Published by BUPA's Health Information Team
January 2004

The aim of tests during pregnancy (antenatal tests) is to monitor the health and wellbeing of the mother and developing baby (fetus). Some antenatal tests are routinely offered to all women and others are offered only to certain women because of their age and medical or family history.

Pregnancy tests
The first test of any pregnancy is one that confirms the woman is pregnant. Conception typically takes place midway through a woman's menstrual cycle. Pregnancy tests are very accurate and can usually detect pregnancy from the time a woman misses her first period - approximately two weeks after conception. Women can buy home-testing kits from a pharmacy, or take a urine sample to their GP surgery.

Check-ups during pregnancy
Once a woman knows or suspects she is pregnant, she can make an appointment with her GP to discuss antenatal care and tests. The GP will ask about any previous pregnancies, general health and whether any close members of the family have a health problem that can be inherited, such as cystic fibrosis.

The GP checks that the woman is taking the right dose of folic acid supplement (400 micrograms a day) and gives general advice about pregnancy. A referral is made for antenatal care throughout the pregnancy. This could be at a hospital, at the GP surgery, in a clinic or at home (although any scans will need to be in a hospital).

Booking visit (first appointment)
The first appointment usually takes place at around 10-13 weeks. This is a detailed antenatal visit and may take some time. Some women need two appointments to cover everything. Women may see a midwife, a doctor or both. The woman's health, previous pregnancies, any medical problems and social circumstances are discussed.

An estimated date is given for when the baby is due. A brief ultrasound scan is performed to confirm that the size of the baby fits with the estimated dates and to check if the woman is expecting more than one baby.

The midwife or doctor takes a blood sample. Although there may be some variation between different healthcare providers, the following are the typical blood tests done at the booking visit:

• blood group and rhesus (Rh) type. Women are either Rh positive or negative. Rh negative women are usually offered an injection after delivery to protect their next baby from the risk of anaemia
• haemoglobin to check for anaemia
• screening for infections that can affect the mother and baby, such as hepatitis B or syphilis and HIV
• immunity to rubella (german measles). Women who are found not to be immune are given advice on how to reduce the risk of catching it and what to do if they catch it

Other blood tests may be offered depending upon a woman's medical history and ethnic background.

The woman's height and weight are recorded. Women who are underweight or overweight may need extra care.

A pelvic examination (internal) is not usually needed although women may be offered a smear if this is not up-to-date, or swabs if there have been symptoms of vaginal infection. The midwife usually feels the abdomen.

Routine tests
Arrangements for antenatal care can vary but the National Institute of Clinical Excellence (see Further information) advises that healthy women have up to 10 check-ups for a first pregnancy, including the booking visit. Women who have had previous healthy pregnancies need only seven. At each appointment blood pressure and urine are tested and the baby's development is checked.

Checking the mother's health
Blood pressure is monitored as this can rise during pregnancy. Urine is tested for infection and for the presence of protein. Protein in the urine and raised blood pressure are two signs of pre-eclampsia - a symptomless condition that can be harmful to both mother and baby and may mean that the baby needs to be delivered early. Blood is tested again at 28 weeks for anaemia.

Checking the baby's development
As the baby grows, the uterus rises out of the woman's pelvis and becomes the "bump". The top of this is called the fundus. The height of the fundus is measured to ensure that the baby is growing.

The baby's heartbeat is not routinely checked, but some mothers may ask to listen to it for reassurance. The midwife or doctor may use a device placed on the abdomen to amplify the heartbeat.

At around 19-20 weeks, women start to feel the baby moving. Babies have active and restful times. In the early months, they have plenty of room and may move around a lot. As the pregnancy progresses, the midwife or doctor will ask about the baby's movements and try to determine the position of the baby by feeling the mother's abdomen. Towards the end of pregnancy, the head usually drops down into the pelvis into a position ready for delivery (when the head is said to be engaged).

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