The prenatal or perinatal period is a sensitive and critical time in which many health outcomes are determined for both the mother and developing baby. Regular prenatal visits with a health professional are important in order to monitor the development of the baby and the health of the mother throughout the pregnancy. A health professional can also provide accurate information to the mother and her partner in order for them to make informed decision regarding prenatal care and any treatment that may be necessary during and after the pregnancy.

Even if a woman has not planned her pregnancy, she can still give her baby a healthy start by following the healthy guidelines for preconception or prenatal health.

Congenital Anomalies

Congenital Anomalies are the leading cause of death and disabilities in infants and young children in Canada. Congenital anomalies are also referred to as birth defects. They are abnormalities that are present right at birth, but may or may not be discovered until much later in life. Congenital anomalies can present as structural or functional abnormalities.

Congenital anomalies may result in spontaneous abortions and stillbirths. They are a common cause of disease. This can be either immediately life threatening, shorten life expectancy, or result in long-term disabilities. The impact of congenital anomalies negatively affects individuals, families, societies, and healthcare systems.

There are four main types of congenital anomalies:
  1. Malformation: The complete or partial absence of a fetal structure.
  2. Disruption: Results from the breakdown of previously normal tissue.
  3. Deformation: Result of a mechanical event that abnormally affects an otherwise healthy tissue; it is often reversible after birth (e.g. Clubfeet).
  4. Dysplasia: Abnormal organization of cells.

Congenital anomalies begin prenatally (before birth). They can be caused by single gene defects, chromosomal disorders, multifactorial inheritance, environmental teratogens, and micronutrient deficiencies (e.g., folic acid deficiency). Some maternal infectious diseases, such as syphilis and rubella, can also cause congenital anomalies.

The causes of majority of congenital anomalies are unknown. Congenital anomalies of a known origin can be classified into the following:
  1. Genetic mutations due to chromosome abnormalities or single-gene disorders. Down syndrome is an example of chromomosmal abnormality while cystic fibrosis is an example of single-gene disorder.
  2. Environmental toxins and toxicants, such as smoking, drinking alcohol, poor nutrition intake, herbicides, pesticides. Fetal alcohol spectrum disorder is an example of a congenital anomaly caused by an environmental toxicant.
  3. Combination of genetic and environmental factors (multifactorial). This is seen when mothers with genetic predispositions are exposed to environmental toxicants or toxins. An example of a combination of genetic and environmental factors is the cleft lip and palate.

Early detection and prevention strategies are very important to ensure the best results for the child. Preventative strategies include preconception counseling, genetic counseling, maternal serum screening, prenatal screening, public health education, daily use of folic acid, and avoidance of exposure to radiation and other environmental toxicants during pregnancy.

It is important to ask your healthcare provider to explain the meaning of some medical terms you have heard or read on genetics. Here are some commonly used terms in genetic clinic and what they mean.

Terms

Genetics:

The field of study that investigates variations within the human genome (one set of chromosomes).

Heredity:

The passing of genetic traits from parents to their children.

Genes:

The basic units of heredity. These are located along the DNA of each chromosome. They provide information for growth, development, and function of our bodies.

Chromosomes:

Threadlike strands (occur in pairs) that carry genes (DNA, RNA, and proteins) and transmit hereditary information.

Allele:

A single chromosome within a set of chromosomes.

Dominant genes:

Requires only one copy of an allele in order for that characteristic to be outwardly present in an individual.

Recessive genes: Requires two copies of an allele in order for that characteristic to be outwardly present in an individual. Where there is generally no effect on a person’s health or development, then only a single faulty copy of a gene is present.

Mutations: A gene is said to be faulty when changes within the gene stop it from working properly. Some mutations will have no effect and others may have a positive effect and yet others may have a negative effect. Everyone has some genetic mutations.

Congenital anomaly:

An abnormality of structure, function, or body metabolism that is present at birth (even if not diagnosed until later in life) and results in physical or mental disability, or is fatal.

