrasound is used to help the doctor find a safe place to insert the needle. A sample of the amniotic fluid that surrounds the baby is taken for testing.
After this test, you may experience cramping. Other disadvantages of this test include:
- Possible increased feeling of anxiousness waiting for the test results.
- Occasionally, the test may need to be taken again because of culture failure (the cells fail to develop).
- Risks to this test include possible infection, possible bleeding, change in the baby's amount of movement and a low risk of miscarriage (less than 1%).
CHORIONIC VILLUS SAMPLING (CVS)
Chorionic Villus Sampling (CVS) is done at 9 to 11 weeks to identify possible birth defects. A needle is inserted into the uterus through the abdomen or a catheter (a fine tube) is passed through the cervix into the uterus. A small sample of special cells (chorionic villi) is taken from the placenta for testing. After the test, you should avoid standing for more than four hours at a time without a break. An ultrasound is used to locate the placenta before the CVS procedure is started.
Disadvantages to this test include leaking of amniotic fluid or bleeding, possible infection and a low risk of miscarriage (less than 0.5%) or injury to the baby.
MATERNAL SERUM SCREENING/TRIPLE SCREEN
Maternal Serum Screening/Triple Screen is a blood test that screens for birth defects, such as Down Syndrome, Neural Tube Defects, Trisomy 21. A blood sample is taken between 16 and 20 weeks that measures specific proteins and hormones (alpha-fetaprotein, unconjugated estriol and human chorionic gonadotrophin). A positive result would indicate that levels of these hormones are elevated and requires further testing (such as an amniocentesis).
There are some disadvantages to this test:
- Test results can be inaccurate if the test is done before 15 weeks or after 20 weeks.
- Test results can also be inaccurate if the mother is a diabetic or is expecting more than one baby.
- Waiting for the results of this test or deciding what to do if the test is positive places increased stress on parents.
PERCUTANEOUS UMBILICAL BLOOD SAMPLING (PUBS)
Percutaneous Umbilical Blood Sampling (PUBS) is done to show anemia in the baby, blood incompatibility and some genetic problems. An ultrasound is done to locate the placenta and cord. A needle is then passed through the abdomen and into the umbilical cord. A sample of blood is removed for diagnosis.
The risks of this test are possible infection, risk of preterm labour, a change in baby's heart rate and possible bleeding at the site where the needle was inserted.
SERUM INTEGRATED PRENATAL SCREEN
This test is done during the first and second trimester to detect Down Syndrome, Trisomy 18 and open neural tube defects. This test is especially indicated if ultrasound is not available to assess the fluid pocket at the back of the baby’s neck called Nuchal Translucency (NT) assessment. It combines the blood tests used during the First Trimester Screening that are taken between 11-14 weeks; and also uses the blood tests taken during the Maternal Serum Screening which is done between 16-20 weeks.
When this screen is done in the specified times there is less chance of inaccurate results and therefore less need for more invasive diagnostic procedures such as chorionic villus sampling and amniocentesis.
A positive screen shows that your baby has an increased chance of Down Syndrome, Trisomy 18 or open neural tube defects. The couple would then need to decide if they wish further invasive diagnostic testing.
There are disadvantages to this screening. The testing results can be inaccurate if the blood tests are not taken within the time period specified. Also, waiting for the test results can increase parents stress.
The ultrasound creates a picture of your baby on a computer screen using sound waves. At present, there is very little solid research to evaluate whether there is any long-term risk to the baby.
Ultrasound is used for the following reasons:
- See the baby's position and how well its growing
- Discover where the placenta is attached to the uterus
- Check the functioning of the placenta
- Check the amount of amniotic fluid that surrounds your baby
- Count the fetal heart rate
- See how many babies there are
- Check for some defects
- Confirm your baby's due date
Nuchal Translucency (NT) assessment is done by ultrasound. For this screening test, the fluid pocket at the back of the baby’s neck is measured. NT measurements are part of First Trimester Screening. The NT measurement is used in combination with a blood test to estimate the chance of Down Syndrome. This ultrasound is done between 11 and 14 weeks to determine if there are defects, and to provide information needed to make a decision about continuing the pregnancy.
A Biophysical profile ultrasound is done to assess the health of the fetus. This ultrasound may be done in late pregnancy. It assesses the baby’s muscle tone, movements, breathing movements and the amount of amniotic fluid. This ultrasound is done when a doctor or midwife needs additional information about the baby.
Adapted From Schuurmans, Nan, Healthy Beginnings: Your handbook for pregnancy and birth, 3rd edition © 2005, Society of Obstetricians and Gynaecologists of Canada.
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In the first trimester, you can expect some or all of the following...
- Menstruation to stop (any light spotting or bleeding should be checked by a doctor)
- Breast changes - fuller, tenderness, darkening of the nipple area
- Fatigue or feeling faint
- Bloated feeling
- Increased urination - needing to pee more frequently
- Increased vaginal discharge (any itchy; foul smelling; odd coloured discharge should be reported to your care provider)
- Nausea and/or vomiting
- Nasal congestion and nosebleeds
- Skin changes
- Changes in weight
- Mood swings
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