All about pregnancy signs and symptoms of pregnancy pregnancy tests home pregnancy test pregnancy stages first trimester of pregnancy second trimester of pregnancy third trimester of pregnancy calculating pregnancy due date prenatal diagnosis healthy pregnancy diet nutrition during pregnancy exercise during pregnancy spotting during pregnancy bleeding during pregnancy smoking during pregnancy sex during pregnancy prenatal care teenage pregnancy twins and multiple births childbirth obstetrics pregnancy ultrasound Chinese lunar pregnancy calendar (Chinese gender chart) fertility charting ovulation: calendar, prediction, test getting pregnant gender selection prenatal tests genetic screening genetic counseling birth control (contraception, pregnancy prevention) male condoms female condoms diaphragm cervical cap birth control pills Norplant Depo Provera spermicides emergency contraceptive pill (morning-after pill) natural family planning intrauterine device (IUD) birth control patch sterilization (vasectomy) fertility awareness method (FAM) abstinence pre-eclampsia, eclampsia HELLP syndrome intrauterine growth restriction (IUGR) premature birth stillbirth Caesarean section preterm labor Rh incompatibility (erythroblastosis fetalis) ectopic pregnancy pregnancy diabetes (gestational diabetes) group B strep morning sickness (NVP) hyperemesis gravidarum miscarriage (spontaneous abortion) postpartum hemorrhage pregnancy-induced hypertension Pica
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Prenatal tests are one of the many ways your practitioner can check on the well-being of your growing baby and find out whether you're at risk for complications. More often than not, the tests will reassure you that all is well. Diagnostic genetic tests use fetal tissue to examine the unborn child's genetic makeup. Some of these tests examine the fetus'
chromosomes, others use biochemical or DNA tests. There are many of these tests now available. They are accurate and identify many but not all genetic birth defects. Unfortunately there are still some genetic disorders for which there is no good prenatal test. These tests are indicated in women at increased risk of having a child with a specific genetic birth defect.
New techniques allow acquisition of reliable specimens with little risk of injuring the fetus or mother. After the tissue cells are obtained they are grown in the lab and stimulated to divide with chemicals. The chromosomes of dividing cells are isolated, stained, and examined. The interpretation of these tests can occasionally be difficult. If you need genetics testing you should have it performed by physicians and laboratories that have considerable experience with the available techniques.
Prenatal diagnosis can detect threats to the health of the mother or fetus early. Physicians can therefore be prepared if the threats materialize. In rare cases, surgeons can operate on the fetus before birth to correct problems. Occasionally, prenatal testing will disclose a very severe problem with the fetus. This could be a visible physical problem or an invisible genetic problem. In such cases, parents face the difficult decision of whether to continue the pregnancy or not.
The definition of "very severe problem" in the preceding paragraph is an ethical and societal one, not a medical one. For some people, no problem will be so severe that they would terminate a pregnancy. For others, no doubt, the wrong sex or the wrong eye color would be enough. These issues are discussed in a separate article: Ethics.
What prenatal testing should a mother and baby have? Most physicians have a usual set of tests they order. But what are the unusual conditions? When is a closer examination wise? Your physician should always be your guide in matters of choosing or not choosing tests. When genetic disorders are being considered, however, your physician may refer you to a genetic counselor. In many cases, speaking to a genetic counselor is wise before becoming pregnant.
Genetic counselors work with physicians to offer information on the medical consequences of genetic disorders, the probability of developing a disorder or of passing it to offspring, and ways in which the disorder can be prevented or treated. Counselors provide literature for patient education, make patients aware of support groups and community resources for particular disorders, and offer ways to cope with the consequences of genetic disorders. They also can explain inheritance patterns, recurrence risk, prenatal diagnosis, and medical consequences of various disorders.
Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether it has a certain hereditary or spontaneous genetic disorder. The most common tests used to detect abnormalities in a fetus include ultrasonography, chorionic villus sampling, amniocentesis, and percutaneous umbilical blood sampling. Most of these tests are offered primarily to couples with an increased risk of having a baby with a genetic abnormality (particularly neural tube defects) or a chromosomal abnormality (particularly when the woman is aged 35 or older). In the United States, ultrasonography is often performed as part of routine prenatal care.
