Playing catch-up with pregnancy screening
April 19, 2012 12:00 PM   Subscribe

She's 14 weeks pregnant and happy about it. So far, the only test she's had is a pregnancy test. What did she miss?

Woman is 35; husband is 47. Found out they were pregnant 3-5 weeks along. It's her first pregnancy, and she has constant nausea but is eating carefully and has gained 10 pounds.

Her family doctor's only directive has been, "have an ultrasound before your first appointment on April 20." Today the ultrasound revealed that she's probably 14 weeks pregnant, not 12 as she assumed. The nurse panicked her by saying, "you're second trimester and it's too late for lots of important tests!" My friend thought she was doing everything right and was dismayed to learn she may have missed important tests.

Tomorrow is her first ob-gyn appointment. She is a wonderfully diligent person and will be a fabulous mom, though neither she nor her husband are the researching type. She wants to be more proactive about her care.

She asked me to help her come up with a clear, written plan:

- what tests she actually missed
- what tests should be done instead
- what to ask the doctor tomorrow
- what tests to make sure to do asap at 14 weeks
- a timeline of other tests and steps to plan as the pregnancy progresses.

I have no knowledge of pregnancy timelines at all, so, Internet, I would really appreciate suggestions and general ways to help this wonderful preggie feel healthy and confident. Thanks!
posted by pseudostrabismus to Health & Fitness (29 answers total) 5 users marked this as a favorite
There's an NT scan at 11-12 weeks, but not everyone gets that. (I didn't.)

Anyway, there's a lot of good info here, for instance.
posted by pyjammy at 12:02 PM on April 19, 2012

- what tests she actually missed

I think mostly tests looking for potential birth defects, conditions and diseases that would lead you to potentially terminate in the first trimester.

But it seems you're more worried about having a healthy pregnancy. I don't think those are the tests they missed. Typically, early on, you'll get a blood test to see if you have any unknown diseases or conditions (like syphilis or toxoplasmosis) that might affect the baby during pregnancy and require you to take certain precautions. But if mom is being proactive about her health, then that shouldn't be too much of a worry.

I know this because I just did all this stuff recently.
posted by jabberjaw at 12:09 PM on April 19, 2012

I had a blood test at around eight weeks, as jabberjaw mentioned, then the dating scan/nuchal translucency test (first Down syndrome check) at 13 weeks. She hasn't really missed anything yet.
posted by goo at 12:16 PM on April 19, 2012

Pretty much just the NT scan.

I didn't have that done either time since it wouldn't have changed my decision to carry to term.

The NT is only important if you have reason to suspect something is going on (and not everything can be seen on the NT anyway) and it would affect the decision to carry to term.

There's some genetic testing that can still be done, which I also declined, and if she is concerned, she can still have an amniocentesis.
posted by zizzle at 12:17 PM on April 19, 2012

This page list the antenatal screening tests routinely offered to pregnant women here in the UK.
posted by goo at 12:20 PM on April 19, 2012

The other issue is that in terms of dating the pregnancy and determining a due date, the earlier the ultrasound the better. I suggest she tell the OB the date that she thinks and NOT the date the FP estimated based on the ultrasound.
posted by the young rope-rider at 12:23 PM on April 19, 2012

She may have missed the CVS, which you can do instead of an amnio, if you so choose. I missed it too. She'll probably meet with a genetic counselor who should help her get squared away and set her mind at ease.
posted by Ollie at 12:27 PM on April 19, 2012

The vast majority of babies are genetically fine. Your friend gets a second bite at the apple with the anatomy scan at 20 weeks.

Your friend should be worried more about fit with the OB and the practice at this time. She should ask about where will she deliver, what is c-section rate, what is approach to pain management in labour, who is on-call in the practice, who will attend delivery, what is approach to inducing late stage pregnancy, etc. At this point it is not too late to find a new OB (or a midwife) if the one she has is not aligned with the birth she wants. I didn't focus on this in my pregnancy and I regret it.
posted by crazycanuck at 12:29 PM on April 19, 2012 [1 favorite]

She likely missed the nuchal translucency test, though a friend of mine told me the other day she had it at 15 weeks. At 35, she does have a greater chance of having a baby with a chromosomal abnormality then somebody younger (and studies show that the father's age plays a small role as well). However, if knowing whether or not the baby has Downs or Trisomy-18 isn't going to change anything for them, then it isn't a big deal.

