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Total OB care
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Basic ultrasound Learn More
Fetal ultrasound is a test done during pregnancy that uses reflected sound waves to produce a picture of a fetus camera.gif, the organ that basic-ultrasoundnourishes the fetus (placenta), and the liquid that surrounds the fetus (amniotic fluid). The picture is displayed on a TV screen and may be in black and white or in color. The pictures are also called a sonogram, echogram, or scan, and they may be saved as part of your baby’s record
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Fetal monitoring Learn More
Electronic fetal heart monitoring is done during pregnancy, labor, and delivery to keep track of the heart rate of your baby (fetus) and the strength and duration of the contractions of your uterus. Your baby’s heart rate is a good way to tell whether your baby is doing well or may have some problems.
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Genetic Testing
On-site labs in all offices ensure fast and accurate results to your testing needs.
NewLife closes the loop in patient satisfaction and convenience by having an on-site lab. NO more scheduling additional appointments, no more days off from work, no more waiting for results from another provider, no more confusion. Your lab tests are performed at the same time of yoru appointment – no waiting, no hassle. Our advanced integration system allows your results to be transmitted to our EMR system when they are completed ensuring accurate, timely reading of your results and with your patient portal, you can view these results when they are ready. -
Amniocentesis Learn More
During pregnancy, the fetus is surrounded by amniotic fluid, a substance much like water. Amniotic fluid contains live fetal skin cells and other substances, such as alpha-fetoprotein (AFP). These substances provide important information about your baby’s health before birth.
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High Risk pregnancies Learn More
Your pregnancy is called high-risk if you or your baby has an increased chance of a health problem. Many things can put you at high risk. Being called “high-risk” may sound scary. But it’s just a way for doctors to make sure that you get special attention during your pregnancy. Your doctor will watch you closely during your pregnancy to find any problems early.
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Nutrition and dietary counseling Learn More
How can I plan healthy meals during pregnancy?
Planning healthy meals during pregnancy is not hard. The United States Department of Agriculture has made it easier by creating www.choosemyplate.gov. This web site helps everyone from dieters and children to pregnant women learn how to make healthy food choices at each mealtime. To learn more .
First Trimester
- Hemoglobin (HGB) and Hematocrit (HCT)
- White Blood Cells: WBCs and WBC Differentia
- Platelet Count
- Blood Type
- Rh Factor
- HIV
- Antibody Screen
- Rubella Titer
- VDRL and RPR Titer
- Hepatitis B, Hepatitis C
- Wet Mount
- Urinalysis
Second Trimester
- Ultrasound
- Test done at 16-18 weeks
- Unconjugated estriol
- Diabetes Screen, Glucola Screen, Post-Prandial Test
Third Trimester
First Trimester
Hemoglobin (HGB) and Hematocrit (HCT)
What it measures.These two tests are used to screen for anemia in pregnancy. Anemia exists when there are not enough red blood cells (RBCs) to meet the oxygen needs of the body. Hemoglobin measures the number of RBCs present in a sample of blood, and HCT measures the percentage of RBCs in the blood. The HGB and HCT are checked at the beginning of the pregnancy and again in the third trimester.
What it tells you. Pregnant women are often slightly anemic compared with nonpregnant women, and this is usually normal. The mother’s blood volume increases during the pregnancy to meet the needs of the growing baby and uterus. As it does, the plasma (fluid part of the blood) expands by 50%, and the RBCs expand by only 30%. The net result is that the blood is diluted slightly, which makes for a lower HGB and HCT. If anemia is present, these tests can indicate if it is mild or severe. However, anemia can have many causes, including inadequate iron stores, an inherited blood disorder, or other rare health problems. The tests won’t tell you the type of anemia. Further tests will be ordered to clarify the cause and how best to treat it.
