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Laboratory Tests During Pregnancy

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Over the past few decades the number of laboratory tests performed during pregnancy has increased dramatically. As medical science has become more sophisticated about pregnancy and childbirth, it has become possible to diagnose a large number of health problems during pregnancy, and to treat them effectively, too. Much of the diagnosing is done with laboratory tests.

Here are brief descriptions of some of the most common laboratory tests you may be given, starting with those that might be done in the beginning of your pregnancy. Of course, if you have any underlying health issues, you may be given other tests as well. Talk to your health care provider if you have questions about testing or any other aspect of your prenatal care that concerns you.


  Tests Performed Early in Pregnancy

  Tests Performed Later in Pregnancy

Tests Performed Early in Pregnancy

1. Blood Tests

Complete blood count (CBC) and/or Hemoglobin/Hematocrit. These tests indicate whether you have anemia (lacking enough red blood cells), you have evidence of infection, or you have certain other problems with your blood.

Rubella titre. This blood test can tell whether you've had the German measles (rubella), a disease that's highly dangerous for the fetus and the mother. The best time to be tested is before you become pregnant, but the test can be done at your first pregnancy visit. If you are considering pregnancy, have a preconception visit with your doctor or midwife and request this test. That way, if it is found that you have not had rubella, you can be immunized against the disease. If you get the immunization, you should not become pregnant for at least three months. If you are pregnant when you have the rubella test, you cannot be given the immunization against rubella, for it could harm the fetus. In that case you will be immunized after you give birth.

Blood type and Rh (rhesus) factor. This test determines the type of blood you have and whether you have or don't have the Rh factor, a protein found on the red blood cells. If your Rh status turns out to be different from your baby's, there could be health problems for the baby and for your future pregnancies. Special testing and treatment may need to be done during pregnancy and after birth.

Syphilis test (also called VDRL). Syphilis is a treatable sexually transmitted disease (STD). Left untreated, the disease can be transmitted to the fetus during pregnancy and can cause serious health problems for you and the fetus, perhaps even miscarriage or stillbirth. If this test shows you have syphilis, it's crucial that you be treated.

Hepatitis B test (HBV). If you have the hepatitis virus circulating in your body at the time of delivery, you could pass the infection on to your baby. Get this test done so you know ahead of time if you have the virus. Special precautions can be taken during delivery and at birth to prevent the baby from becoming infected.

HIV. This viral infection can be transmitted to the fetus through the placenta. If you have HIV, you need to take medicine to prevent this transmission, and the infant may need special care at birth. All pregnant women are now being asked to take the HIV test.

2. Skin test

A PPD is a skin test that determines if you've been exposed to tuberculosis (TB). A positive test does not necessarily mean that you have TB, just that you've been exposed to the disease. If the test is positive, you may need further tests. Pregnancy may activate tuberculosis that has been unnoticed. TB can be treated safely in pregnancy with special drugs that do not harm the fetus.

3. Urine tests

Urine is tested for sugar, which may be a sign of diabetes. It's also tested for protein, which may indicate preeclampsia— a dangerous condition of pregnancy involving high blood pressure—or a urinary tract infection. A urine culture might also be done to look for "silent" urine infections. These symptomless infections can be dangerous during pregnancy, and can even lead to premature labor.

4. Cervical test

The Pap test (also called the Pap smear) is an excellent test for cervical cancer. If that test is positive during pregnancy, other tests would be done to confirm a diagnosis of cancer.

Tests Performed Later in Pregnancy

1. Blood Tests

Alpha Fetoprotein (AFP) is also called a Triple Screen (when testing is done for two additional substances) or a Quad Test (when testing is done for three or more additional substances). In some states the test is called a Multiple Marker Screen or a Double Screen. Alpha fetoprotein is a protein normally produced by a fetus. If this substance is present in large quantities in the mother's blood at around 18 weeks of pregnancy, the fetus could have spina bifida or some other spine deformity. If it is present in very low amounts, the fetus could have Down's syndrome. Keep in mind that a positive test result does not mean that your baby definitely has one of these conditions. It just means that further testing is necessary.

Diabetes Screen. This test is done at around 26 to 28 weeks of pregnancy to see if you might have diabetes. If this test is positive, additional tests to diagnose diabetes will be ordered. Diabetes can and should be treated in pregnancy in order to give the fetus the best chance for being healthy.

Hemoglobin/Hematocrit. This test is performed at 26 to 28 weeks to see if you have anemia, a red blood cell deficiency.

2. Cervical Cultures

A cervical culture is used to determine whether a woman has chlamydia, gonorrhea, or the human papilloma virus (HPV), all sexually transmitted diseases. Both chlamydia (which often has no symptoms at all) and gonorrhea (which usually does have symptoms) can and should be treated and cured during pregnancy. The human papilloma virus, which used to be called genital warts, is a very common, sometimes symptomless infection found on the cervix or deep in the vagina. While this virus cannot be cured completely you should know if you have it so you can be treated. If you have an acute case of HPV when it's time to give birth, your health care provider may want to avoid a vaginal birth so your baby won't come in contact with the virus.

3. Special Tests

Amniocentesis is a procedure offered to women when there might be a risk of a specific type of genetic abnormality—such as Down's syndrome—in a fetus. Women over the age of 35 are commonly urged to have an amniocentesis because the risk of Down's syndrome rises at that age. An amniocentesis has a risk of miscarriage of about 1 percent.

Here's how it works: A very thin needle is inserted into the uterus through the abdomen and a small amount of amniotic fluid is removed for testing. You will feel very little pain during the procedure, and you'll probably be advised to take it easy for a few hours afterward.

Before you decide to have this procedure, think about whether you want to know the results and what you would do about them. Some women, for instance, want to know everything about their fetus, including the possibility of a genetic abnormality, to be prepared for whatever happens. Some women want to know the results because they might choose to terminate the pregnancy. Some women do not want to know the test results because they feel they would maintain the pregnancy no matter what the results were, and a bad result would only be upsetting to them. No one can make these decisions but you, so it is important to consider all the options before you decide whether to have the amniocentesis.

 
 
 
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