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Your antenatal care - Routine pregnancy checks

Once you’ve found out you are pregnant and chosen your caregiver, you will be asked to make an appointment for some routine tests at the beginning of your pregnancy.

For the remainder of your pregnancy, you’ll attend regular appointments where some simple checks and tests will be performed to make sure everything is going smoothly.

This also gives you the opportunity to ask questions and check anything you’re unsure about.

Routine Tests at each visit

Urine Test: At each visit, your urine will be tested for the presence of sugar or protein, which are early indicators of various conditions such as gestational diabetes or pre-eclampsia. Some clinics keep test strips in the loo so you can do the test yourself; others ask you to provide a sample at the time of the appointment, or give you a specimen jar for your next visit.

Blood Pressure: At each visit, your blood pressure will be tested and recorded using an inflatable arm cuff and your caregiver will check your pulse at the same time, often with a stethoscope. High blood pressure during pregnancy can affect your health and that of your baby and can be a sign of conditions such as pre-eclampsia.

Palpation: At each visit, your caregiver will feel the outside of your abdomen to assess the size and position of the baby inside the uterus. They will also use a stethoscope to listen to the baby’s heartbeat – and may use a little hand held Doppler instrument so that you can also hear your baby’s heartbeat, though it can be hard to hear before about ten weeks. Don’t be surprised by the sound - the normal fetal heart-rate is very fast, between 120 and 160 beats per minute.

Number and Timing of Routine Visits

The number and frequency of antenatal appointments will depend on your circumstances; these days, the Royal College of Obstetricians recommends around ten appointments during the duration of pregnancy for women classified as low-risk who are expecting their first baby and around seven for those who have had previous pregnancies without complications.

However some caregivers prefer the traditional schedule of 14 visits; this is something you can discuss with your caregiver.

Usually appointments will be around six weeks apart in the first two trimesters, with visits becoming more frequent towards the end of the pregnancy.

First Trimester

In the first trimester, your carer will be focusing on assessing your well-being and that of your baby – and trying to assess your risk of complication.

The visits will be scheduled around the screening tests that you will be offered in the early part of the pregnancy.

Your first appointment with your caregiver should be fairly early in your pregnancy – ideally before 12 weeks.

In this appointment, your doctor or midwife will try to date the pregnancy and take a case history, which involves finding out about your general health, previous physical or mental illnesses.

Don’t be shocked by the routine questions; caregivers will also ask if you smoke, drink alcohol or use street drugs and will give you the opportunity to discuss a vulnerable situation – for example, are you coping financially or have you experienced domestic violence or sexual abuse. You may be offered a referral for further assistance.

Your caregiver will probably give you information about pregnancy services and the various options available to you and discuss diet and exercise and any aspects of your life which may affect the health of you or your baby.

They will also talk to you about the routine screening tests and the other optional screening tests that you may choose to have in pregnancy. There may be implications associated with your decision to have some of these tests – and your caregiver should discuss this with you.

The first visit usually involves a urine test, blood pressure check and measuring weight and height to determine BMI.

These days, weight is not usually checked throughout the pregnancy as it can cause unnecessary anxiety in the pregnant woman and doesn’t provide useful information about the progress of the pregnancy as there is so much variance in weight gain.

You will also be asked to have a blood test – this may involve a referral to a pathology lab.

Additional tests which you may choose to have in the first trimester include an early ultrasound (offered to check for a multiple pregnancy or to check pregnancy dates), Nuchal scan (offered at 11 to 13 weeks to test risk of Downs Syndrome), or Chorionic Villus Sampling (offered between 11 to 14 weeks to test for several chromosomal abnormalities) – see ‘Special Tests’ for more information.

Blood Test

The initial blood test will check your blood group and whether your blood is Rhesus (Rh) positive or negative; if your partner has a different blood type or Rh factor, precautions can be taken in case your baby also has a different Rh factor, to avoid problems which can occur in second or subsequent pregnancies.

Screening for a number of conditions is routinely done, including Asymptomatic Bacteriuria, Rubella, Syphilis, Hepatitis B or C and HIV, although you can ask not to be tested for any of these conditions if you wish. Your haemoglobin levels will also be checked – if they are low, you may be at risk of anaemia and iron tablets and dietary changes may be recommended.

Second Trimester

In the second trimester, your caregiver will be monitoring your baby’s growth, your own well-being and signs of any abnormalities, such as early-onset pre-eclampsia.

Tests which are routinely offered in the second trimester include an obstetric ultrasound (usually at around 18 weeks), blood tests for anemia and red cell antibodies, and glucose tolerance screening (offered at around 24 to 28 weeks.)

Additional tests offered include amniocentesis and additional blood tests.

If you are rhesus negative, the first of two anti-D treatments may be offered at around 28 weeks.

Third Trimester

Your caregiver will be monitoring your baby’s growth and your own wellbeing in the third trimester, looking for signs of pre-eclampsia and other complications – and will also be getting you ready for your admission, labour and delivery and ‘going home’ after the birth.

If you are rhesus negative, a second two anti-D treatments may be offered at around 34 weeks.

At 36 weeks, your caregiver will be checking to see if the baby is head-down; you may be given options to encourage the baby to turn if it is in a breech (feet-first) position.

Additional tests offered might include screening for group B streptococcus (GBS), a bacterial infection that can pass to your baby, at 35 to 37 weeks.

By Fran Molloy – journalist and mum of 4

Pregnancy Jargon Special tests