First Antenatal blood testing:

What are first antenatal bloods and what are they for ?? Everyone wants to be healthy but more importantly it is vital for a pregnant women to remain healthy during her pregnancy and give birth to a healthy baby. Antenatal blood tests are designed to protect your health and the health of your baby and family/whanau by identifying conditions or diseases as soon as possible in your pregnancy so that treatment can be offered. Six different tests are recommended routinely when you are first pregnant, and your midwife will discuss these with you These tests are usually from the same blood sample.

The Ministry of Health (MOH) recommends that you have these tests as soon as possible after you know you are pregnant because knowing whether you have these conditions can help keep you and your baby well. The decision to have these blood tests is yours and your choice will be respected, but it is highly recommended.

ABO BLOOD GROUP TEST
Your blood group can be A, B, O or AB. Your blood is checked for your group and for the presence of antibodies (part of your immune system). Some antibodies can be harmful for your baby during pregnancy. If you are found to have antibodies that could affect your baby, monitoring and treatment to protect your baby are recommended.

RHESUS BLOOD GROUP TEST
This is an immune system test, for rhesus factor (mainly Rh D). Your blood group either has or does not have this factor present, so you are either Rh positive (Rh+) or Rh negative (Rh–). If you are Rh– and your blood mixes with your baby’s blood you can make antibodies which can cause severe anaemia and jaundice in this or your next baby. Your blood can only mix with the baby’s if you have an antenatal bleed, miscarriage or abortion or during your birth. An
injection of ‘anti-D’ after any of these things happen can prevent your body from making these potentially harmful antibodies.

FULL BLOOD COUNT
This test checks whether you have enough iron stores needed in pregnancy. If your iron levels are low, you will feel more tired and will be less able to manage with the blood loss that occurs during birth and the postpartum period (after birth). Low iron can also have an effect on your growing baby. You will be given advice about how to increase the iron in your diet if this is low or being given a script for iron tablets. The full blood count also checks your platelet levels, this is the part of the blood that helps your blood to clot or help stop your body from bleeding. 

RUBELLA (GERMAN MEASLES)
This test checks that you are protected from Rubella or German measles as it is sometimes called. If you were to catch the rubella virus in pregnancy it can lead to severe problems for your baby such as deafness, brain injury or a miscarriage. If you are not immune, It is recommended that you have a Rubella vaccination as soon as possible after your pregnancy, miscarriage or termination. This vaccination cannot be given while you are pregnant

HEPATITIS B
Hepatitis B can be passed from mother to baby during birth. You may also have this virus and not be aware of this as there are more often than not no symptoms. It can also be passed on to other family/whanau members through blood contact. Hepatitis B can cause significant health problems, such as liver damage. While approximately 20% of babies exposed to hep B virus during birth and who are not treated, become infected. Over 90% of untreated babies become carriers of the virus. If your midwife knows you have hepatitis B they can offer your baby immunoglobulin and vaccination at birth to help prevent your baby becoming infected.

HIV - (Human immunodeficiency virus)
This virus limits the body’s ability to fight infection which may lead on to developing AIDS ( Acquired immune deficiency syndrome or acquired immunodeficiency syndrome). HIV is passed from person to person by contact with blood or bodily fluids. HIV positive mothers can pass the virus on to their baby during pregnancy, during birth, or by breastfeeding. HIV is now routinely tested at your first antenatal bloods. The chance of a baby being infected with this virus from a HIV positive mother has reduced significantly since testing began, (from 25%–31.5% to less than 1%). 

SYPHILIS
Luckily syphilis is considered rare in New Zealand, but is unfortunately becoming more common. If not treated the result can be serious health problems for you and your baby. Like HIV, it can be passed thru the transfer of bodily fluids or from mother to baby during pregnancy. Most women with syphilis do not know they have it because they have no symptoms of being unwell and feel generally well. 

HBA1c 
This test measures an average blood glucose level over several weeks- months. The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'. By checking for your HBA1c level in early pregnancy Your midwife will be able to get an overall picture of what your average blood sugar levels have been over a period of weeks/months.

And finally ...

URINE TEST: 
A midstream urine test is used to check for bladder or kidney infections, diabetes, dehydration and pre-eclampsia (toxaemia) by screening for high levels of sugars, proteins, ketones and bacteria.  Recurrent and untreated Urinary Tract Infections ( UTI's) in later pregnancy can lead to pre-term labour and birth.

Antenatal Screening  ( info obtained from -nsu.govt.nz)

This screening can provide some information about the chance of your baby having Down syndrome or another condition. The screening options available provide a risk estimate for Down syndrome (trisomy21), trisomy 18 (Edwards syndrome), trisomy 13 (Patau syndrome) and some other rare genetic disorders. This screening is OPTIONAL and it is not diagnostic meaning it givens you a risk ration In NZ the cut off is 300. a ratio under 1:300 would be considered high risk and we would then discuss further genetic testing which is a diagnostic tool. A ration over 1:300 is low risk and no further testing would be indicated (dependent on other hereditary factors).