Red Blood Cell Indices: Mean Corpuscular Volume (MCV); Mean Corpuscular Hemoglobin (MCH); Mean Corpuscular Hemoglobin Concentration (MCHC) Measures
What it measures. The red blood cell indices measure specific characteristics of the RBC. Mean corpuscular volume is the average volume of the RBC; MCH is the weight of the RBC; and MCHC is the proportion of the RBC volume that comes from the hemoglobin.
What it tells you.These tests can help to determine the possible causes of anemia. Normal RBC indices combined with a low HGB and HCT may indicate iron-deficiency anemia.
White Blood Cells: WBCs and WBC Differentia
What it measures. White blood cells (WBCs) are an important part of the body’s immune system. There are different types of WBCs, and the WBC differential counts the percentage of each type.
What it tells you. An elevated WBC count might indicate that the body is fighting some kind of infection, usually bacterial in nature. There are many other, less common, causes for both high and low WBC counts. The test alone does not tell you the cause of these abnormal levels. The differential might give further clues as it shows which types of WBCs are active.
Platelet Count
What it measures. Platelets are the blood component responsible for your ability to clot blood when you bleed. The platelet count test measures the number of platelets in the blood sample. Since it is normal to have bleeding after the birth, it is very important to be able to clot blood.
What it tells you. This test will tell you if you have the normal number of platelets. If they are low, it will be important to determine why and to watch platelet levels closely during pregnancy. If they are high (which is rare), further tests might be ordered to determine the cause.
Blood Type
What it measures. The test determines your specific blood type: O, A, B, or AB. In the U.S., 46% of the population have type O, 41% have type A, 9% have type B, and 4% have type AB.
What it tells you. This is important information to know if you ever need a blood transfusion. Also, if the father of the baby has a different blood type than you, the baby may have a different type as well. In most cases, this is not a problem. Occasionally something called ABO Incompatibility occurs, such as when the baby is A, B, or AB, and the mother has a different blood type. In this case, the infant has an increased risk of getting jaundice in the early newborn period.
Rh Factor
What it measures. Rh Factor refers to the Rhesus factor in the blood. If a certain group of factors are absent, you are Rh-negative. If they are present, you are Rh-positive.
What it tells you. If you and the father of the baby are Rh-negative, the baby will also be negative – and there will be no problem. If mom is Rh-positive and the baby is negative, it will again be fine. However, if the mom is negative and the baby is positive, there will be a risk for sensitization – where the mother’s blood makes antibodies against the baby’s blood.
HIV
What it measures. The HIV test screens for the presence of antibodies to the human immunodeficiency virus, which can lead to autoimmune deficiency syndrome (AIDS). HIV can be transmitted to the baby.
What it tells you. The test most accurately reflects exposures that occurred over six months prior to the test. If you have been exposed to the virus more recently than that, the test might show a false negative, because you don’t yet have enough antibodies to detect the virus. Test again six months after a negative test result if you are at risk.
Antibody Screen
What it measures. The antibody screen checks for the presence of antibodies to other blood types in the mother’s blood. This test is done on all mothers at the beginning of their care. For Rh-negative mothers, it will also be repeated at 28 weeks.
What it tells you. If you are Rh-negative, the test determines whether you have ever been sensitized against another blood type. It does not tell you when or how that sensitization occurred. Antibodies against Rh-positive could attack infant blood cells when the two blood supplies connect during birth. This causes a breakdown of those cells, called hemolysis. Broken-down red blood cells release bilirubin, which causes jaundice. Too much bilirubin at once can make the baby sick, and he or she will require additional medical care.
Rubella Titer
What it measures. Rubella, also called German measles, is a virus. This test determines whether antibodies to the virus are present, and how many. A positive antibody titer means you have antibodies (immune), a negative means you don’t (non-immune). It is possible to have an equivocal (indecisive) result, in which case you will be treated as if you are non-immune. If a mother gets rubella during pregnancy, there can be very serious effects on the baby.
