Wednesday, July 6, 2011

Prenatal Testing

I'm not sure why I'm on such a blogging kick lately. Maybe I'm doing some pre-pregnancy psychological nesting? As we all know, I do want to have more children. I guess it's good to be prepared at any moment (especially when you're practicing NFP, since we all know that people who practice NFP are called parents, I don't know whether to smile in assent or gag).

Here's a list of testing I had during my pregnancies, and what I learned from each:

A1C. I love the hemoglobin A1C. It makes me feel secure and validated about my blood sugar management. I am motivated but not anxious if it's less than 7.0, pat myself on the back if it's less than 6.5, and celebrate my victory if it's less than 6.0. I had mine tested every trimester both pregnancies.

24-hour urine. I actually don't know a lot about what this test tells my doctor, except that it has something to do with your kidney health and mine have always been OK. Also done every trimester.

Blood. I had my blood levels measured early in my first pregnancy and again towards the middle of the second trimester. I say "blood levels," because all I know is that I had my blood drawn and they tested it for some stuff. Not sure if it was a CBC or what. Anyway, it was tested again at the beginning of my second pregnancy and again at the beginning of the third trimester. Two problems I encountered were Vitamin D (borderline low during the middle of my first pregnancy and clinically low right before I got pregnant the second time, while breastfeeding), and elevated cholesterol. As it turns out, elevated cholesterol during pregnancy is normal, so it's probably not even worth checking.

Blood pressure. Man, I get so anxious when I see that cuff now - even when I'm not pregnant. They don't like pregnant women to have blood pressure over 140/90. Mine rose at the very end of my first pregnancy, and improved after my doctor told me to quit work (I was already 40w5d). I avoided induction because of that advice!

18-20-week comprehensive ultrasound. This one takes a while and they do a whole lot of measurements. They measure head circumference, chest circumference, length of arms and legs, and tell you whether your baby is a boy or girl. They check out the baby's heart, and look at placement of the placenta. They also measure blood flow through the umbilical cord and in the baby's brain. It is AMAZING what they see at this ultrasound. I asked a ton of questions. With diabetics, they worry about babies that are too big (although you are less likely to see a baby LGA this early on), and heart defects. They will confirm your due date or note discrepancy. If they see a possible defect, they may recommend additional testing. Otherwise, they will send you home amazed at what you know about a baby that weighs about as much as a cell phone.

Fetal echocardiogram. This is to look more closely at the baby's heart. It was never recommended to me in St. Louis, but I was told it was standard protocol here in the large metropolitan area where we live now. I declined it because two comprehensive ultrasounds during my second pregnancy failed to show any problem with my son's heart, and I thought it would be a waste of time and money. I asked the doctor whether it would affect delivery and he said no. He also thought it unlikely that they would need to operate on the baby immediately after birth, which made me think that if there really was a problem we could safely wait to discover it until after birth. Further research also showed me that some non-life-threatening heart defects in babies may even correct themselves after birth. My son has not showed any problems with his heart so far.

Echocardiogram. This one was for me! I still have no idea why my doctor in St. Louis asked me to do this, but it made me feel pampered. It was like the ultrasound equivalent of a pedicure. In hindsight, if I had known more about it, I probably would have declined it, filing it under the category "waste of time and money." I have never had a heart problem and I'm not even sure how it related to pregnancy and delivery. In any case, my insurance company paid for it and I left feeling very confident of the health of my heart.

Growth ultrasound. I published a separate post on this so I'll just hit the highlights. Babies add weight during the third trimester and if they are going to get too big, this is when it will happen. Growth ultrasounds usually start at 28 weeks and are done at 3 week intervals, but if your doctor is chill, he/she may wait until closer to delivery and do them less frequently (or, if you pester him/her not to). They may not be reliable, and it's unclear how to determine whether a baby is really "too big to deliver." I'm going to try these things next time around to keep my babies from being too big, just in case, but I'm not convinced that it's as common a problem as doctors cite it to be.

Amniotic fluid volume. These are done by ultrasound, always along with the growth ultrasound and sometimes by themselves. They measure amniotic fluid to make sure you don't have too much or too little, which are both higher risks for diabetics. I've never had a problem with it.

Fetal non-stress testing. Measures contraction activity (Braxton-Hicks included) and baby's heart rate. They look for appropriate variability associated with baby's movements and mom's contractions, and make sure that the heart rate doesn't stay elevated (above 180) or lowered (below...I think 120?) for long periods of time. It may be done once or twice a month until 36 weeks, when it will be done every week. After 40 weeks, if you insist on going that long, they'll ask you to come in 2x per week.

Biophysical Profile. I think this is abbreviated Fetal BPP. I haven't ever undergone one of these, but I think Jenn might have. It includes the contraction measurements and fetal heart rate measurements of the normal non-stress testing, but they also do a continuous 30-45 minute ultrasound in which they measure amniotic fluid and they look to make sure the baby is making breathing movements (opening and closing the mouth?) and maybe a few other things. I think Jenn told me they decided a few years ago that this test was not worth doing most of the time.

Amniocentesis. They usually wait until at least 35 weeks to do these, and it seems the main reason is to figure out whether the baby's lungs are ready to breathe outside the womb (they also do them early in pregnancy to detect genetic defects in the baby). It can cause premature labor, so it's usually only for women that they are anxious to deliver early - maybe in the case of preeclampsia or if the baby is measuring weeks and weeks ahead of his or her gestational age.

Happy reading!

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