Tests During Pregnancy
What tests am I having and why?
In pregnancy, many tests are considered ‘routine’ and the standard of care and others are targeted specifically towards certain at risk populations. Below is a brief overview of common tests in pregnancy, although as always, your specific circumstances and preferences will be discussed prior to initiating testing.
We recommend patients undergo the following blood tests
- Blood group and antibody screen (repeated at 28 weeks if you a “negative” blood group)
- Full Blood Examination (to exclude anaemia and other blood conditions)
- Iron and Vitamin D testing
- Midstream urine specimen (to rule out a silent urinary tract infection)
- Infectious diseases screening (including Hepatitis B, C, HIV and syphilis)
- Assessment of immunity to Rubella and, if appropriate, Varicella
- Random blood glucose, plus a formal glucose tolerance test for certain populations at high risk of diabetes (e.g. PCOS, past history of gestational diabetes, family history)
- B12 and folate, if indicated
**Although it seems like a lot of testing, this can all be done on just a few millilitres of blood and be done concurrently. All tests have evidence to support them and we do not organise tests which we do not feel will benefit you or your baby. Many patients will have already had these performed by their GP before they even meet their obstetrician.
Screening for genetic abnormalities
This testing is completely optional and up to personal preference, and some patients will opt not to do any screening at all. We completely respect and honour these choices, however some other families are concerned about the risk of Down Syndrome and other chromosomal conditions, and wish to undergo testing in this regard. There are many options available and they vary in terms of accuracy and cost. Some can be performed at any stage in the pregnancy, from as early as 10 weeks, and others are confined to certain time periods or trimesters. These will be discussed in detail at your first antenatal appointment.
Ultrasounds
- Many women, particularly if uncertain of their due date, will have an early dating or viability scan, at anywhere from 6 to 10 weeks. The remainder of the recommendation applies to single pregnancies only. If there are twins on board, expect scans to be more frequent.
- 12-13 weeks: Nuchal translucency + early morphology scan (historically performed as part of the combined first trimester screen, this scan is still valuable, even if you have had an NIPT)
- 18-20 week: Mid-trimester morphology ultrasound, assessment of cervical length and placental location
- Growth or placental location scans later in the pregnancy, if indicated, usually in the third trimester
Later in pregnancy
- Diabetes screening at 26-28 weeks is considered routine and recommended for all pregnancies. Gestational diabetes complicates more than 1 in 8 pregnancies and with diagnosis and appropriate management, can still result in excellent pregnancy outcomes. If you are considered ‘high risk’, you may be encouraged to have diabetes screening on more than one occasion in your pregnancy
- Rechecking FBE (blood count), iron stores and vitamin D at 26-28 weeks (performed on the same blood sample as the diabetes testing)
- GBS screening at 36/37 weeks (this is not a blood test, but is a swab from the vagina and perineum). GBS (group B streptococcus) is a bacterium commonly and transiently carried in the genital tract and while it causes no problems for the pregnant woman, can be transmitted to babies and cause infections to susceptible newborns.
Other
- We will also assess if your pap smear is due and if so, we are happy to arrange that for you. Pap smears are safe to perform in pregnancy.
Common Pregnancy Questions
Can I travel while pregnant?
If your pregnancy is uncomplicated you are most welcome to travel, including by plane, in pregnancy. Most airlines allow travel up to your 40th week if there is only one baby on board and 36 weeks if you are carrying twins (or more), for flights up to four hours’ duration. The rules for flights longer than four hours are a bit stricter, allowing you to travel up to 36 weeks with a single foetus and 32 weeks with a multiple pregnancy. If flying after 28 weeks, you will require a certificate of clearance, which can be provided by your GP, midwife or obstetrician.
It is important to be aware that the risk of Deep Vein Thrombosis (DVTs) from travel is higher in pregnancy and post-partum, and so you should take certain precautions on your journey. Whether in a car or a plane, be sure to get up and walk around regularly, moving your legs and feet, stay hydrated by drinking water and consider using anti-embolism (TED) compression stockings, which are available from pharmacies.