What it tells you. The test will tell you if you have been previously exposed to rubella. Most people are immune to rubella because they received childhood vaccinations to prevent it. If they had rubella, they would also be immune. However, it is important to remember that vaccinations do not guarantee permanent immunity, and even someone who was vaccinated can become non-immune. If you are non-immune during your pregnancy, you will be cautioned to avoid any possible exposure to the measles, and your provider will recommend rubella vaccine for you after the baby is born.
VDRL and RPR Titer
What it measures. The Venereal Disease Research Laboratory (VDRL) and the rapid plasma reagin (RPR) tests measure for the presence of antibodies to syphilis. Syphilis is a sexually transmitted infection, and can have devastating effects on both the mother and the baby.
What it tells you. The test can tell you if you have been exposed to syphilis. However, the antibodies measured can sometimes be present in response to other illnesses, which means there can be false positives. Therefore, the tests are used for screening only. If these initial tests show the presence of antibodies, then secondary tests that look for the presence of Treponema pallidum – the organism that causes syphilis – will be ordered. A diagnosis cannot be made without multiple tests proving positive.
Hepatitis B, Hepatitis C
What it measures. There are two different tests that measure for antibodies to the hepatitis B and C viruses. Hepatitis B and C can seriously affect the mother’s health and, depending on the viral count of the mother, can be transmitted to the baby at birth.
What it tells you. The presence of antibodies can indicate that you have been exposed to the virus. It will not tell you when you were exposed, nor if you actually had or have an active form of the illness. Further testing can check for active hepatitis and determine if your liver function has been affected.
Wet Mount
What it measures. A wet mount is a slide taken from swabbing the walls of the vagina. It might be done routinely in pregnancy. It tests for the possibility of an overgrowth of normal vaginal yeast and bacteria, and it can also detect certain signs of infections. A wet mount is usually performed in response to a woman’s complaints about itching, vaginal burning, and unusual discharge.
What it tells you. Most commonly, the wet mount is used to determine if there is an overgrowth of yeast in the vagina (a yeast infection) or an overgrowth of bacteria called bacterial vaginosis – which has been associated with an increased risk for preterm labor. The wet mount can also be done throughout the pregnancy if the woman has a history of premature labor.
Urinalysis
What it measures. There are two versions of urinalysis: a sample sent to a lab for analysis, and a “dipstick” version done at the location of the prenatal visit. This second version will be repeated at every prenatal visit. Both tests check for the presence of protein, sugar, ketones, WBCs, RBCs, and nitrites in the urine. The test sent to the lab can also detect the presence of bacteria. When a urinalysis suggests the presence of bacteria, a urine culture will be performed to give information on the specific bacteria, the number of organisms present, and which antibiotics will be the most useful for treatment.
What it tells you. No abnormal urine test is conclusive, and often the presence of small amounts of these elements are normal. Further tests would be needed to diagnose the possible problem. The main reasons urine is tested are: A large amount of protein is one possible symptom of pregnancy-induced hypertension (PIH), which is also known as pre-eclampsia or toxemia; a large amount of sugar might indicate diabetes; ketones in the urine indicate the body is rapidly breaking down fat stores, and high ketone levels are toxic for the mother and the baby; and WBCs, RBCs, nitrites, and bacteria might be signs of a urinary tract infection (UTI) or a kidney infection. UTIs in pregnancy can lead to serious problems, such as kidney infections and premature labor.
The accuracy of the test can easily be affected by contamination, in which other bacteria that were not actually from the woman?s urinary tract get into the sample. In addition, if not refrigerated properly during transport, an abnormally high number of organisms can grow?making it look like there is an infection when there is not (false-positive).The best indication of a true infection is when WBCs, nitrites, and sometimes RBCs are present in conjunction with a high bacterial count.
Second Trimester
Ultrasound
What it measures.Second-trimester ultrasounds are usually done to more accurately estimate gestational age, confirm the number of babies in the womb, determine the location of the placenta, and to scan the baby’s body to look for normal and abnormal anatomy. First-trimester ultrasounds can be done when there are problems with bleeding, possible miscarriage, or to rule out ectopic pregnancies. Third-trimester ultrasounds might be focused on the infant’s growth, size, and quantity of amniotic fluid, position, and fetal well-being. It may also be used to check for cervical length if there is a concern about preterm labor. These ultrasound tests can be done abdominally or through the vagina, depending on what the provider is looking for and the age of the pregnancy. For instance, very early ultrasound is more accurate if it is done through the vagina, as is cervical length.