I also had tests for all the STDs and a PAP smear early on, but I don't know if there's any reason that can't be done later. I met with a genetic counselor at 11.5 weeks as well, but again I imagine that can be done later as well.

As for the date descrepancy, she may be 12 weeks along by gestational age and 14 weeks by the calculation from her last period.
posted by amro at 12:57 PM on April 19, 2012

than someone younger, not then. Ugh.
posted by amro at 12:57 PM on April 19, 2012

The only significant prenatal screen she's missed at this point is chorionic villus sampling, which is typically done around 10-12 weeks. CVS is often offered to women of advanced maternal age because the risk of chromosomal abnormalities is higher. The benefit to CVS is that it can be done so early; if an abnormality is found, the parents can then consider termination earlier in the pregnancy. CVS is riskier than amniocentesis, however, and amniocentesis will provide the same information. So she really hasn't missed anything at all. She can still have amniocentesis done as well as the quad scan, both of which screen for chromosomal abnormalities.

She's also missed the First Trimester Screen (a part of which is the nuchal translucency test others have mentioned), but frankly, that's unimportant. It has, in my opinion, a high false positive rate and it's really not a true "screen" for anything. A positive only indicates that you need further testing...such as an amniocentesis, which she still has the option to have.

As far as maternal health goes, yes, they'll generally do some blood workup early in pregnancy to test for STDs, toxoplasmosis, etc. They'll also draw your rubella titers to see if mom has antibodies for rubella; if not, she'll be offered the vaccine after giving birth (it can't be given while pregnant). They can still do all of this.
posted by pecanpies at 1:03 PM on April 19, 2012 [1 favorite]

The nurse needs to chill. You don't even HAVE to have an ultrasound that early on. Some doctors don't get them until 20 weeks.

For an AFP (alpha fetal protein) test, the timing is important because it should be done at 16 weeks, but that test has a pretty high rate of false positives anyway (probably because the 16-week mark can be hard for some to judge accurately).

Your friend should:
Take prenatal vitamins.
Expect to have a lot of blood drawn when she sees the ob/gyn.
Take the tests her ob/gyn suggests.
Relax, and get as much sleep as possible.

One timeline to be aware of: Remember that although she is "eating for two", one of them is very, very small just yet!

I only mention this at all because I gained 35lbs with each pregnancy, and honestly, with hindsight I know I could easily have gained less and been fine (my kids were less than 7 pounds each when they were born).

Doctors used to tell women not to gain more than 25 pounds, tops, and that's pretty harsh. I don't want anyone to get paranoid or feel like they have to watch every mouthful! And I absolutely don't think anyone should be policing what your friend eats or anything.

On the other hand, I know several women who gained 65, 70 lbs (!) once they got pregnant, and they'd be the first to say Don't Ever Do That. Too much weight is just tough on your body. One of them had gestational diabetes, another had to be on bedrest.

Your friend might be underweight and need to gain more weight. Or she might be overweight and need to keep that gain down. I don't know. But the fitter you are during your pregnancy, the easier your recovery afterward. Here's a helpful chart to give your friend a general idea of what reasonable weight gain during pregnancy looks like. She can customize what's best for her personally by using this tool.

As far as due date--well, the FP estimate might just be a better indicator than your friend's memory, because women will often start dating their pregnancy by their first missed period, when normally they will have actually become pregnant a couple weeks prior to that.
posted by misha at 1:15 PM on April 19, 2012 [1 favorite]

One timeline to be aware of: Remember that although she is "eating for two", one of them is very, very small just yet!

Oh yeah, I meant to comment on that. Ten pounds weight gain is a little on the high side for 14 weeks.
posted by amro at 1:18 PM on April 19, 2012 [2 favorites]

What she missed was a lot of worry and talk about miscarriages. Public health studies show that regular visits with a doctor throughout the pregnancy correlate with a healthy pregnancy, delivery and good maternal and child outcomes. What that has turned into for some folks is "If you don't go to the doctor immediately after finding out and then at least every 4 weeks after you are already a crappy mother." Also, it can freak out some well meaning but very inflexible staff who have a specific time line of tests associated with your visits.

