Investigations in Pregnancy

Across the nine months of pregnancy, you and your baby will be monitored with various tests to ensure your safety and the healthy development of your baby.

Ultrasound in pregnancy

Ultrasound imaging is a diagnostic procedure that uses high-frequency sound waves to produce images of the internal structures of your body. It is performed during pregnancy to determine the health of your pelvic organs and monitor the development of your baby in the womb. It helps to monitor the progress of pregnancy, determine your baby’s age, growth, heartbeat and position, detect problems and identify multiple pregnancies.

The procedure is performed as an outpatient procedure on a full bladder. While you lie on your back, a gel is applied to your abdomen and pelvic area. A device called a transducer is gently glided over the gelled area. The transducer emits and receives sound waves as they bounce off the internal organs. The sound waves are converted into images that can be viewed on a monitor. The procedure is painless and involves no risks to you or your baby.

Screening for down’s syndrome

Down syndrome is a chromosomal disorder associated with intellectual disability and certain physical abnormalities. Screening tests help determine your chance of having a baby with Down syndrome, and are performed during the first and second trimesters of pregnancy.

The first trimester screening test (performed in your 9th to 13th week) includes a blood test and ultrasound exam. The second trimester screening test (performed between 15 and 20 weeks) include blood tests. The ultrasound measures the thickness of a fluid pocket behind your baby’s neck, and the blood tests detect the levels of a protein and pregnancy hormones. The tests of the first and second trimester screenings are usually combined to confirm if your baby has Down syndrome, a congenital disorder due to a chromosome defect, causing intellectual impairment and physical abnormalities. Positive screening tests are usually followed by other diagnostic tests for further information.

Testing for gestational diabetes

Gestational diabetes refers to diabetes during pregnancy, a condition in which the levels of sugar in your blood are higher than normal. It usually develops in the second trimester, and most often, your blood sugar levels return to normal soon after delivery. High blood sugar levels can affect you as well as the development and growth of your baby.

If you have a high risk of developing gestational diabetes i.e., if you have a family history of diabetes or you are obese, you will usually be screened at your first prenatal visit, otherwise, else during your second trimester. The initial glucose challenge test will involve the measurement of your blood glucose levels one hour after drinking a glucose solution. If your levels are high, a follow-up glucose tolerance test will be performed where you will be asked to fast overnight and drink a glucose solution. Your glucose levels, before and every hour for three hours after drinking the solution, will be measured to confirm a diagnosis of gestational diabetes.

Based on these results, your doctor will suggest ways to control your pregnancy-induced diabetes with dietary changes, regular exercising, insulin administration and frequent monitoring.

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Insulin use in gestational diabetes

Insulin is a hormone produced by the pancreatic gland to maintain normal levels of glucose in the blood. High levels of blood glucose in gestational diabetics can lead to complications such as preeclampsia, preterm delivery, a large-sized baby, caesarean section, or a newborn with low blood sugar, breathing difficulties and jaundice. It can usually be controlled by simple lifestyle changes, but some may require insulin hormone injections to lower blood glucose levels.

Your doctor will instruct you on how to draw and administer insulin. Here is a step by step process.

  • Always store insulin in the refrigerator until opened.
  • Insulin may be kept at room temperature once you’ve opened it for use, as long as you keep it away from direct sunlight and other sources of heat.
  • Wash your hands well and attach the needle to the syringe.
  • Prime the needle with insulin.
    • Fill the syringe with the prescribed amount of units of insulin.
    • Hold the needle pointing up and remove all air bubbles by tapping the sides.
    • Push the syringe up slowly until a drop of insulin exits out the needle.
    • You may have to repeat the priming process until the insulin flows out of the needle.
  • After priming you can insert the needle into the selected site once the site has been cleaned. The recommended sites for injection during pregnancy are the abdomen and thighs.
  • • Depress the plunger to release the medicine and remove the needle.
  • Dispose all used needles into approved sharps containers that you can purchase from retail pharmacies.

In order to avoid unpleasant problems, avoid injecting yourself at the same place each time and instead follow a regular pattern of rotation. Consult your doctor immediately if you notice change of colour, lumpiness, depressions or burns at the injection site. The administration of insulin hormone poses no harm to your baby as the injected insulin works the same as the insulin produced by your body.

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GBS screening and management during pregnancy

Group B streptococcus (GBS) is a type of bacteria normally present in some women’s vagina or rectum. It is usually harmless, but when present in pregnant women, it can potentially pass onto a newborn during delivery. Although this is rare, health risks to the baby are serious, so precaution is recommended.

You will be screened for GBS during weeks 35 and 37 of pregnancy with a culture test. Using a swab, a sample is taken from the vagina and rectum and sent for laboratory testing.

If the test result is positive for GBS, IV antibiotics are administered during labour to protect your newborn from contracting the infection.

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