When you travel, be sure you take some form of pregnancy record with you, so that in case of emergency the local doctors can know what stage you are up to and what your important test results are. Be sure to purchase travel insurance which covers not only yourself, but also your baby, should it be born early whilst away. Be familiar with the availability of medical services at your destination, as well as clean drinking water and food safety. Also, avoid travelling to Zika prone areas whilst pregnant or within 6 months of trying to conceive.
Here are some other good sources of information
Air Travel and Pregnancy PDF
The CDC’s Resonse to Zika and special precautions for travel to at risk areas Zika Pregnancy Travel PDF
Current outbreaks of Zika https://www.cdc.gov/zika/
Is it safe for me to exercise?
Yes, absolutely, in fact it is recommended that you do 150 minutes of moderate intensity activity per week. Exercise is vital in pregnancy and has been shown to improve women’s self-esteem, increase muscle tone, lower rates of gestational diabetes and high blood pressure and a quicker recovery from birth. Exercise can also improve sleep and mood, which is especially important in pregnancy, and when practiced sensibly poses no risks to the unborn baby.
It is important to be aware that pregnancy can causes joint loosening, posture changes, an altered centre of gravity and blood pressure fluctuations, all of which can increase your risk of injury. If something feels uncomfortable, painful or unsafe, don’t do it, but otherwise, find something that you enjoy and that makes you feel good. This might be swimming, cycling on a stationary bike, Pilates, yoga, jogging, walking and don’t forget pelvic floor muscle exercises! Avoid contact sports and those with a high risk of falling (e.g. skiing or horse riding), and be sure not to lie completely flat on your back once you’ve hit the halfway point of your pregnancy. Make sure you warm up before exercise, stretch, and cool down afterwards. Drink plenty of water, avoid overheating and limit your intensity to a point where you can still carry out a conversation while you’re working out (the “talk test”).
If you have any complications in your pregnancy, consult your obstetrician, GP or midwife to discuss if your exercise plans are appropriate for your needs, as they may some adjustments.
Fact sheet for more details Pregnancy and Exercise PDF
What vitamins should I take and what should I eat?
Although there is a lot of concern about food safety in pregnancy, it’s important to make sure you still eat regularly and a balanced diet. Most women struggle to get enough of the right foods in during the day, especially when experiencing nausea or food aversions, and so a pregnancy multivitamin is advisable throughout the pregnancy. You may need to try a few until you find one which doesn’t cause constipation or upset your tummy. Your doctor will let you know if you need additional supplements of a specific vitamin or mineral.
Avoid alcohol altogether in your pregnancy and limit sugary drinks. Drink plenty of water or carbonated water (soda or mineral) if you don’t like plain tap water.
Food safety in pregnancy and a guide to good nutrition Food Safety and You Pregnancy Brochure PDF
Should I stop drinking coffee?
Not necessarily. It is considered safe to have up to 200mg of caffeine per day, which equates to one café coffee or two cups of instant per day. Tea contains much less caffeine, although it will differ, depending on how ‘strong’ you make the cup. Herbal tea and decaf is a safer option if one cup is not enough to get you through the day. Excess caffeine intake has been linked to an increased risk of miscarriage and a baby with a low birth weight. Be especially wary of energy drinks as they have extremely high levels of caffeine and other stimulants (and usually a high sugar content), which is unsafe in pregnancy.
Caffeine also increases the heart rate and can trigger palpitations, as well as worsening reflux and heartburn, so as your pregnancy progresses you might find your allotted one cup a day not as pleasant anymore!
What about my sex life?
Unless you have a complication in your pregnancy (such as bleeding, placenta praevia or a shortened cervix), sex is safe to continue throughout your pregnancy. There may be times where you may feel queasy, exhausted and not in the mood and other times where the increased blood flow to the pelvis and genitals may make you feel particularly aroused or playful. Avoid putting too much emotional pressure on yourself and when the time is right, find a position that’s comfortable and enjoy!
PCOS
What is PCOS?
It is an endocrine (hormone) condition that affects at least 1 in 10 women and is diagnosed by irregular or absent periods, polycystic appearing ovaries on ultrasound and/or excess male-hormones. Many women have polycystic ovaries on ultrasound and do not have the “syndrome”, so it is important to clarify your exact diagnosis. Women with true PCOS need careful (and compassionate) care throughout their lifetime as they are at increased risk of several health problems, including diabetes, heart disease, fertility problems, certain cancers, body image problems, depression and anxiety.