Babies normally float in a sea of amniotic fluid within the uterus. This fluid contains living fetal cells that have been released from the baby's skin and other tissues. Withdrawing fetal cell-containing amniotic fluid provides genetic material for examining fetal chromosomes. Other genetic and biochemical testing is also possible. For example, measurement of acetylcholinesterase and amniotic fluid alpha-fetoprotein can also be performed on amniotic fluid. These two tests assist in prenatally diagnosing spina bifida and some other birth defects. This procedure is usually performed at 15-17 weeks gestation. Results generally return in 7-14 days. There are risks to the procedure. Fetal loss is the worst risk. Your risk of fetal loss is increased by about 0.5% (5 out of 1000) of procedures when performed at 15-17 weeks of pregnancy. In general, amniocentesis is a safe procedure that yields accurate information. There are advantages to knowing the fetus' genetic test results earlier in pregnancy than 16-18 weeks gestation. However, there are also increased risks when performing the procedure before 14 weeks.
Chorionic Villus Sampling (CVS)
Another way of obtaining fetal tissue is to take a small amount of the placental tissue from within the uterus. Placental tissue should have the same genetic composition as the fetus. A needle is inserted into the placental attachment to the uterus and a small amount of tissue is removed and sent for analysis. The placenta can be approached either through the cervix or through the mother's abdominal wall.
This procedure can be performed at 10-12 weeks, much earlier than routine amniocentesis. The results are available in about 5-10 days, sooner than with routine amniocentesis. The specimens obtained from this procedure can be contaminated with maternal tissue about 1% of the time (compared to about 0.2% in amniocentesis). This can confuse interpretation of the genetic tests. There are also rare circumstances when the abnormalities seen in the placenta may not be present in the fetus. Not only do you need a experienced professional performing the test, you also need one who can accurately interpret the test results.
Having CVS increases the risk of fetal loss by about 1.2% over your risk without the procedure. Your actual risk is dependent on the skill of the person doing the procedure and your specific condition. There have been concerns about the procedure itself causing malformations of the legs and arms. This risk seems to be about 0.03% and is probably greater the earlier the procedure is performed.
Percutaneous Umbilical Cord Blood Sampling (PUBS)
The PUBS procedure takes fetal blood directly from the umbilical cord to obtain the fetal cells or plasma needed for DNA, chromosomal, or biochemical testing. This test is used only in certain circumstances and is usually used only when amniocentesis or chorionic villus sampling would not be adequate. It provides the most accurate information and the most rapid results. A needle is inserted through the mother's abdominal wall, into the amniotic cavity and into the fetal umbilical cord. The PUBS procedure increases your risk of fetal loss by about 2%. The procedure requires considerable skill and should be done only at referral centers.
Technology is now available to identify many genetic disorders in your fetus before delivery. Most of these tests examine only for a single disorder or group of disorders; your doctor must know which disorder she suspects in order to obtain the appropriate test. The most important consideration is how the information will be used. For some couples, genetic testing helps your doctor manage your pregnancy and delivery. It may also decrease your anxiety. You should know why your doctor recommends the testing and how it may influence your pregnancy, delivery, and newborn baby. Genetic counseling is available to help you in this process.
Concerns about genetics do not end when the baby is born. Every newborn in the United States is checked for two genetic disorders: phenylketonuria and hypothyroidism. When these disorders are diagnosed at birth, they can be treated and mental retardation avoided. Several states require screening for two to four additional disorders, such as cystic fibrosis and maple syrup urine disease. Some children need to be evaluated by a geneticist. These are children born with an obvious birth defect or genetic disorder, or children who do not develop normally.
Clinical geneticists are physicians skilled in the diagnosis, management, treatment, and counseling of persons and families affected by genetic disorders. Their examination usually involves a detailed medical history, a family history and pedigree, and a thorough physical exam of the patient and often other family members. Sometimes chromosome, DNA, or biochemical studies are required. These usually involve samples of blood and possibly a tissue biopsy.
More information on pregnancy
Pregnancy - Pregnancy is period of time between fertilization of the ovum (conception) and birth, during which mammals carry their developing young in the uterus (see embryo).
Pregnancy signs and symptoms - During pregnancy a woman's body undergoes a number of changes to allow the fetus to develop inside the womb. The symptoms of pregnancy vary from woman to woman.
Pregnancy tests - A pregnancy test is a test of blood or urine used to determine whether a woman is pregnant. There are two types of pregnancy tests - blood and urine tests.
Home pregnancy test - A home pregnancy test measures the presence of the hormone human chorionic gonadotropin (hCG) in your urine. All home pregnancy test kits test your pregnancy on the basis of your urine sample.
Pregnancy stages - There are three stages of pregnancy called trimesters. Each trimester is three months. The word "trimester" comes from a Latin word meaning "three months long."
First trimester of pregnancy - First trimester pregnancy is the early stage of pregnancy from conception to 12 weeks gestation, or about 14 weeks from the first day of the last normal menstrual period (LNMP).
