Pregnancy is an important phase in a woman's life. At different stages of pregnancy, various tests help determine the development of the baby and the mother's wellbeing.

Early signs of pregnancy:

Missed periods, Implantation bleeding, Fatigue, Headache, Nausea, Abdominal cramps, Vaginal discharge, Frequent urination, Breast soreness & tenderness.

Once pregnancy is confirmed, certain pathology tests are undertaken to keep track of the overall health and assess the risk of infections, chronic health conditions like Feto-maternal complications.

Regular testing can help you ensure a safe & healthy pregnancy. Doctor-recommended tests for every stage of your pregnancy

FIRST TRIMESTER (EARLY PREGNANCY CHECKUP)

• Antenatal Profile: Helps determine the risks to normal fetus development thus helping in the identification of factors requiring special care.

o   Complete Blood Count

o   Blood Group ABO & Rh

o   Glucose – Fasting/Random

o   Thyroid Stimulating Hormone (TSH), Ultrasensitive

o   Rapid Plasma Reagin (RPR)/ VDRL

o   Hepatitis C Virus Total Antibody (Anti- HCV)

o   Hepatitis B Surface Antigen (HBsAg)

o   HIV 1 And 2 Antibody

o   Urine Routine & Microscopy

• Hemoglobin Electrophoresis; Abnormal haemoglobin studies
• TORCH Profile IgG & IgM (10 tests): Determines the presence of certain infections caused by Toxoplasma(T), a group of other (0) pathogens, Rubella(R), Cytomegalovirus(C) and Herpes Simplex (H) virus (TORCH) that may cause maternal illness or birth defects in the newborn.
• Dual Marker: Test Assesses the risk of certain genetic abnormalities like Down syndrome and Trisomy syndrome in the fetus. It includes two markers - Free beta human chorionic gonadotropin (Beta-hCG) & Pregnancy-Associated Plasma Protein (PAPP-A)
• First Trimester Quad Screen by Auto Delfia (Time Resolved Fluorescence): Alpha Feto Protein (AFP) (Maternal), Free Beta -hCG, PAPP – A, Placental Growth Factor (PLGF)
• Early Pregnancy USG (Early Viability Scan): This is usually done during early pregnancy to look at the site of the pregnancy, the number of gestational sacs, the cardiac activity of the foetus, gestational age and other structures like the uterus and the ovaries.
• Ultrasound NT Scan: Nuchal translucency screening uses an ultrasound to examine the area at the back of the fetal neck for increased fluid or thickening. The nasal bone may not be visualized in some babies with certain chromosome abnormalities, such as Down syndrome. It is done between weeks 11 and 13 of pregnancy.

SECOND TRIMESTER

To ensure the second trimester of your pregnancy passes off smoothly, the following checkups and tests are performed during this sensitive period:

• Oedema or swelling in your feet, ankles or legs. It could be normal particularly with multiple pregnancy or it may be a sign of feto-maternal complications such as preeclampsia, blood clot or gestational diabetes.
• Weight: During this phase, your weight is measured to compare and assess the change in weight with pre-pregnancy weight.
• Blood pressure: Blood pressure decreases during pregnancy in response to changing hormones and blood volume. High blood pressure can lead to serious problems during pregnancy. In such cases, the doctor may look for symptoms of preeclampsia or gestational hypertension.
• Glucose Challenge Test (GCT) or Glucose Tolerance Test (GTT) is done to test for gestational diabetes (diabetes during pregnancy) because the placenta makes hormones that could cause sugar to rise in the blood. This test is done towards the end of the second trimester (16 to 18 weeks) if you have had gestational diabetes before, and also in the third trimester (24 to 28 weeks). If you have risk factors for gestational diabetes, you will be tested earlier in your pregnancy as per your doctor suggests, these risk factors include:

o   Being older than 35

o   Obesity (defined as a pre-pregnancy BMI greater than 30)

o   Aboriginal, African, Asian, Hispanic, or South Asian ethnicity

o   Family history of diabetes

o   Polycystic ovarian syndrome or acanthosis nigricans

o   Corticosteroid uses during pregnancy

o   Previous pregnancy with GD

o   Previous delivery of a baby large than 4000 g

• Urine Routine & Microscopy: Urine test for preeclampsia – A urine test for the presence of protein may be able to detect preeclampsia, a condition marked by high blood pressure and signs of damage to liver, kidneys, or other organs. It can cause blood clotting problems, seizures, and if untreated, can be fatal for the mother and infant.
• USG Level II or anomaly scan: show how your baby is growing and check the fetal movements, makes sure your baby's internal organs are developing well, detects certain birth defects in your baby, estimates the amount of amniotic fluid, checks the umbilical cord and position of the placenta, checks for markers of chromosomal abnormalities, checks your cervix, and measure the birth canal.
• Fetal Echocardiography test: detect structural or functional disorders associated with an unborn child’s heart. test can be carried out around 18 to 24 weeks of pregnancy in majority of pregnancies
• Quadruple marker test: This test measures the levels of four marker AFP, Unconjugated Estriol, β -HCG and inhibin A in blood. This test is done between 14 and 22 weeks of pregnancy. However, the best time for this test is between 15 and 20 weeks of pregnancy to evaluate your risk of carrying a baby who has any of the following conditions: Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), Spina bifida, and Anencephaly.
• Non-Invasive Prenatal Test (NIPT) performed on maternal blood to screen the most common fetal chromosome abnormalities such as t21, t18, t13, Monosomy X, Triploidy and Microdeletions. The test can be used as early as 9 weeks of gestation. (Valid Between 10-24 weeks of gestation)
• Amniocentesis is invasive testing involves taking a small sample of the amniotic fluid that surrounds the fetus. It is used to diagnose chromosomal disorders and open neural tube defects, such as spina bifida. Testing is available for other genetic defects and disorders depending on your family history and the availability of lab testing at the time of the procedure. An amniocentesis is generally offered to women between the 15th and 20th week of pregnancy who have an increased risk of chromosomal abnormalities.
• Chorionic Villus Sampling (CVS) is a prenatal test that involves taking a sample of some of the placental tissue. This tissue contains the same genetic material as the fetus and can be tested for chromosomal abnormalities and some other genetic problems. CVS also need a follow-up blood test between 16 and 18 weeks of pregnancy to screen for these defects.

THIRD TRIMESTER

Starts from month 7 and lasts until 9 months when the mother is ready to give birth. largely look for infections and deficiencies.

• Iron profile Blood test to check for anemia.
• Glucose test is done to test for gestational diabetes.
• USG Scan An ultrasound to determine where the placenta is and how the baby is growing.
• Group B Streptococcus Test – To screen a pregnant woman for the presence of group B streptococcus (GBS) in her vagina or rectum to determine the risk that she will pass the bacteria on to her newborn during labor and delivery, possibly resulting in a serious infection in her newborn called early-onset GBS

VACCINATIONS FOR ALL PREGNANT WOMEN

• Routinely recommended during pregnancy: Tetanus, diphtheria, pertussis (Tdap) vaccine or Td and the influenza (flu) vaccine.
• May be recommended during pregnancy if risk of infection is high: Hepatitis B, Meningococcal infection, Rabies, and Polio. Travel vaccine: Hepatitis A, Typhoid fever ((inactivated formulation only)
• Not recommended during pregnancy: Human Papillomavirus (HPV), Measles, Mumps, and Rubella (MMR), Chicken Pox, Shingles, and Tuberculosis (TB)

Medically Reviewed by

• Dr. Sajana Shrestha, MD, Consultant Gynecologist
• Ramendra Kumar Raman, PhD, Clinical Research