But there are plenty of great mothers with great pregnancies that see the doctor for the first time starting in the second trimester. Now your friend will probably get a lot of tests on her first visit instead of spread out over the first trimester - a long questionnaire, weighted, and blood pressure check, blood tests for HIV, syphilis, if she has the Rh factor (positive blood type) or not (negative blood type) etc; vaginal tests like a pap smear and other sti screening; urine test for proteins, sugars, pH, etc, and then she will be offered genetic testing (there is plenty of time for the same information to be reached with different tests as discussed above). She will be right back on track by the next appointment - the doctors will guide rest of the process and make sure she gets all the tests. I recommend that she schedules a series of appointments based on the doctors suggestions (probably every 4 weeks) so she can feel like she has a plan for the next couple months.

She may also want to go the store (maybe as a way to celebrate the first doctor's appointment) and buy a couple pregnancy book that answers the questions she has - there are tons. Some are very detailed month by month and some are technical and some are a good overview.
posted by mutt.cyberspace at 1:24 PM on April 19, 2012

Do not worry about weight gain unless your doctor tells you to, and even then--don't worry about it too hard. A ten pound weight gain could be primarily bloating and constipation (god bless pregnancy).
posted by the young rope-rider at 1:27 PM on April 19, 2012 [3 favorites]

My ob-gyn offers the nuchal translucency test as an option; if you don't want it, she doesn't have a problem with that. The first trimester blood screen, though, she doesn't treat as optional. It may test for things that would change the way the patient is treated? I have no idea, but her ob-gyn will.

I do think it's a little odd for a family doctor to tell a pregnant patient to sit tight until (what she thought was) 12 weeks before seeing an ob-gyn. It's very common for women to be farther along than they think. She's seeing an ob-gyn for the pregnancy, right, not her family doctor?
posted by palliser at 1:43 PM on April 19, 2012

I got my blood screening done late too, with two different pregnancies. There are some things that can be good to know as early as possible (for example, with my first pregnancy I turned out to be mildly anemic, so I was instructed to take an iron supplement in addition to my normal prenatal - the second time around I was already doing this). But overall I wouldn't fret about it, as everyone else has said, the doctor will let her know what needs to be caught up on.
posted by celtalitha at 1:51 PM on April 19, 2012

That nurse was an ASS. There are a non-trivial number of women who don't even know they're pregnant until their 2nd trimester. There are also plenty of first world countries where prenatal visits don't start until after 12 weeks. The only thing your friend has missed is tests that are optional, like the nuchal test (which is optional) and she should be Rh status tested if she has not been.
posted by DarlingBri at 1:55 PM on April 19, 2012

Congrats to the couple, and good for her for being able to eat! Food was not my friend in the first trimester. She should totally pick up a book so there's a handy reference to hand - my favorite one is the Mayo Clinic Guide to a Healthy Pregnancy. It was recommended here on AskMefi, and it's been great to have. I also have Great Expectations; it's got a more chatty style, but occasionally covers things the other book doesn't and vice versa. Both books have a neat week-by-week section that's fun to read as things progress.

There's a whole pile of great pregnancy and baby related questions in the AskMe archives. Worth reading all of those. Also, I've settled on as my online community of choice. They're non-judgmental and don't go in for those absurd DD DH TTC acronyms that infect so many other forums.

This is also the right time to start looking around and choosing a place to have the baby. Depending on where they are, she might have a choice between a hospital w/OB, hospital w/midwife, birthing center w/midwife, or a homebirth. Absolutely ask about their routine procedures; in some hospitals they'll immediately run an IV and a fetal monitor and effectively curtail your movement during labor.

Seconding not to worry about the weight unless your doctor/midwife is concerned.
posted by WowLookStars at 1:56 PM on April 19, 2012 [1 favorite]

Also, I didn't have my first appointment until I was 11 weeks along. I knew at 4 weeks (we'd been trying, so I was paying attention). I'm in the US and using a birth center + midwives, for what it's worth. They told me over the phone to take my prenatal and eat whatever I could manage to keep down and that was that. :)
posted by WowLookStars at 2:01 PM on April 19, 2012

Hive, thanks so much for this advice. I just talked to her and summarized these answers. She says she feels much better, and sent a heartfelt thanks to AskMeFi.

I'm realizing that both parents get overwhelmed when weighing a million options and explanations. They don't care why, and they don't want to make decisions all the time. They don't want to compare and consider all the things they could do... they want clear directives on what they should do.