What it tells you. There is no evidence that ultrasounds should be routinely done in low-risk, healthy pregnancies. Rather, they should be done only when there is an indication. However, 60%-70% of all women have at least one ultrasound during their pregnancies. The American College of Obstetricians and Gynecologists concludes that ultrasounds should be performed for specific indications, including unknown last menstrual period (poor dating), suspected twins, unexpectedly large or small uterus, and unexplained vaginal bleeding. The March of Dimes reports that there are no physical risks for mother or baby that have been found to be directly associated with the ultrasound procedure.
Maternal Serum Genetic Screen (Triple Screen or Triple Marker)
Test done at 16-18 weeks
What it measures. This test uses a blood sample from the mother to screen for possible genetic disorders in the baby. For mothers over 35, these tests will be highly encouraged since the risk of these genetic disorders increases with age. It is called the Triple Screen because it tests for three things:
Maternal alpha-fetoprotein (a substance produced in baby’s liver that can be detected in mother-s blood)
Unconjugated estriol
Human chorionic gonadatropin-two hormones of pregnancy
The values of the three tests are calculated along with the mother’s age to suggest a risk status for such genetic problems as Down’s syndrome, neural tube defects, and Trisomy 18.
A fourth test for dimeric Inhibin-A is being evaluated. This substance should increase the test’s ability to more accurately screen for Down’s syndrome.
What it tells you. This is an optional test. However, if done, it must be performed between weeks 15 and 20 in the pregnancy, and is best when done between weeks 16 and 18. When combined with an accurate due date, it will detect 70% of the babies at risk for Down’s syndrome, 75% of those at risk for neural tube defects, and 60%-80% at risk for Trisomy 18. When the fourth test is added, it is estimated that 75%?80% of the babies at risk for Down’s syndrome will be identified.
However, while it is fairly effective at screening for actual problems, its ability to detect the absence of problems is low. As a screening test for Down?s syndrome, it has been estimated that as many as 80% of abnormal test are false positives (i.e., the test result indicates a problem, but the fetus does not actually have Down’s syndrome).This is due, in part, to the fact that the test is so reliant on accurate gestational dating and maternal age. Other factors such as undiagnosed multiple pregnancies, maternal conditions, and lab errors add to this problem. By the same token, the test will not detect all babies with a genetic defect.
When the test result is positive, further genetic screening tests are offered. Those include high-resolution ultrasound and amniocentesis, which will give more accurate information.
Diabetes Screen, Glucola Screen, Post-Prandial Test
Done at 24-28 weeks
What it measures. During pregnancy, a small number of women (1.5%-2%) will develop difficulty in processing the normal sugars (carbohydrates) in their bloodstreams. This can lead to what is called gestational diabetes mellitus (GDM). If not detected and treated, GDM can cause serious problems for both the mother and the baby.
This test screens for the possible presence of GDM. The basic test is called the one-hour diabetes screen or one-hour glucola test. A sweet drink (glucola) is given to the mother after she has fasted for 12 hours. Then, one hour later, blood is drawn to see if the mother’s system appropriately cleared the sugar from her system. For women considered to have a greater than normal chance of developing GDM (women with a family history, prior problems with GDM, or who are overweight), this test will be administered twice: once at the beginning of the pregnancy, and again closer to 28 weeks.
What it tells you. The test will indicate how your body did in clearing that one dose of sugar. It will not tell you whether you have diabetes. If the blood-sugar level was still high after the one-hour test, a second test called the three-hour screening test will be offered. Done on a different day, this test will check your blood-sugar level before the drink (after fasting), and then once each hour for three hours afterwards. If two of the levels measured are high, you are considered to have GDM. Some women with GDM are able to control their blood sugar with diet changes and exercise, while others might require insulin.