Birth Defects:

Structural or functional abnormalities present at birth that cause physical or mental disability. Some may be fatal. Also known as congenital anomalies. Currently, birth defects are the leading cause of death for infants during the first year of life.

Functional birth defects:

Related to a problem with how a body part or body system works. These problems often lead to developmental disabilities and can include: nervous system or brain problems, sensory problems, metabolic disorders, and muscular degenerative disorders.

Syndrome:

Recognized pattern of malformations resulting from a single specific cause.

Chromosomal:

Changes in the normal chromosome pattern. These can be numeric which results from the addition of one chromosome to each of the existing pair, or structural which involves some degree of chromosome breakage. The fragments that have broken off can be lost. This is called a deletion and translocation, and results in abnormal chromosome configurations.

Risk Factor:

Exposure to a condition or habit that may predispose or increase the chances of developing a disease or illness.

Teratology:

The field of study that investigates and evaluates the causes of structural or functional damage to the developing embryo or fetus.

Teratogen:

An agent that produces congenital malformations or increases their incidence.

 

Common Tests to Prevent, Screen, and Diagnose Congenital Anomalies:

These tests may be offered by your healthcare provider during your prenatal clinic visit. The physician would ask you to do these tests if there is a chance of your baby having certain congenital anomality, based on your family history, age , medical or social hsitory.

The result of the test would enable you and your family to plan the delivery of the baby, in consultation with the physician.

Genetic Testing:

This is done if the maternal history includes genetic disorder in the family, recurrent abortion, advanced age, consanguinity, viral infections, exposure to street drugs.

Screening Tests:

First Trimester:

  1. Nuchal Translucency Ultrasound Test: This prenatal test is performed with or without early pregnancy testing of the mother’s blood. During the first trimester of pregnancy, specifically during the 11th and 13th week, a blood test along with an ultrasound is done to screen for Down syndrome. This method can also identify heart disorders.
  2. Maternal Blood Screen: This test measures the two levels of proteins; human chorionic gonadotropin (HCG) and plasma protein A [PAPP-A]. If these protein levels are abnormally high or low, then a chromosomal disorder may be suspected.

Second Trimester:

  1. Maternal serum screen, also known as the “triple screen” or “quad screen”, is a simple blood test used between 15 to 20 weeks of pregnancy to detect neural tube defects and chromosomal disorders. It is called a triple screen if it measures three proteins and a quad screen if it measures four proteins.
  2. Anomaly Ultrasound: During the second trimester ultrasound, the size of the baby is measured and the technician looks for birth defects and other problems that may be identifiable during this time.

Diagnostic Tests:

If a screening test is abnormal, the physician may order a diagnostic test in order to confirm if a birth defect or other possible problems are present. These tests are offered to women who are considered to have “high risk” pregnancies. Women in this category include those with advanced maternal age (35 years of age and above), those who have had a previous pregnancy or child with a birth defect, women with chronic health problems, and those who use certain medications.

  1. High Resolution Ultrasound: This ultrasound is typically done during the 18th and 22nd week of pregnancy. The picture that is created has more detail to look for birth defects or possible problems that were suggested by the initial screening tests.
  2. Chronic Villus Sampling (CVS): This test is completed by the physician who takes a small piece of the placenta (chronic villus) and tests it for genetic and chromosomal disorders. This test is usually done during the 10th to 12th week of pregnancy on those women whose first trimester screen resulted in an abnormal test. CVS is not recommended before 10 weeks of pregnancy.
  3. Amniocentesis: This test is completed by the physician who takes a small sample of the fluid that the baby is surrounded by (amniotic fluid) and tests it for genetic and chromosomal disorders. The fluid is tested for the baby’s protein levels. Abnormalities can indicate birth defects. For example, AFP (alpha-fetoprotein) is a protein that is produced by the baby. If a high level of this protein is detected in the amniotic fluid, then the baby may have a defect indicating an opening of tissue. Possible conditions include: anencephaly or spina bifida, omphalocele, or gastroschisis. The cells from the fluid can also be tested for chromosomal disorders. This test is usually completed during the 15th and 18th week of pregnancy to women who either had an abnormal screening test or have a high risk pregnancy. Acetylcholinesterase is an enzyme that the baby produces. If there is a neural tube defect (an opening of the tissue of either the spinal cord or head), then this enzyme can pass from the baby into the amniotic fluid (the fluid that surrounds the baby).