Screening options: There are two screening options available for women in New Zealand, who are less than 20 weeks pregnant.

First Trimester screening - Is available if you are less than 14 weeks pregnant. This option combines the results of a blood test from you and a nuchal translucency (NT) ultrasound scan with other information, such as your age and weight, to give a risk result.

Second Trimester Screening - Is available if you are 14-20 weeks pregnant and combines the results of a blood test from you, with other information, such as your age and weight, to give a risk result.

28 WEEK BLOOD TESTS:

FULL BLOOD COUNT AND FERRITIN STORES:
Just like the first antenatal test This test checks whether you have enough Haemoglobin and iron stores needed in pregnancy. If your iron levels are low, you will feel more tired and will be less able to manage with the blood loss that occurs during birth and the postpartum period (after birth). Low iron can also have an effect on your growing baby. You will be given advice about how to increase the iron in your diet if this is low or being given a script for iron tablets. The full blood count also checks your platelet levels, this is the part of the blood that helps your blood to clot or help stop your body from bleeding. 

POLYCOSE TEST: (ALSO KNOWN AS SUGAR / DIABETES TEST). 

On arriving at the lab ( there is no need to book for this test) you will be given a 50 gram sugar loaded fizzy drink to drink and your bloods will be taken 1 hr later. You will not be allowed to leave the lab during this test (so take a good book and a bottle of water).This test will check how your body copes with a concentrated sugar load and is a screening test for diabetes in pregnancy. If this result was to come back positive we would then need to undertake the GTT (Glucose tolerance test).

GLUCOSE TOLERANCE TEST: (GTT, required only if the polycose test comes back positive, or other risk factors)

On arriving at the lab (you must book a time for this test with the lab) you will have a fasting blood test taken to see what your sugar levels are after not eating for a restricted period of time. You will then be given a 75 gram sugar loaded fizzy drink to drink and the TWO hours later your bloods will be taken. This test is a diagnostic test and will confirm or refute diabetes in pregnancy (gestational diabetes mellitus GDM). If GDM is confirmed then you will be referred to the diabetes clinic at Rotorua Hospital for care of the diabetes. You can still remain under our care for your pregnancy but the diabetes will be monitored and controlled by the specialist team at the hospital. 

URINE TEST: 
A midstream urine test is used to check for bladder or kidney infections, diabetes, dehydration and pre-eclampsia (toxaemia) by screening for high levels of sugars, proteins, ketones and bacteria.  Recurrent and untreated Urinary Tract Infections ( UTI's) in later pregnancy can lead to pre-term labour and birth.

36 WEEK BLOOD TESTS:

FULL BLOOD COUNT AND FERRITIN STORES and urine:
Just like the first antenatal test This test checks whether you have enough Haemoglobin and iron stores needed in pregnancy. If your iron levels are low, you will feel more tired and will be less able to manage with the blood loss that occurs during birth and the postpartum period (after birth). Low iron can also have an effect on your growing baby. You will be given advice about how to increase the iron in your diet if this is low or being given a script for iron tablets. The full blood count also checks your platelet levels, this is the part of the blood that helps your blood to clot or help stop your body from bleeding. 


ULTRASOUND SCANNING:

12 week Nuchal Translucency scan:

Nuchal refers to the neck this scan looks at the baby's neck and measures a thin fluid area which all babies at this stage of development have. The fluid found around the neck looks black in colour on the ultrasound, because the sound waves pass straight through it without an echo. This fluid  creates a translucency which is then measured and sent for testing (this is one half of the downs syndrome testing). The results will be discussed with you and a detailed report sent to your midwife However a full picture cannot be obtained without the blood test combination. 

Anatomy Scan:

Undertaken  between 20-21 weeks gestation this specialised scan has a very close look at all baby's features. Measurements of your baby will be taken to see if he / she is growing properly and carefully checked to make sure it appears structurally normal. All scans have ,limitations while structurally a scan can show all the working parts it doesn't not tell us that these part are working properly. The scan will look closely at your baby’s head, face, spine, heart, abdomen and limbs. The fluid balloon that your baby is sitting in will be checked as well as the placenta to check the position of where it sits in relation to your cervix. This is the scan that if baby is in a good position and lying well then you maybe able to find out the gender. BUT you don't have to find out sometimes its nice to have a surprise and remember scans are not 100% right. The results of the scan will be discussed with you at the completion of the examination. A written report is also sent to the referring midwife. You should discuss the results with the midwife who referred you since the results often need to be interpreted in the light of other tests or clinical information which might only be clear to the person looking after the pregnancy.