What causes PCOS?
No-one knows the cause but there seems to be a genetic component because you are far more likely to have PCOS if your mother or sister has it. Although obesity (being overweight) does not cause PCOS, it can worsen the symptoms, so you may find that if you’ve gained a bit of extra weight, symptoms that never used to be troubling are now significant.
How do you treat it?
There is no cure for PCOS but the symptoms are treatable and the long-term health consequences can be managed and minimised. It is important to maintain a healthy weight and exercise regularly. You should see your GP or gynaecologist on a yearly basis (at least) for a check-up and to discuss your general wellbeing, emotional health, PCOS symptoms and goals of therapy.
Where can I get more information or support?
jeanhailes.org.au/health-a-z/pcos
betterhealth.vic.gov.au/health/conditionsandtreatments/polycystic-ovarian-syndrome-pcos
mivf.com.au/about-fertility/female-reproductive-system/pcos-polycystic-ovarian-syndrome
There is no Australian support website but there is a Facebook group and the US awareness association can be found at pcosaa.org
Endometriosis
What is Endometriosis and what are the symptoms?
Endometriosis, commonly referred to as “endo”, is a chronic condition which affects one in ten women. It refers to when endometrial cells, the type that line the inside of the uterus (or womb) make their way to other sites in the body, usually within the pelvis, such as the ovaries or peritoneum (tissue which covers the pelvic organs).
Some women with endometriosis have no symptoms at all, some experience varying degrees of pain, others infertility. The pain that women experience is not always in association with periods and can be at other times of the cycle, and includes pain with urinating, upon using bowels and with sexual intercourse.
What causes it and can it be cured?
It is not fully understood what causes endo, and there is no “cure”. It is considered a chronic condition which, while does not affect life expectance, can certainly affect quality of life and cause significant disruption to young women. The treatments are targeted towards managing and minimising symptoms and endometriosis usually resolves with menopause.
How is it diagnosed?
Usually endometriosis is diagnosed at a laparoscopy (keyhole surgery), but this is not always necessarily performed before starting treatment. If you have pain and it is likely you have endo, there are several treatments we can try which don’t involve having surgery. If endometriosis has caused cysts on the ovaries, or larger deposits (called nodules), that can often be seen on an ultrasound.
How is it treated?
Treatments for endo are targeted towards the symptoms, and as many women have no regular symptoms of endometriosis it is reasonable to not have any treatment. Otherwise, the treatments range from over the counter medications, usually anti-inflammatory pain relief, to prescription medications, to surgery for removal of the endo. Physiotherapy, acupuncture and many other allied health professionals can also be helpful in managing endometriosis and pain in general.
Will I have difficulty falling pregnant?
Not necessarily. Most women with endo will have no difficulty conceiving (so if you are not planning a family, and you have endo, you should still use contraception). Some women will find that it takes them longer to get pregnant and more rarely, there may be significant difficulty falling pregnant. It is important to talk to your specialist or GP if you are planning a pregnancy, or are concerned about the impact your endo may have on conceiving.
Where can I get more information?
Here are some good, reliable sources of information about the topic
jeanhailes.org.au/health-a-z/endometriosis
healthdirect.gov.au/endometriosis
endometriosisaustralia.org/about-endometriosis
Vulval Health
What is the vulva?
The vulva is the outermost part of the female genitals, and includes the clitoris, the labia majora and minora, the urethral meatus (where urine comes out of) and the opening of the vagina.
How do I look after my vulva?
The vulva is an extremely sensitive area of the body and does not need to be washed with soap – plain water is fine. Especially avoid fragranced body washes, lotions, baby wipes and even traditional soap. If you feel you absolutely must use something other than plain water to clean your vulva, use a soap substitute such as QV and sparingly. Pat dry rather than rubbing vigorously with a towel, or use a hairdryer on a cool setting.
What do I do if I’m itchy, painful, dry or irritated?
First, make sure you see your GP, gynaecologist or dermatologist for a check-up, and avoid self-diagnosing and treating for conditions such as thrush. Make sure you practice vulval hygiene, as above, to avoid drying out or irritating the skin. In the meantime, if you’re having periods, try to avoid pads (use tampons instead if you can), and don’t use liners when you’re not bleeding – the plastic backing is not kind to the skin. Wear comfortable cotton underwear and avoid nylon, pantyhose, G-strings and control garments (such as Spanx). Feel free to go without underwear – particularly at night.