Prevention:

Not all congenital anomalies can be prevented; however, most that are caused by environmental toxins or toxicants can be prevented by public health initiatives. These include the prevention of sexually transmitted infections, precautionary approach towards household and environmental chemicals, vaccination against rubella, and fortification of basic foods with micronutrients (iodine and folic acid).

Domestic Violence

Pregnancy can be a dangerous time for women and the children of women who are abused. Abuse often starts or increases during pregnancy.

Abuse can be emotional, physical, sexual, spiritual or economic. All abuse must be taken seriously and all abuse is damaging. There are many ways that an abuser can assert power and control over a partner before, during and after pregnancy, such as:

  • forcing her to have an abortion or injure her with the intent of causing her to lose the baby
  • forcing her to continue an unwanted pregnancy
    directing physical assaults at the woman’s breasts, abdomen and/or genital area
  • controlling, limiting, delaying or denying her access to prenatal care
    refusing to support her during pregnancy, labour and delivery and/or recovery
  • restricting her access to food or resources
    making negative comments about her appearance, the baby, or her parenting abilities
  • denying her access to her newborn child
  • blaming her for the baby and any changes that have to be made in the household because of it
  • threatening the woman’s or child’s safety or custody

There are many emotional and/or physical consequences of violence during pregnancy, and these may lead to further problems, such as stress, substance use and illness.

If a woman suffers from an abusive partner she should seek help and guidance from a health professional, counsellor, social worker or close friend to discuss her options. Women may find it difficult to leave an abusive relationship because they love their partner, need the support they receive from the partner, fear what the partner may do, are isolated, lack community resources and/or cannot escape with their children.

Gestational Diabetes

Gestational Diabetes Mellitus (GDM) is a form of diabetes or high blood sugar that starts or is first diagnosed during pregnancy. The hormonal changes of pregnancy affect the body’s ability to use glucose (sugar). Throughout pregnancy, a woman will consistently need more insulin. Women with gestational diabetes cannot produce enough insulin for their body’s needs.

The risk of developing GDM is increased if the woman:
  • is older than 35 years of age
  • is overweight
  • has a family history of diabetes
  • is of Aboriginal or Asian ancestry

GDM often does not have any symptoms for the woman and a glucose screening test is needed to measure blood sugar levels. However, women with GDM have an increased risk of developing Type II Diabetes and developing gestational diabetes in future pregnancies. The possible outcomes for the baby include:

  • high birth weight (macrosomia) which may increase the chance of Caesarean delivery
  • low blood sugar (neonatal hypoglycemia)
  • increased risk of developing diabetes

There are several treatments of GDM. Good blood sugar control reduces the risk of complications in pregnancy and for the baby. Regular prenatal check-ups are important to find and treat problems early.

Gestational Diabetes Mellitus (GDM) can persist into the postpartum period of a woman’s life and may develop into Type 2 diabetes and abnormal glucose tolerance in the future. Postpartum screening at 6-12 weeks has been recommended for women who had Gestational Diabetes Mellitus, impaired fasting glucose level, or impaired glucose tolerance during pregnancy.

It is important that women, who have had these concerns in the past and may have subsequent pregnancies, screen more frequently to detect abnormal glucose metabolism before pregnancy and provides an opportunity to ensure preconception glucose control. If they have changed primary care physicians, women may want to discuss past pregnancies and the need for early screening for GDM, impaired fasting glucose level, or impaired glucose tolerance with their doctor.

