Family - Antenatal Examinations

• Pre-Booking Contact

Once you are (or think you are) pregnant, you can make an appointment with your midwife to discuss antenatal care and tests. This happens at about 8 weeks normally, and the midwife will ask about any previous pregnancies, general health and whether any close members of your family have a health problem that can be inherited, such as cystic fibrosis. 

You will also be asked about your folic acid intake (you should be taking 400 micrograms a day - women with diabetes may be advised to take 5mg) and he or she will give you general advice about pregnancy before referring you for antenatal care throughout the rest of your pregnancy.

This can be at a hospital (if you are in an area with more than one nearby hospital you will be asked to choose), at the GP’s surgery, in a clinic or at home (although any scans will need to be in a hospital). At each appointment your blood pressure and urine are tested and your baby's growth is checked.

• Booking visit (first appointment)
Your first antenatal appointment will usually take place at around 10-13 weeks. This is probably the most detailed antenatal visit and so may take some time; it is the ideal time to raise any and all questions you may have! You may see a midwife, a doctor or both, and your health, any previous pregnancies (full term or not), any medical problems, and your social circumstances are discussed. Your height and weight will be recorded, and if you are underweight or overweight this will be noted and you will be given advice as you may need extra care. Other tests that will be performed, often at the booking visit are as follows.

Blood Tests

A blood sample will be taken and, although there may be some variation between different healthcare providers, the following are the typical blood tests done at the booking visit:

• Blood group and rhesus (Rh) type
Everyone is either Rh positive or negative, and neither causes a problem unless a Rh negative mother is carrying a Rh positive baby because when the blood of the RH positive baby enters her bloodstream (usually at delivery) she may produce antibodies to the baby’s blood. These antibodies will attack and destroy any following Rh positive fetuses, resulting in an inability to conceive, miscarriage or anaemia in the following baby. Rh negative women are usually offered an injection after delivery to prevent this happening, and are also offered AntiD at 28 and 34 weeks of the next pregnancy now – although this may be changing to a single dose at 34 weeks in the near future.

• Haemoglobin to check for anaemia.
 
• Screening for infections that can affect the mother and baby, such as hepatitis B, syphilis, HIV and haemoglobinopathies. Some women will also be offered Hep C.

• Immunity to rubella (German measles)
Women who are found not to be immune are given advice on how to reduce the risk of catching it and what to do if they catch it, as it can cause blindness in a fetus. She’ll also be offered vaccination soon after the birth to protect future fetuses.

Other blood tests may be offered depending upon a woman's medical history and ethnic background.

Pelvic Exam

A pelvic examination (internal) is not usually needed although women may be offered a smear if this is not up-to-date, or swabs if there have been symptoms of vaginal infection. The midwife usually feels the abdomen to give an idea of dates. Your midwife will estimate the date for when they think your baby is due. A brief ultrasound scan is performed either now or at a later visit to confirm that the size of the baby fits with the estimated dates and to check if you are expecting one baby or more.

Blood Pressure

Blood pressure is monitored as this can rise during pregnancy, and a really raised blood pressure can be the first indication of pre-eclampsia – the precursor of a condition called eclampsia, which can be harmful to both mother and baby and may mean that the baby needs to be delivered early. Blood pressure varies enormously from individual to individual, and with age and lifestyle.

Urine

Urine is tested for infection, such as kidney infections for example,  and for the presence of protein. Protein in the urine and raised blood pressure are two signs of pre-eclampsia, while sugar in the urine suggests the development of gestational diabetes. Blood is tested again at 28 weeks for anaemia.

Legs and Hands

Legs are checked for varicose veins, while hands and ankles will be checked for any swelling, known as water retention, or oedema, which could indicate the onset of pre-eclampsia

Abdominal Palpation

As the baby grows, the uterus rises out of the woman's pelvis and becomes the "bump", and the top of this is called the fundus. The height of the fundus from your pelvic bone is measured in cms from bout 17 weeks to ensure that the baby is growing adequately. Your midwife will also feel for the head and rump to check where the baby is positioned – but not until about 34 weeks now.

Baby's Heartbeat

The baby's heartbeat is not routinely checked, but you can ask to listen to it if it isn’t offered. The fetal heartbeat is about twice as fast as an adult’s and ranges from 110 to 160 beats per minute) (the midwife or doctor may use a Doppler device, which uses small doses of ultrasound, placed on the abdomen to amplify the heartbeat so you can hear it.
 
At around 19-20 weeks, women start to feel the baby moving. Babies have active and restful times. In the early months, they have plenty of room and may move around a lot. As the pregnancy progresses, the midwife or doctor will ask about the baby's movements and try to determine the position of the baby by feeling the mother's abdomen. Towards the end of pregnancy, the head usually drops down into the pelvis into a position ready for delivery (when the head is said to be engaged).