Second trimester of pregnancy - In the second trimester the embryo, now known as a fetus, is recognisable as human in form, but is not developed enough to be viable if born. The second trimester is often called the planning trimester.
Third trimester of pregnancy - The third trimester of pregnancy lasts from 28 weeks after your last menstrual period (LMP) until the birth, which usually occurs between the 38th and 42nd weeks of pregnancy.
Calculating pregnancy due date - The due date is usually computed from the first day of the last regular period. In the calendar, this can be figured by taking that date, subtracting three months, and adding seven days.
Prenatal diagnosis - Prenatal diagnosis is the process of detecting and diagnosing fetal abnormalities before birth. A targeted prenatal diagnosis is done when there is a concrete suspicion that there might be a particular disorder.
Healthy pregnancy diet - A balanced diet is key to having a healthy pregnancy. Pregnancy places substantial demands on the availability of iron in the body.
Nutrition during pregnancy - Nutrition is an essential component of prenatal care. During pregnancy, your body needs more nutrients in order to provide a baby with what it needs. Eat enough food to gain weight at the rate recommended by your health care provider.
Exercise during pregnancy - Exercise plays an important role in promoting health and well-being for pregnant women. Excessive levels of physical activity in pregnancy can reduce fetal growth and increase the risk of preterm delivery.
Spotting during pregnancy - Spotting is light bleeding similar to your period and it can happen at any time during pregnancy, but it is most common during the first trimester.
Bleeding during pregnancy - Bleeding from the vagina in early pregnancy is very common. First trimester bleeding is any vaginal bleeding during the first 3 months of pregnancy.
Smoking during pregnancy - Cigarette smoking during pregnancy can cause serious health problems to an unborn child. Many complications of pregnancy are more likely to occur in smokers.
Sex during pregnancy - Sex and sexual intercourse are not harmful during pregnancy. For most women and their partners, sex during pregnancy is fine as long as both partners consent and are comfortable.
Prenatal care - Prenatal care is the health care that a woman receives before her baby is born. Prenatal care is provided for women during the period between conception and birth of the baby.
Teenage pregnancy - Teenage pregnancy is a pregnancy that occurs in an adolescent. Babies born to teenagers are at risk for neglect and abuse.
Twins and multiple birth - Multiple pregnancies are on the rise in recent years with more and more twins and other types of multiples being born. A multiple birth is when more than one human baby results from a single pregnancy.
Childbirth - Childbirth (also called labour, birth, or parturition) is the culmination of pregnancy, the emergence of a child from its mother's uterus.
Obstetrics - Obstetrics is the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium (the period shortly after birth).
Pregnancy ultrasound - Pregnancy ultrasound is a method of imaging the fetus and the female pelvic organs during pregnancy.
Chinese lunar pregnancy calendar - The Chinese pregnancy calendar was allegedly discovered about 700 years ago. The accuracy of the chart has been proved by thousands of people and is believed to be 99 percent accurate.
Fertility charting - Fertility charting allows you to predict ovulation, pinpoint your most fertile time in your cycle, and increase your chances of becoming pregnant.
Ovulation: calendar, prediction, test - Ovulation is the process of discharging a mature ovum (egg) from an ovary after a Graafian follicle - representing the final stage of follicular development before ovulation - has been formed.
Getting pregnant - The best or most fertile time to get pregnant is the period of ovulation in your menstrual cycle. Most women ovulate (release an egg from the ovary) about two weeks before their period.
Gender selection - There are three main techniques of sex selection: pre-natal testing and termination of pregnancy, pre-implantation genetic testing of embryos, and sperm sorting.
Prenatal tests - Prenatal tests are one of the many ways your practitioner can check on the well-being of your growing baby and find out whether you're at risk for complications.
Genetic screening - Genetic screening is a process used to find out what diseases or birth defects a child might inherit from his or her parents.
Genetic counseling - Genetic counseling is the process of determining the risk you have of passing on an inheritable disease to your baby.
Birth control (contraception, pregnancy prevention) - Birth control is the practice of preventing or reducing the probability of pregnancy without abstaining from sexual intercourse; the term is also sometimes used to include abortion.
Male condoms - Condoms are thin barriers made of latex, plastic, or natural membranes. The male condom fits over a man's penis. The female condom fits inside a woman's vagina.
Female condoms - The female condom is a polyurethane sheath or pouch about 17 cm (6.5 inches) in length. It is worn by a woman during sex.