Primary healthcare providers can use the Postpartum DM Checklist as a reminder when seeing women, who have experienced GDM during pregnancy, to review their diabetes screening results between six weeks and six months postpartum.

 

Healthy Weight Gain

As the health and development of an unborn baby is closely connected to the mother’s health, it is important for the mother to pay attention to her food choices and physical activity levels in order to promote the health of her baby.

During pregnancy, a woman will need more calories each day to support the growth of her unborn baby. She should also make healthy food choices, consuming fruits and vegetables, whole grains, low fat protein and low-fat milk product in accordance with Canada’s Food Guide. Pregnant women should also take a multivitamin every day that contains at least 0.4 mg of folic acid and contains iron.

Gaining weight is a natural and important part of pregnancy. However, gaining too much weight during pregnancy may lead to health problems and gaining too little weight can increase the risk of low birth weight. A woman’s weight and Body Mass Index (BMI) before pregnancy will help to determine how much weight she should gain during pregnancy.

  • if a woman’s BMI is below 20, she should gain between 28-40 pounds (12.5-18 kg)
  • if a woman’s BMI is between 20 and 27, she should gain 25-35 pounds (11-15.5 kg)
  • if a woman’s BMI is over 27, she should gain between 15-25 pounds (6.5-11 kg)

Physical activity is also important to maintain or begin during pregnancy. If a woman is active before her pregnancy, she can continue to exercise as before making changes as necessary with the changes in her body. If a woman is not active before her pregnancy, she should begin an exercise program slowly. Discussing safe ways to engage in physical activity with a healthcare professional will help develop a routine that is best for mother and baby.

Links

Maternal Obesity, Excessive Gestational Weight Gain and Pregnancy Outcomes Final Report

This literature review, conducted by the Saskatchewan Prevention Institute, aimed to: (a) examine the relationship between maternal obesity and pregnancy outcomes (i.e., maternal outcomes and neonatal, infant and child outcomes); and (b) assess the association between excessive gestational weight gain (GWG) and pregnancy outcomes (i.e., maternal outcomes and neonatal, infant and child outcomes). The document reports on findings from a review of the literature on maternal obesity, excessive gestational weight gain and pregnancy outcomes, conducted between December 1, 2009 and March 31, 2010.

 

Interventions for Weight Management in Pregnancy – Overview of Systematic Review and Meta-Analysis Studies

More than two-thirds of women of childbearing age are overweight or obese, and these numbers have increased dramatically in the last few decades in Canada. Further, average weight gain in pregnancy has increased over the last four decades from 10 to 15 kg and a significant number of women are exceeding pregnancy weight gain recommendations.

The increasing prevalence of preconception overweight and obesity and excessive gestational weight gain is a significant risk factor for adverse maternal and infant outcomes. The risks may involve the pregnancy, birth, and later life for both the woman and her infant. One important downstream risk is childhood obesity.

Weight management strategies are increasingly focusing on pregnancy as a potentially key time to target weight management to address the rapidly increasing prevalence of obesity in the population. This review of various systematic review and meta-analysis studies examining the effectiveness of weight management interventions during pregnancy discusses potential strategies to enable more effective dialogue between pregnant women and care providers to ensure optimal health and wellness for mom and baby.

 

Hypertension and Pregnancy

High blood pressure or hypertension in pregnancy can cause problems for both the woman and her baby. At the beginning of pregnancy a woman’s blood pressure will normally fall. However, in some women blood pressure will be increased leading to gestational hypertension. Hypertension can often be prevented in low-risk women through physical activity before and during pregnancy and early and regular prenatal care.