Some professionals feel the combination of the required fasting and the use of the glucola is not the best measure of the body’s response to normal food and might lead to a high number of false-positives. An alternative test called the post-prandial test (meaning “after a meal”) is offered in some areas. In this case, you eat a prescribed diet and a specified breakfast and then have your blood drawn two hours later.
Third Trimester
Group B Strep Test
35-37 weeks
What it measures. Although maternal and infant infections during birth and the postpartum period are rare, they can be very serious. Group B (beta-hemolytic) streptococcus (GBS) is a bacteria that has been identified as being one of the main causes of these rare infections. This organism is normally present in the vagina or rectum in about one of every four women. In nonpregnant woman, GBS rarely causes any problems. During pregnancy and birth, however, the bacteria can possibly cause an infection in the mother’s uterus or in the baby. Out of 100 women who have the bacteria, less than 1% of the infants will actually get an infection from it.
New guidelines from the Centers for Disease Control and Prevention state that all pregnant women receive a test for GBS at 35-37 weeks. This involves swabbing the area around the opening of the vagina and the rectum to screen for the presence of the bacteria. If detected, the mother will be offered antibiotics while in labor.
What it tells you. The effectiveness of the GBS test is dependent upon both the performance of the test and on the processing at the lab. One study found that it was about 70% sensitive (positive test, bacteria present) and 90% specific (negative test, no bacteria present). However, this means that about 30% of women who have the bacteria will test negative. The latest guidelines from the CDC recommend that all pregnant women be tested for GBS and women who are positive be offered antibiotic treatment during labor.
Third Trimester Hemoglobin and Hematocrit (H&H)
28-32 weeks
What it measures. These tests check for anemia in the last part of the pregnancy. Some practices do a regular CBC blood draw, while others use a finger stick hemoglobin test.
What it tells you. It is normal for pregnant women to have a drop in their H&H around 28 weeks in their pregnancies. If the H&H have dropped lower than expected, iron supplementation and possibly more tests before and at the time of labor will be suggested.
Fetal Fibronectin (fFN) Testing
What it measures. Fetal fibronectin (fFN) is a biochemical marker used as a predictor for the risk of preterm delivery. The presence of fetal fibronectin in the cervical or vaginal secretions is highly correlated with preterm labor.
The test involves placing a simple swab briefly at the back of the vagina, behind the cervix. It is then sent to a lab where the sample is checked for the presence or absence of fetal fibronectin.
It is used when a mother may be having, or be at risk for, premature labor. Not a routine test, it may be performed between 24 and 35 weeks when a woman is having regular contractions or her cervix is softening, shortening, or opening too soon in the pregnancy. It may also be used between 22 and 30 weeks as a screening test for women with multiples or premature rupture of membranes, or those with a history of a previous preterm delivery.
What it tells you. Fetal fibronectin testing is new. It is used both for women with symptoms and for women who have risk factors for possible preterm labor or delivery.
If the fFN test is negative it is considered to have a predictive value of 99.2% in women with symptoms. Thus, a negative result reassures both mother and provider that the baby will not be born in the next two weeks. The test’s positive predictive value is significantly less accurate. A positive test is considered to be accurate only about 16.7% of the time in predicting that the baby will be born early (i.e., in the next two weeks).Vaginal bleeding and/or recent intercourse will cause a false positive test.
This test is also often used in conjunction with a special kind of ultrasound called trans-vaginal ultrasound (TVUS), in which a small probe is placed in the vagina to measure the thickness and length of the cervix. The practitioner can do a manual check of the cervix to determine if it is open or closed, and its length in the vagina. The TVUS can actually get a picture of the portion of the cervix one cannot feel on exam. The combination of a negative fFN test and a normal TVUS are very reassuring.
Since the test is only predictive for a two-week time period, someone with continued symptoms or risk factors may have repeat tests at two-week intervals.
