Hi.
I'm Ravi Kashyap, one of the senior obstetricians
at Monash Health.
When you book for maternity care at Monash,
we will recommend you to have many screening tests.
I am going to explain eight of those tests
and why they are important.
Most of the time the results will be normal,
and you need do nothing more.
Sometimes the results will be abnormal
and further tests may be required.
We believe it is important these tests are done,
and it is important you attend to discuss the results.
The first test is the blood group and antibody screen.
It Is important to know your blood group.
There are two parts, the ABO type and the Rhesus D part.
Most women are Rhesus positive.
Some are Rhesus negative.
Checking your blood group and Rhesus will let us know
if your blood is potentially not compatible with your baby's.
If you have no antibodies detected,
this means that you currently do not
have any antibodies which will affect this pregnancy.
You do have the potential to develop antibodies
if your baby is Rhesus positive.
If you have Rhesus-negative blood,
we will recommend further antibody screening tests
to try and prevent any problems.
We normally offer repeat blood tests
for antibodies at 28 weeks, and if none are present,
we recommend an injection of Anti D. At 34 to 36 weeks,
we again offer another injection of Anti D,
although we do not test your blood again.
We also recommend a full blood examination.
This checks for red and white blood cells and platelets.
This also acts as a screening test for iron deficiency
and thalassaemia.
We also now test ferritin, which is a more sensitive indicator
of iron deficiency.
If this is low, we will recommend
you take iron supplements.
We also ask for a haemoglobin electrophoresis,
if it has not been previously done.
This will show some blood disorders,
which may not show up on the full blood examination.
Thalassaemia is a group of blood disorders affecting hemoglobin
production.
Hemoglobin is a protein in the blood that carries oxygen
around our bodies.
Thalassaemia is passed from parent to the child in genes.
If both parents have a minor form of thalassaemia,
the baby may have a major form, so, if identified,
we would also arrange for your partner to have a blood test.
Next, we recommend screening for a number
of infectious diseases, which can
affect management of your pregnancy.
These are hepatitis B, hepatitis C, HIV, syphilis, and rubella.
These are all uncommon, but you may carry any of these diseases
without obvious symptoms.
If we know about them, we can reduce the chance
they will be passed to the baby.
With rubella, most people have been vaccinated in childhood.
However, sometimes the immunity wears off.
If you are not immune, we will advise you to avoid contact
with anyone who may have rubella,
and we will vaccinate you after the baby is born.
At your first visit to the hospital,
we make an assessment of your risk of diabetes.
If you are older, overweight, had prior gestational diabetes,
or come from a population with high risk of diabetes,
we will offer you an oral glucose tolerance test.
Women at low risk of gestational diabetes in early pregnancy
are offered a random non-fasting glucose level
as part of the initial screening tests.
Later in the pregnancy, you'll be offered an oral glucose
tolerance test.
This is to make sure you have not
developed gestational diabetes.
We also recommend testing your urine in early pregnancy.
This is to see if you have bacteria growing in it.
Some women will have bacteria in the urine
without any signs or symptoms.
In pregnancy, this may cause severe kidney infections
or even premature labour.
We also test the urine for protein and blood, which
may indicate kidney disease.
We offer screening for vitamin D deficiency,
as it is common in Melbourne.
Vitamin D deficiency in infants can
cause rickets, which causes bone and muscle weakness and bone
deformities.
Adults with vitamin D deficiency are
at risk of bone and joint pain, muscle and bone weakness,
and fractures.
The recommended level is 75.
If low, you can improve your level
by spending time in the sun and taking a vitamin D supplement.
Next, I want to talk about screening for Down syndrome.
We offer all women a screening test for Down syndrome.
Down syndrome is a chromosomal abnormality,
which is associated with typical features in the baby.
It is always associated with some degree of handicap,
so if it can be diagnosed early, you
have the option to terminate the pregnancy.
There are a number of different ways to test.
The first trimester combined screen
involves a blood test around 10 to 12 weeks
and an ultrasound around 11 to 13 weeks.
If you want screening at the hospital,
we generally offer a second trimester test,
which is just a blood test between 14 and 20 weeks.
Both tests are just as accurate and will identify 85% of babies
with Down syndrome.
The blood test is a screening test, so if it is abnormal,
it needs to be confirmed by an amniocentesis.
If you would not have a termination
for an abnormal baby, you may choose not to do the test.
We recommend all pregnant women have at least one pregnancy
ultrasound at 18 to 22 weeks.
This is to assess that you have a single pregnancy,
that your baby is growing normally,
that the baby has no abnormalities of the heart,
lungs, or other major organs, and that the placenta is
in the correct position.
Your local GP may arrange this, or it
may be organised at the hospital.
In closing, all the tests we do will pick up
many of the complications of pregnancy.
However, there might always be new developments
and abnormalities, which may be present,
but not detected on tests.
It is important you attend for regular review appointments
with the hospital or your community provider,
and if things change, we will investigate further.