Hypertension is defined as a diastolic blood pressure of 90 mmHg or higher on at least two separate occasions that are at least six hours apart, whereas average blood pressure is less than 120 mmHg systolic and 90 mmHg diastolic. A woman has an increased risk of developing gestational hypertension if she:

  • is having her first pregnancy, or first pregnancy with a new partner
  • had a previous pregnancy with hypertension
  • has a family history of hypertension
  • is obese
  • is older than 35
  • is experiencing multiple gestation (i.e., twins, triplets, etc.)
  • has diabetes or pre-existing kidney disease

Mild to moderate hypertension usually does not have any negative effects on the woman or her baby. Severe cases of high blood pressure can damage blood vessel walls and affect the flow of blood between the mother and her baby. High blood pressure can also occur with proteinuria (protein in the urine), which can be a very serious problem increasing the risk of preterm birth, lowbirthweight, seizures and stroke.

Pre-Term, Post-Term

Labour prepares a woman’s body for the birth of her baby and indicates that the baby’s delivery is imminent. The first stage of labour lasts from the beginning of contractions until the cervix is fully dilated. The baby is delivered in the second stage. The third stage involves the delivery of the placenta.

Labour can begin at any time throughout the pregnancy; however, it usually begins between weeks 37-42 of pregnancy and can last hours to days. Sometimes, labour and delivery will occur before the due date (preterm) or will not occur until after the due date (post-term).

Premature labour increases the risk of complications in labour and delivery for both the woman and the baby, as well as the possibility of complications in later life. Premature babies now have healthier outcomes because of increasing medical technology; however, there are still health risks involved. Labour later in pregnancy is associated with better outcomes for both the mother and child. Women and their partners should educate themselves on the signs of preterm labour and seek medical help if necessary. Caring for premature babies can also be different than that of full-term infants and new parents should talk with a health professional in order to provide the best care for their premature baby.

Post-term labour can also be serious. Due dates are not always concrete and some babies’ gestation time may be longer. If a woman is past her due date, the baby should be monitored closely and labour should be induced if any complications arise.

Sometimes complications for either the mother or the baby may warrant the induction of labour. Induction of labour is the manual or medicinal initiation of labour. This is generally done only if the risk to the woman or baby is lowered through labour and delivery or if the woman is over 42 weeks gestation.

Pre-term Labour

Pre-term labour is defined as labour that begins before the 37th week of pregnancy. A full-term pregnancy lasts 37 to 42 weeks. Preterm labour occurs in approximately 8.2% of all pregnancies and premature babies account for 60 to 70% of all infant deaths and illnesses in Canada.

Babies born prematurely may need treatment in special care facilities and be more likely to have problems with:

  • temperature instability
  • breathing (i.e., Respiratory Distress Syndrome)
  • eating
  • infections and/or
  • jaundice
Signs of preterm labour include:
  • regular contractions that may or may not be painful
  • bleeding or leaking fluid from the vagina
  • cramps
  • low, dull backache and/or
  • pressure in the pelvic area, as if the baby is pushing down

Babies that are born too early may have health problems and need special medical care. They also may have respiratory, feeding or growth problems and they have an increased risk of infection and Sudden Infant Death Syndrome (SIDS).

Pre-term labour cannot always be stopped. However, to reduce the risk of pre-term labour a woman should:
  • get early and regular pre-natal care
  • choose healthy foods
  • get lots of rest
  • avoid alcohol, tobacco and other drugs when pregnant and
  • find healthy ways of dealing with stress
Preterm labour is very serious. If a woman has possible symptoms of preterm labour, or if the symptoms worsen, she should get medical help immediately.

Pre-labour Rupture of Membrances (PRoM)

Usually when labour begins the sac of amniotic fluid where the baby develops will rupture. However, sometimes, the sac will break before labour begins, leading to fluid leaking from the vagina. It is called Pre-labour Rupture of Membranes (pROM). If this happens, near the due date, labour will usually begin or be induced. However, if this happens before the due date it is called Preterm Pre-labour Rupture of Membranes (pROM). The earlier in pregnancy that this happens, the more serious it is. pROM may cause premature birth and may also cause infection or bleeding in the mother.