So they need a step-by-step, minimalist, non-verbose plan to follow. Instead of "some women decide to do ABC because of reason D but others try to do E because of F and G is also an option if...". They really want to hear, "Hey, you're 15 weeks along! Baby is starting to kick! This week, call your doctor and ask to schedule test X".

Is there a really simple, clear, non-overwhelming resource to guide them? A thorough but non-verbose checklist would probably be better than a book.... suggestions? Thanks again!
posted by pseudostrabismus at 2:28 PM on April 19, 2012

Her OB will do this for her. They tend to have a set process and tests that they use for their patients. It does vary between OBs and based on the patient's individual medical record and worries. There are also test results that lead to different tests being's more like a choose-your-own adventure than a checklist, with the OB guiding you through it.
posted by the young rope-rider at 2:42 PM on April 19, 2012 [1 favorite]

Trying to give a heartfelt response here, but if they have an OB/GYN appointment tomorrow they should be able to get a lot of this guidance from their doctor. At my appointments (though the Kaiser system in northern California) there were a great deal of handouts and week-by-week guides through the pregnancy that included regular appointments, tests, optional educational classes, etc. I agree that the nurse in their case was not helpful and has probably unnecessarily pushed them into an overwhelmed state - but perhaps 24 hours out after the doctor visit they will feel in a more informed place.

My point being, of course they want this type of information! But you shouldn't (right now) feel you have to recreate it for them - if they still feel lost after they get to talk to their doctor then you might be able to help more with research, maybe helping them locate a doctor who they feel more comfortable with, etc. Their doctor deals with dozens of women a week who are pregnant - they are probably a well-oiled machine in guiding them through the basics (their recent nurse notwithstanding).
posted by handful of rain at 2:45 PM on April 19, 2012 [2 favorites]

I don't know how applicable these forms and newsletters are for your friend, but I found some week-by-week documents from Kaiser Permanente. As an example, here is one for Weeks 13 to 16. There are "to do" sections about what expecting parents should do.

There's also a sidebar with URLs for other pregnancy-related information.

Note that the upper left will say "California - Northern" but the information therein appears rather general and is probably applicable for any area.
posted by CancerMan at 2:48 PM on April 19, 2012

Regarding crazycanuck's advice above, I want to stress that it is never too late to change to a different OB/GYN / midwife. If you decide, at any point up to and including labor, that your care provider is not listening to you / communicating with you / whatever, you can find someone else. Seriously. The second half of my pregnancy I started to have serious doubts about the road we were going down with our OB/GYN (ie I decided I really didn't want a hospital birth, with all its IV/fetal monitor/etc "requirements" and my doctor was not willing to forgo these things) but I thought it was too late, that I was locked in. My doula told me stories about women she knew who changed care providers while in labor, which emboldened me to change to a midwife/waterbirth center at 35 weeks, and I'm very glad I did, I got the birth I wanted, and in my specific case, it is certain that I would have been forced into a c-section if I'd stayed with my original doctor.

More to the point of your questions about tests, though, seriously, don't worry about it. You're not "behind" in anything. Amnio is generally done around 15-16 weeks, so if you want genetic testing you can still do that. A blood draw might be in her near future to check for anemia. But that's around it. Early on there's not that much stuff to do; later in the pregnancy you'll have weekly appointments to check how things are going but this early on, it's really not that interesting.
posted by rabbitrabbit at 3:07 PM on April 19, 2012

She and baby will be fine. Generations of moms like me had kids before any of these tests were around, and they are fine. Maybe get another doctor as some have suggested. Most pregnancies are normal and result in healthy babies. The many tests are more about liability and malpractice cases than actual help to the majority of moms and babies. Relax, eat right, take vitamins and all will be well.
posted by mermayd at 3:49 AM on April 20, 2012

I agree with mermayd.

And tell the doctor that the nurse was being hyper and making you uncomfortable.
posted by gjc at 5:58 AM on April 20, 2012

Haven't read this book myself, but her other stuff is no-nonsense and good fun.
posted by superfish at 11:26 AM on April 20, 2012

Thanks for all the insights. Baby was born healthy. He is absolutely gorgeous and a huge source of joy.
posted by pseudostrabismus at 2:19 PM on March 24, 2013 [3 favorites]

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