Pregnancy Follow Up
A routine pregnancy follow-up aims to provide basic information about the health and well being of the mother and developing baby. Here in AAFC, we have divided your 9-month pregnancy journey into 10 essential steps and visits, during which you will be tested for your progress. Depending on your results, less or more visits may be required. Alternatively, if you would like to consult your doctor and midwife for anything that may arise or concerns you at any point of your pregnancy, outside these pre-planned visits, please feel free to contact us and book an appointment.
The timeline of a pregnancy is normally tracked from last menstruation and organized in three trimesters or about 40 gestational weeks. Any discrepancies between the last menstruation and gestational stage, it can be found during the first trimester with the help of an ultrasound examination.
The 10 essential visits should be any time around the mentioned weeks:
Around this time, we perform the first ultrasound to determine the location of the pregnancy, the size and heartbeat of the fetus.
At this stage, we will give you a follow-up personalized card with appointments for tracking your pregnancy to term.
Routine tests performed at this point include: blood count, fasting glucose, urine culture, blood type for Rhesus (Rh) marker and presence of Rh antibodies if negative, rubella antibodies,Venereal Disease Research Laboratory (VDRL), Cyto-Megalo-Virus (CMV) antibodies, toxoplasma, Hepatitis B surface AntiGen (HBsAG), and if necessary Human Immuno deficiency Virus(HIV) testing. Depending on your individual circumstances, the level of thyroid hormones might also be checked at these weeks. All of these parameters / markers can be checked through blood testing.
In addition, we recommend to perform the first trimester screening, which is a prenatal blood test offering early information about a baby's risk of certain chromosomal conditions, including Down syndrome (trisomy 21), extra sequences of chromosome 18 (trisomy 18) and 13 (trisomy 13). Around the 12th week, we also perform an ultrasound test for the fetal Nuchal Translucency (NT). The NT examination checks the area at the back of the fetal neck for any signs of increased fluid or thickening.
Depending on the maternal age, early chromosomal genetic diagnostic testing may also be performed around these weeks. With Chorionic Villus Sampling (CVS), a sample is taken from the placenta tissue and analyzed for genetic conditions, depending on personal and family history.
In AAFC, we also provide a Non-Invasive Prenatal Testing (NIPT), also known as Non-Invasive Prenatal Diagnosis (NIPD), which is a sophisticated blood test. NIPT can detect fetal DNA in the maternal bloodstream and determine whether your baby is at risk of any chromosomaltrisomies (21, 13 and 18) or of a sex chromosome abnormality, such as Turner syndrome. This test can also be used to determine the sex of the baby and its Rh blood type. NIPT, being non-invasive, is ideal for avoiding tests that can place your baby and you at risk. Your doctor here in AAFC will advise on which genetic test is the most appropriate for your case at this stage of your pregnancy.
The above mentioned tests can be arranged to be done in one or two visits, depending on which ones are most essential for you.
At this time point, more ultrasound screening takes place, and the levels of Alpha-Feto-Protein (AFP) can be checked. This protein is produced by the fetal liver and is present in the amniotic fluid (the fluid surrounding the baby). From there, it crosses the placenta and ends up into the mother's blood stream. Abnormal levels of AFP may be a signal of a number of conditions, including open neural tube defects (spina bifida, for instance), Down syndrome and other possible chromosomal abnormalities.
In the case that AFP levels are outside the normal range, other markers and additional testing may be required. For instance an amniocentesis may be needed for a more accurate diagnosis of a chromosomal abnormality.
During this time, you will have another ultrasound scan to determine whether there is a late anomaly in the development of your baby.
At this stage, you will have a glucose challenge or a glucose tolerance test. Your doctor will give you specific instructions of what and when you can eat and hydrate for this test. Abnormal sugar levels will point the development of gestational diabetes.
Further parameters that will be checked from your blood and urine tests at this stage include blood cell count, Rh antibody levels (for those with negative blood type), and urine culture for Group B Streptococcus (GBS). This test checks for the presence of GBS in the lower genital tract, as this infection affects about 25% of all women. A GBS infection normally does not cause problems to non-pregnant women, but it can cause serious implications and illness in expectant mothers, including infection of the placenta tissues, preterm labor, kidney infection, and in rare, very serious cases, sepsis (blood poisoning).
During this time, you will also have a physical examination. Your doctor will check your arms and legs for swelling (edema), take your blood pressure and measure the length of your uterus (fundal height). Additionally, the baby's heart rate will be determined, as well as its position in the womb. These will be done with a fetoscope (a type of stethoscope, but for fetuses) or a Doppler device, and the use of ultrasound imaging.
By that time, your doctor can discuss your glucose test results and whether you need to receive an Rh immune globulin treatment. If you are Rh negative and your spouse is Rh positive, then you will need this treatment. For an Rh positive baby, this can be a life-threatening situation during labor.
Around this time, you will receive a review of the fetal growth and a follow-up visit will be arranged.
Labor is only a few weeks away. At this stage, you can opt for a weekly or bi-weekly tracking of fetal growth weight.
Your pregnancy journey comes to an end. You will have a follow-up ultrasound and your biophysical profile will be checked every 2-4 days.
You will reach this time point if you are late. Your doctor will refer you to the delivery room, where you may have a contraction stress test and induced to give labor.