It is important for a woman to be educated on the signs of preterm labour and call her doctor or go to a hospital if she feels she is in preterm labour or if she experiences pre-labour rupture of membranes.

Post-term Pregnancy

A post-term pregnancy is a pregnancy that has lasted 10 days past the expected due date. Being overdue does not usually harm the baby. However, a doctor can advise the woman on any possible problems or complications that may occur, such as:

  • fetal heart rate abnormalities in labour
  • labour complications
  • macrosomia (large for gestational age)
  • meconium staining (feces in the amniotic fluid) which may also cause
  • Meconium Aspiration Syndrome (when the baby inhales feces in the amniotic fluid, causing complications)
  • oligohydramnios (not enough amniotic fluid)
  • Post-Maturity Syndrome
  • death (either stillbirth or death during the first week of life)

Some pregnancies may appear to continue post-term because of an incorrect due date. As well, some women will conceive earlier or later in their cycles and some babies just need a shorter or longer gestation period. Other post-term pregnancies may be related to factors such as:

  • a first pregnancy
  • having a previous post-term pregnancy
  • having a male baby
  • some birth defects

If a woman is overdue, she should talk to her doctor about the options of fetal surveillance or labour induction. Fetal surveillance involves careful monitoring of the baby and waiting for labour to begin. If there are any complications labour will be induced. Labour induction involves taking medications that will start labour instead of waiting for it to begin on its own.

Induction of Labour

Induction of labour is a medical intervention to artificially start labour using an external method to cause the uterus to contract, the cervix to open and the baby to be born. Labour is usually induced when the risks of the pregnancy continuing (to either the woman or the baby) are greater than the risks of birth.

Some common reasons for labour induction include:
  • maternal disease (e.g., diabetes)
  • non-reassuring fetal status or concerns about fetal well-being before labour begins
  • hypertension
  • Oligohydramnios or Polyhydramnios (not enough or too much amniotic fluid, respectively)
  • fetal growth problems
  • post-term or overdue pregnancy
  • Pre-labour Rupture of Membranes (pROM)
  • infection
  • maternal bleeding
Labour can be induced in many different ways. Some methods use medication, others use manual methods. Labour is often induced because there is increased risk to the baby if it stays within the uterus.

Routine and Special Tests

At the prenatal visits, the doctor or health professional will monitor the infant’s development and the mother’s health. The frequency and complexity of the visits will vary depending on the special needs of the baby and mother. Additional tests may be done if the mother is in a high risk group due to age, family history or specific health concerns. Such tests give doctors valuable information that will allow them to provide the best prenatal care for both a woman and her baby.

Amniocentesis is a test in which a small sample of amniotic fluid is collected from the bag of waters that surround your baby. The procedure is done by inserting a needle through the abdomen and into the uterus. This test is performed to see if the baby has certain conditions such as DownSyndrome or Cystic Fibrosis. It is usually done between the 15th and 18th week of pregnancy.

Amniocentesis

Amniocentesis gathers information about the genetic makeup of the baby. The test will typically be done if:
  • the woman is over 40 years old;
  • the woman already has a child with certain genetic disorders (birth defects);
  • the woman is at risk for having a baby with a genetic disorder;
  • there is a family history (maternal or paternal) of genetic disorder.

Amniocentesis and maternal serum screening are testsavailable to all pregnant women in Saskatchewan as part of their prenatal care. The results of the test indicate the chance of having a baby with spinal defects (open neural tube defects) and some chromosome abnormalities (Down syndrome, trisomy 18). These conditions are not common.

Biophysical Profile

A biophysical profile checks how the baby is developing using two tests, the non-stress test and the ultrasound. The non-stress test measures the baby’s heartbeat to see if it speeds up during movement. The ultrasound looks for breathing movement, body movement, muscle tone and amniotic fluid. This test is usually done in later pregnancy for women who may be having pregnancy problems such as a baby that is growing slowly, or is overdue.

