Antenatal Care - When to start clinics, Anti D, Ultrasound (low lying placenta), Obs Gyn, Lab test

In developed countries, antenatal care is adequately provided to pregnant women. However, the issue is not addressed very well in developing countries and several urban areas. Care of the mother and fetus is crucial in achieving healthy pregnancy and delivering full term baby. It also minimizes the risks of complications, helps in early detection of potential fetal anomalies and decreases morbidity and mortality.

Ideally, antenatal care and clinics must be started as soon as positive pregnancy is diagnosed. Timely visits to OB-GYN and midwives should be continued till birth and even after delivery to ensure that optimum postnatal care is provided to the mother and neonate. Your OB-GYN will carry out routine investigation lab tests and a few ultrasounds during the course of your pregnancy. Additional tests and therapy might be needed in case of any complication occurring during this period.

Lab Tests

There are a series of tests that are conducted during each trimester. Each of these is briefly discussed below:

• Blood Group Test – It indicates the blood group of mother, which will usually be among A, B, AB or O. Rh factor test will also be conducted which will reveal whether or not the mother is Rh-negative.

• Complete Blood Count (CBC) – Being the most common routine blood test, CBC is vital during pregnancy as it helps in early detection of anemia or iron deficiency in the mother – one of the most crucial things to watch out throughout pregnancy.

• Rubella – Most mothers are immune to Rubella virus but in cases when they are not, critical care is needed to avoid risks of miscarriage and birth complications.

• Testing for Hepatitis B and Syphilis – Although rare in healthy women, the testing and appropriate treatment for each of this is compulsory if present during pregnancy.

• HIV and AIDS – Most regulatory bodies including Centers for Disease Control and Prevention (CDC) and American Congress of Obstetricians & Gynaecologists highly recommend that all pregnant women be tested for HIV. If positive, immediate treatment should be started in order to prevent the baby from being infected with the virus.

Ultrasounds

Gynaecological ultrasounds are mandatory for all pregnant women. In a normally progressing pregnancy, a set of three ultrasounds is performed routinely. These include,

• Ultrasound for Fetal Viability – It ensures that the fetus is live and indicates whether the pregnancy is of a single foetus or multiple foetuses. This scan is usually performed anywhere between 6-13 weeks.

• Fetal Anomalies Scan – Performed between 18-24 weeks, a fetal anomalies scan is the major ultrasound that gives a detailed presentation of normal fetal growth and identifies any abnormalities that are arising in the fetus. One of the common complications that arise in late pregnancy is Placenta Previa, in which the placenta is abnormally positioned below the fetus. Although common in early pregnancy, placenta previa in advanced pregnancy increases the risk of bleeding. Low-lying placenta is the most challenging type of placenta previa because it requires close monitoring of the mother and the baby.

• Growth and Position Scan – Although not compulsory, this ultrasound helps in keeping track of normal growth of the baby and assuring that the baby is positioning itself well for delivery. Growth scan is usually performed during the third trimester.

Other Tests

Women with a history of urinary tract infection (UTI) or existing UTI during pregnancy need to be assessed and diagnosed and treated early as it increases the risk of kidney damage and may result in preterm birth with a premature baby and low birth weight. Genetic testing is also performed in some countries to rule out the presence of certain genetic diseases in foetus, such as Down Syndrome.