What tests are necessary during a normal pregnancy?

A guideline from the Federal Knowledge Centre for Health Care (KCE) on the follow-up of pregnant women with a low risk describes which tests are necessary. The main reason for this is that many screenings are not 100% accurate. An 'abnormal' result is more often a false alarm than a real abnormality. However, this false alarm does cause great concern for many women whose pregnancy is nevertheless progressing normally. Moreover, it results in a series of additional tests being performed, or even in treatment being started, which itself can also involve risks.

Every year, approximately 115,000 births are registered in Belgium, and each of these events deserves optimal preparation and guidance. This means that every pregnant woman must be adequately and regularly monitored from the first weeks, and that any risk factors must be identified and addressed in time.

Also read: Pregnancy calendar: your pregnancy week by week

Normal pregnancy

The KCE guideline advocates a demedicalisation of pregnancy. In normal pregnancies, it advises against examinations that do not clearly have more advantages than disadvantages for mother or child. This applies to pregnant women with a low risk. 78.3% of Belgian pregnant women are considered a pregnant woman with a low risk.

The guideline does not include information on the additional care that some women may need as a result of specific risk factors, pre-existing conditions or pregnancy complications, such as treatment for pre-eclampsia, foetal abnormalities and multiple pregnancies. This guideline also does not provide advice on general lifestyle and nutrition during pregnancy (with the exception of CMV and toxoplasmosis), nor on procedures or care that are not specifically related to pregnancy (e.g. breast examination for cancer screening). Furthermore, this guideline does not address topics related to the long-term follow-up of health status, such as diabetes, renal failure, heart failure that occurred during pregnancy.

Also read: What is toxoplasmosis and is it dangerous for a pregnant woman?

Recommended studies

• Monitoring of weight (BMI) from the first consultation (possibly the consultation before pregnancy).
• Monitor blood pressure from the first consultation (possibly the consultation before pregnancy). A diastolic blood pressure = 90 mmHg is considered a risk factor for complications, such as pre-eclampsia.
• Urine test (proteinuria). During the first consultation, a urine test can be performed to detect excessive amounts of protein in the urine (proteinuria) in order to detect kidney disease and urinary tract disorders. After 20 weeks of pregnancy, proteinuria can be checked during each consultation, in combination with measuring blood pressure, to assess the risk of pre-eclampsia. The test strips used in Belgium often also allow other elements to be measured, such as nitrites.
• Growth of the uterus (fundal height). From the 24th week of pregnancy, the growth of the uterus (fundal height) of the uterus is determined during each consultation.
• Fetal position: From the 36th week or later, the position of the fetus is determined by means of the Leopold's grips. If it is suspected that the fetus is in an abnormal position, this is confirmed with an ultrasound examination.
• Fetal movements: Every pregnant woman should pay attention to the movements of the child. When the baby moves less or not at all, she should contact her doctor as soon as possible.
• Ultrasound: Two ultrasound scans (in early and mid-pregnancy) are necessary. A third ultrasound scan is not necessary, but it provides additional information, has no major medical disadvantages and … is very much looked forward to by the future parents. A first ultrasound scan is performed between 11 weeks and 13 weeks and 6 days of pregnancy, to determine the gestational age and to be able to detect multiple pregnancies. A good knowledge of the gestational age improves, for example, the results of tests to screen for possible Down syndrome and can reduce the number of inductions caused by errors in determining the gestational age. A second ultrasound scan is performed between the 18th and 22nd week to detect any structural abnormalities. If necessary, an ultrasound scan can be performed during the 3rd trimester to check the position of the fetus, to detect any growth abnormalities and, if necessary, to check the location of the placenta.
• Fetal heart rate measurement. From the 12th week of pregnancy, it may be useful to detect the fetal heart rate during each consultation using Doppler auscultation. Although this test is not strictly necessary, it confirms that the baby is still alive and reduces the mother's concerns and ensures that she becomes (even) more attached to the baby.
• Anemia. At the beginning of pregnancy, a blood test is performed to test for the possible presence of anemia. In addition to the hemoglobin level, it is also useful to measure MCV, MCH and MCHC. A second test at the beginning of the 3rd trimester may be indicated with a view to delivery. The determination of white blood cells and platelets has not been proven useful during pregnancy. However, in Belgium, this test is often routinely performed by the laboratory when taking blood to detect anemia.
• Blood group and rhesus factor. At the beginning of pregnancy (or before), the blood group and rhesus factor (RhD) are determined if these are unknown. In addition, the blood is tested for irregular erythrocyte antibodies.
• Infections. For some infections, the KCE proposes testing all pregnant women: Group B Streptococcus (GBS), Hepatitis B, HIV, Rubella (German measles), syphilis, urinary tract infections (Asymptomatic bacteriuria, ASB), varicella (chickenpox), Down syndrome (via the NIPT).

Also read: Why are Group B Streptococcus (GBS) dangerous during pregnancy?

Not recommended studies

The following tests are not recommended for all pregnant women, but can be performed for certain risk groups.

• Abnormal red blood cells (Hemoglobinopathies)
• Infections: Bacterial vaginosis, chlamydia, cytomegalovirus (CMV), Hepatitis C, herpes simplex, toxoplasmosis
• Gestational Diabetes
• Thyroid disorders (hypothyroidism)

• Vitamin D deficiency

• Risk of preterm birth, by means of transvaginal ultrasound
• Risk of preeclampsia
• Routinely perform electronic fetal heart rate monitoring (cardiotocography) or ultrasound to evaluate fetal well-being in women with uncomplicated pregnancies who are less than 1 week past their expected due date. Induction of labor is generally proposed from 41 weeks of gestation.

Source:
https://kce.fgov.be