You should be aware that you are NOT alone and many women experience vulval irritation at some time, but it is important to see a specialist for an accurate diagnosis and treatment plan, and to prevent long-term complications.
Where can I find more information?
Here are some great resources:
Australian and New Zealand Vulvovaginal Society anzvs.org/patient-information
UK Vulval Pain Society vulvalpainsociety.org/vps
Jean Hailes Centre for Women’s Health jeanhailes.org.au
Helpful Links
Pregnancy, Birthing & Postnatal, Parenting, Mental Health, Grief & Loss
An organization dedicated to support, advocacy and education regarding breastfeeding. The ABA offers breastfeeding classes, links to pump hire and information about storage of expressed breastmilk.
The place to go to assess your eligibility for payments such as Parental Leave, Newborn Upfront Payments and Family Tax Benefits. Be sure to create a my Gov account and link your bank details to your Medicare card so that you can receive rebates for your appointments and scans.
Run by two Melbourne midwives, Hey Baby! offers Calmbirth classes, teaches Gentle Parenting and breastfeeding support. Both practitioners are lovely people whom we have worked with in the past and the Calmbirth approach is an effective means of managing many of the anxieties and fears about labour and birth
PANDA (Perinatal Anxiety & Depression Australia) | panda.org.au
PANDA is a national hotline where women seeking support for mental health issues in pregnancy and post-partum can contact a counsellor who can provide telephone support and referrals to local care providers. They also take calls from concerned friends and family members who want to know how best to support a mum in crisis and all of the calls they receive are confidential.
They have a brother site, howisdadgoing.org.au to support Dads and expectant fathers too.
An Australian government website supporting parents on the journey “from pregnancy to preschool”. It includes a huge number of evidence based resources and an easy to use search function to find answers to your questions and a search function to find your local Maternal, Child and Family Health Services.
RCN is an Australian government supported site which provides scientific and well considered information on topics related to raising children from newborns through to teenagers. It acknowledges that in parenting there is rarely one right answer and always a huge number of differing opinions and looks at the many different approaches to dealing with problems. It has topics relating to common questions in pregnancy and normal newborn behaviour (including sleep routines).
Sands is the Australian miscarriage, stillbirth and neonatal death support association. Miscarriage or the loss of a baby is perhaps one of the most devastating experience a family could possibly experience. Sands provides a 24-hour support line, online resources and the ability connect with people in your area who have experienced similar grief and loss.
An initiative of the Continence Foundation of Australia, Pelvic Floor First is dedicated to preventing incontinence and pelvic floor damage brought about by unsafe exercise practices, especially during pregnancy and the postnatal period. Make sure to watch the guided video on performing Pelvic Floor Muscle Exercises and read their recommendations on exercise in pregnancy and post birth. They also have an app!
The premier Victorian source of kid’s health information. You’ll find fact sheets about various childhood health conditions and a free app that provides access to their 300+ fact sheets from anywhere, at any time.
Gynaecology and General Health
Family Planning Victoria | fpv.org.au
Information about STIs (sexually transmitted infections), contraceptive options, gender and sexual identity and sex education for young people.
An Australian government website with links to answers to many women’s health issues, ranging from breast lumps to endometriosis to urinary leakage. A great source of quality health information.
Jean Hailes Centre for Women’s Health | jeanhailes.org.au
Named after legendary GP Dr Dorothy Jean Hailes, this is an Australian women’s healthcare, advocacy and research service. The website is a source of plain-language summaries of various health conditions, ranging from fertility to menopause and everything in between
Another Victorian source of quality health information
A UK based charity organisation supporting women experiencing vulval pain and a source of information, podcasts and a facebook group supporting partners of sufferers. Includes personal accounts of experiences and helpful skincare advice.
Hospitals
Maternity Services
Cabrini Maternity Services | cabrini.com.au
Jessie McPherson | jessiemcpherson.org
Gynaecology
Epworth HealthCare | epworth.org.au
Monash Health | monashhealth.org
