PRENATAL ASSESSMENTS

INITIAL BLOOD WORK

CBC (iron & platelet levels)

Group & Screen (blood type + antibodies)

Random Glucose

Public Health Blood Work

  • Hepatitis
  • Rubella
  • Syphilis
  • HIV

Additional tests if clinically indicated

  • Ferritin (iron stores)
  • Thyroid stimulating hormone (TSH)
  • Immune status of infectious diseases (i.e. parvo B19, CMV, toxoplasmosis, chicken pox)

URINE TESTS

Urine sample to test for urinary tract infection (UTI)
Urine sample to test for Gonorrhea & Chlamydia infections
Urine dip stick for protein & glucose, if clinical indicated

ADDITIONAL INVESTIGATIONS (As Needed)

Vaginal Swabs for infections:

  • Yeast
  • Bacterial Vaginosis
  • Sexually Transmitted Infections (STIs)

Additional CBC for hemoglobin (iron) monitoring (It is recommended that all pregnant clients receive a repeat CBC around 30-32 weeks to ensure iron level is appropriate in time for delivery.)

DATING ULTRASOUND

Performed during the first trimester

Fetus is measured from head to rump (crown-rump length) to determine the most accurate estimated due date.

This ultrasound also confirms the number of fetuses.

SECOND TRIMESTER ULTRASOUND (Anatomy Scan)

Performed between 18-20 weeks, preferably after 19 weeks

Ultrasound tech and radiologist will analyze baby’s full anatomy – bones, organs, measurements, sex (optional) etc.

The location of the placenta is determined to ensure it is not covering the opening of the uterus (the cervix).

CERVICAL CANCER SCREENING (Pap Test)

Screening guidelines are set by The Ontario Cervical Screening Program.

It is recommended that those who have been sexually active have a Pap test every 3 years beginning at age 21.

More frequent Pap tests may be recommended if the results are abnormal.

An instrument called a speculum is gently inserted into the vagina to be able to see the cervix. A sample of cells is taken from the cervix and tested for signs of cervical cancer.

A pap test can be performed in pregnancy up to 20 weeks if a client is due for their routine screen. Registered Midwives are trained to do Pap tests and will offer in pregnancy or at 6 weeks postpartum if warranted.

For more information about cervical cancer screening, or Ontario’s Cervical Screening Program call 1-866-662-9233, visit www.ontario.ca/screenforlife or www.cancercareontario.ca

GESTATIONAL DIABETES SCREENING

Gestational Diabetes is diabetes that develops in pregnancy and affects how your body manages sugar.

A screening for gestation diabetes is recommended in every pregnancy. This screen will identify those at higher risk of developing gestational diabetes. The screening is called the Oral Glucose Challenge Test (OGCT) and can be completed at TMC with your midwife between 24-28 weeks of pregnancy.

For the OGCT, your midwife will ask you to come 45 minutes to 1 hour before your scheduled appointment, at which point you will be given a glucose drink. One hour after you are finished the drink, your midwife will take a blood sample to see how your body manages the sugar. We ask that you refrain from eating for 1 hour before the test and avoid foods with high sugar that day.

If the screening comes back positive, you may be at risk of having gestational diabetes. Your midwife will offer a follow-up diagnostic test, called an OGTT. Usually, gestational diabetes can be managed through diet and exercise to control blood sugar. Occasionally, gestational diabetes requires the client to take insulin. If it is diet-controlled, the client is still suitable for midwifery care, though your midwife will recommend a consultation with an obstetrician and the gestational diabetes clinic at MGH. If insulin is needed, the care will be transferred to an obstetrician for the remainder of the pregnancy.

Those at higher risk of gestational diabetes include: clients older than 35, gestational diabetes in a previous pregnancy, family history of diabetes or gestational diabetes, high BMI (30+), previous baby over 9 pounds or with birth defect, non-white race, polycystic ovarian syndrome and a previously unexplained stillbirth or miscarriage. Some clients who are not at high risk may choose to decline this screening after discussing risks/benefits with their midwife.

For more info, please visit: www.diabetes.ca/diabetes-and-you/living-with-gestational-diabetes

GENETIC SCREENING

Prenatal genetic screening is an OPTIONAL screening that is offered to all pregnant clients in Ontario. Your midwife will discuss with you the options for genetic screening at your first appointment. Please keep in mind; the following screening options are NOT DIAGNOSTIC of the conditions listed below. These tests are simply used to determine which pregnancies are at higher risk of being affected. If a prenatal screen comes back positive, meaning the pregnancy may be affected; your midwife will offer a consult with a genetic counselor to discuss options for further testing if you wish.

Conditions

Trisomy 21 (Down Syndrome)
DNA has 3 copies of chromosome 21. People with Down Syndrome can live into their 50s & 60s. They often have congenital anomalies and intellectual disability.

Trisomy 18 (Patau Syndrome)
DNA has 3 copies of chromosome 18. Many affected fetuses will not survive to term. Of those who are born, average age of survival is 14 days.

Trisomy 13 (Edwards Syndrome)
DNA has 3 copies of chromosome 13. Most affected fetuses will not survive to term. Of those who are born, 90% will not survive their first year.

Open Neural Tube Defect (Open Spina Bifida)
Membranes that surround the brain/spinal cord fail to close. If this occurs at the top of the neural tube, the fetus often does not survive to term or past the first couple of days. If it occurs at the bottom, the baby will have spina bifida.

For more information, please visit: https://www.prenatalscreeningontario.ca/en/pso/about-prenatal-screening/about-prenatal-screening.aspx or http://www.mountsinai.on.ca/care/family-medicine-genetics-program/prenatal