Blood Tests

Throughout pregnancy many different blood tests will be taken, some only once at the beginning of the pregnancy and others repeated.

A woman’s blood group and Rh (Rhesus) type must be obtained in case a blood transfusion is needed or in the event her Rh is negative and her baby’s is positive. A shot of rhimmune globulin will be given at 28 weeks, again if there is bleeding during the pregnancy, and again after the birth to prevent the mother’s blood from developing antibodies against her baby’s different blood.

The iron (hemoglobin) levels in the mother’s blood must also be measured. Hemoglobin carries oxygen from the lungs to the rest of the body. If a woman has anemia or low hemoglobin levels, she may feel tired and have low energy levels. To raise hemoglobin levels, the woman would be encouraged to eat an iron-rich diet, or to take an iron supplement.

The blood test for Rubella (German Measles) is to check for antibodies in the mother’s blood. If you get Rubella during pregnancy, it can cause disabling conditions in the infant.

Glucose screening is a blood test that measures the amount of sugar in the blood. During pregnancy, women are at risk of developing gestational diabetes. If a woman has high amounts of sugar in her blood during a glucose screening, the doctor will request a longer blood test to determine if she has gestational diabetes.

Gestational diabetes often has no symptoms for the woman, but can be harmful to the developing baby. It can often be treated with diet and exercise alone, but in some cases, insulin injections may be needed throughout pregnancy. This test, therefore, helps to ensure the healthiest outcome for both the woman and her baby.

Other blood tests during pregnancy include Hepatitis B and C and HIV. Please refer to the Preconception Health Section for more information.

Group B Streptococcus

Group B streptococcus, or GBS, is a common type of bacteria found in the vagina and rectum of many healthy women. This type of bacteria does not cause any problems for adults, but it can cause serious infections in newborns. It is therefore important to be tested for Group B streptococcus during pregnancy.

Treatment of GBS generally involves antibiotics. Most women who are not treated will have healthy babies. However, there is also risk of infection, pneumonia or meningitis after birth for the infant.

Non-Stress Test

A non-stress test is used to measure the baby’s heart rate and how it changes with the baby’s movements. A healthy baby’s heartbeat will speed up when the baby is moving, just as an adults will. Depending on the reason for running the test, it may be repeated regularly (at least once a week) until the baby is born.

This test will be done if:
  • the baby is overdue
  • the baby appears to be small or growing slowly
  • the baby is more or less active than usual
  • there is a small or large amount of amniotic fluid around the baby
  • other tests indicate that a non-stress test is necessary
  • the woman has a condition such as hypertension or diabetes, or is having pain in her stomach

Ultrasound

An ultrasound is usually done between the 16th and 20th week of pregnancy and may be repeated later in pregnancy. This test uses sound waves to show a picture of the baby and placenta. Ultrasounds give information on the fetus, such as:

  • the age of the baby
  • the development of the baby
  • where the baby and placenta are within the uterus
  • if there is more than one baby and
  • how the different parts of the baby are growing (e.g., the heart, lungs, stomach, kidneys, brain and spine).

Vaginitis

Vaginitis is a common disease that is caused by overgrowth of bacteria that is found naturally in the vagina. Vaginitis is commonly linked to three diseases; bacterial vaginosis, trichomonas, and vulvo-vaginal candidiasis. These diseases can negatively affect the fetus and are associated with preterm birth, therefore, it is important to be tested.

Some women with vaginitis have no symptoms, but others might experience:
  • fluid leaking from the vagina, possibly with an odour
  • burning during urination
  • genital itching

Counting Baby’s Movements

A woman can play an important role in checking the health of her baby by counting her baby’s movements. Keeping track of a baby’s movements allows a woman to get to know her baby and to notice when her baby is quiet and when it is active. This will make it easier for her to tell if the baby is unusually quiet. If this occurs, a woman should talk to her healthcare professional, who may conduct other tests to check the health of the baby.

Resources