What’s happening this week

Your baby…

• is about the size of a bean, average 9mm
• digestive tract and lungs are continuing to form
• face is gaining definition – mouth, nostrils, ears and eyes
• the arm bud that developed last week now has a hand on the end of it
• the genital tubercle is present but gender is not distinguishable by sight.

You…

• may be on an emotional rollercoaster; up one minute and down the next
• face may break out in spots due to increased hormone levels
• flushing of face/hands due to an increased blood supply may occur
• your cervix now has a mucus plug which has formed to seal off the uterus for protection
• may experience some breast heaviness.

Early pregnancy can be a time of joy, but also anxiety. Here we look ahead to some antenatal tests and also look at some common worries in these early weeks.

Miscarriage

The loss of a baby can be very distressing. Sadly, up to one in five pregnancies will end in a miscarriage and the reasons why aren’t clearly understood. Most miscarriages take place before 12 weeks of pregnancy; ‘late’ miscarriages are rare.

A miscarriage usually begins with bleeding, and you may feel cramps like period pains. You may have a hospital checkup and might need an operation to remove any blood clots that have not come away.

If it happens to you, don’t blame yourself. It is unlikely that there was anything you did or didn’t do that would have caused it. If you need to talk about it, even sometime later, there are support groups that can help. Call the Miscarriage Support Inc. on 0800 611 116 www.miscarriage.org.nz

You could also ask your GP or LMC if there are any local support groups. If you’ve had a miscarriage before it may be a while before you let yourself really enjoy this pregnancy. But most women who have had one or even two miscarriages go on to have a healthy baby next time.

Remember, this baby is different, stay positive and look forward to the future.

Antenatal blood tests, scans and screening

These assist your LMC to monitor your and baby’s health.

The difference between screening and diagnostic testing

• Screening puts you in an increased or low chance group but does not give a definitive diagnosis
• Diagnostic tests confirm if the condition being tested for is present

At your first antenatal visit, you will be offered information regarding these tests.  For well women with no pre-existing medical conditions and well babies the expected tests during pregnancy include:

Blood tests:  At booking, 28 weeks and 36 weeks, and as clinically indicated at any stage

Ultrasound scans: NT scan for chromosomal abnormalities at 11-13 weeks, 6 days, an anatomy scan at 18-19 weeks and as clinically indicated at any stage

Women with pre-existing medical conditions, or who develop pregnancy-related conditions, or who are exposed to some illnesses or toxins or who are pregnant with twins/triplets may require additional blood tests or scans.

You must be informed with regards to all testing during pregnancy and give consent for these tests. You may choose not to have some tests/screening but remember that these assist your LMC to provide appropriate care for you and your baby. They help ensure you have appropriate information from which to make informed choices regarding the health of you and your baby.

First AN bloods include:

When you first see your midwife (or specialist doctor) during pregnancy you will be offered a blood test. This blood test is free, and it checks:

• Blood group and rhesus factor (negative or positive blood group, ask your midwife or specialist doctor to explain what this means)
• Screening for antibodies that may be harmful to your baby
• Full blood count including haemoglobin count (a test for anaemia) and platelet count (clotting factor)
• Tests for syphilis, immunity to rubella, immunity or carrier status of Hepatitis B, HIV(may be followed by diagnostic HIV blood tests) and may include screening for Hepatitis C.
• If you have diabetes or are at risk of developing diabetes

For more information, see the Antenatal blood test fact sheet on the National Screening Unit website.

First trimester combined screening

Between 9 and 13 weeks 6 days, you may choose to have combined screening for chromosomal abnormalities, including Down syndrome.  This is a combined scan and blood test which gives a more accurate screening result than a scan on its own. It includes information such as age, weight, ethnicity, gestation, previous pregnancies with chromosomal abnormalities and if this pregnancy involves assisted reproduction.

Blood test MSS1 blood test between 9 and 13 weeks, 6 days measures the pregnancy-associated plasma protein-A (PAPP-A) and beta human chorionic gonadotrophin (BhCG).

Scan between 11 and 13 weeks, 6 days measures the thickness of the fluid-filled space at the base of baby’s neck (nuchal translucency- NT).

Your screening results will be low or increased chance. Your LMC will discuss these with you and offer further tests if the result suggests an increased chance.

For more information about screening see www. nsu.govt.nz

Second-trimester maternal serum screening (MSS2)

Sometimes an NT scan result may be difficult to obtain and you will be offered this screening blood test. If you were too far on in your pregnancy to obtain the NT scan or MSS1 bloods you may have this screening blood test instead.

It tests four different substances in your blood and includes additional information as in MSS1 bloods.

Additional tests during pregnancy may include:

Blood tests for

• Gestational Diabetes- HbA1C, Polycose or Glucose Tolerance Test at any stage(especially if you have a family history of diabetes, certain ethnicities and women with higher BMI’s) but most frequently GTT at 28 weeks
• Ferritin- a test for anaemia which tests your bodies stored iron levels. These may drop as baby grows and may mean you need to increase your Iron consumption through diet or supplementation
• TORCH screen- testing for exposure to some infections such as Toxoplasmosis, Rubella, Cytomegalovirus, Herpes or other infections
• Extra blood tests for other reasons.

Diagnostic tests such as

• Ultrasound scans of parts of baby’s anatomy
• Chorionic Villus Sampling (CVS)
• Amniocentesis

Ultrasound scans for

• Growth of baby
• Placental position
• Amniotic fluid levels
• Extra scans for other reasons

Non-Invasive Prenatal Testing (NIPT)

NIPT is a blood test that screens pregnancies for chromosomal abnormalities, including Down syndrome, Edwards syndrome and Patau syndrome.  NIPT has the highest accuracy for Down syndrome among the prenatal screening tests available and can be performed anytime from 10 weeks pregnancy onwards.

Amniocentesis

Another way of checking that your baby is developing normally is through an amniocentesis which is a process in which amniotic fluid is sampled using a hollow needle inserted into the uterus, to screen for abnormalities in the developing fetus.