Diaphragm - A diaphragm is a rubber disc a woman places into her vagina. The diaphragm blocks a man's semen from entering the cervix (the opening to the womb).
Cervical cap - The cervical cap is a small latex cup that a woman inserts into her vagina before sexual intercourse. The cervical cap fits snugly over the woman's cervix.
Birth control pills - The birth control pill is a small, usually white, tablet that is taken orally (by mouth). The pill usually comes in a packet that has days marked off for a cycle lasting about a month.
Norplant - Contraceptive implants (Norplant?) are six match stick size implants inserted into the upper arm. Norplant is a form of progestin that is placed under the skin.
Depo Provera - Depo Provera is a hormone, much like the progesterone a woman produces during the last two weeks of each monthly cycle. Depo-Provera or progesterone stops the woman's ovaries from releasing an egg.
Spermicides - Spermicides are chemicals that make the sperm unable to function. Spermicide can be used alone or with other birth control methods to reduce the risk of pregnancy.
Emergency contraceptive pill - Emergency contraception is the use of certain methods after unprotected intercourse to prevent pregnancy.
Natural family planning - Natural family planning is defined as the understanding and use of the natural phases of fertility and infertility by a couple in order to either achieve or avoid pregnancy.
Intrauterine device (IUD) - An intrauterine device (intra meaning within, and uterine meaning of the uterus), is a birth control device also known as an IUD or a coil.
Birth control patch - The birth control patch is a thin plastic patch (1 3/4 inch square) placed directly on the skin of the woman. It is a hormonal method of contraception obtained by prescription.
Sterilization (vasectomy) - Sterilization is a surgical technique leaving a male or female unable to procreate. It is a method of birth control.
Fertility awareness method (FAM) - Fertility awareness is a means of understanding a woman's reproductive cycle by observing and writing down fertility signs.
Abstinence - Periodic abstinence is a way that sexually active women prevent pregnancy by becoming familiar with their fertility patterns and abstaining from vaginal intercourse on the days they think they could become pregnant.
Pre-eclampsia, eclampsia - Pre-eclampsia is a condition which only occurs during pregnancy. It causes high blood pressure, protein leaks from the kidneys, and other symptoms may develop.
HELLP Syndrome - The HELLP syndrome is a complication of pregnancy featuring a combination of abnormal conditions including emolysis, elevated liver enzymes, and low platelet count.
Intrauterine growth restriction - Intrauterine growth restriction (IUGR) refers to the condition in which a foetus is unable to grow to its genetically determined potential size to a degree that may affect the health of the foetus.
Premature birth - Premature birth is defined medically as a birth occurring earlier than 37 weeks. Infants born prematurely have an increased risk of death in the first year of life.
Stillbirth - Stillbirth refers to the death of a baby after 24 weeks of pregnancy but before birth. A pregnancy that ends before the twentieth week is called a miscarriage rather than a stillbirth.
Caesarean section - A Caesarean section (Cesarean section AE), is a surgical procedure to deliver one or more babies through an incision in the mother's abdomen and uterus.
Preterm labor - Preterm labor, or premature labor, is when the uterus (womb) contracts and the cervix opens earlier than normal.
Rh incompatibility - Rh incompatibility is a condition that occurs when the mother of a fetus or newborn has Rh-negative blood type and the fetus or newborn has Rh-positive blood.
Ectopic pregnancy - An ectopic pregnancy is one in which the fertilized ovum is implanted in any tissue other than the uterine wall.
Pregnancy diabetes (gestational diabetes) - Gestational diabetes is a condition in which the glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes.
Group B strep - Group B streptococcus (group B strep) is a type of bacteria that causes infection among newborns, pregnant women or women after childbirth.
Morning sickness (NVP) - Morning sickness, also called nausea and vomiting of pregnancy (NVP), affects between 50 and 85 percent of all pregnant women.
Hyperemesis gravidarum - Hyperemesis gravidarum means excessive vomiting during pregnancy. The severe vomiting associated with hyperemesis gravidarum requires medical attention.
Miscarriage (spontaneous abortion) - Miscarriage is the term used for a pregnancy that ends on it's own, within the first 20 weeks of gestation.
Postpartum hemorrhage - Postpartum bleeding (severe postpartum bleeding) is the loss of more than a pint of blood within the first 24 hours after delivering a baby.
Pregnancy-induced hypertension - Pregnancy-induced hypertension (also referred to as toxemia, preeclampsia and eclampsia) is a condition that may develop during the second half of a woman's pregnancy.
Pica - Pica is a pattern of eating non-nutritive substances (such as dirt or paper), lasting for at least one month.