Details of previous pregnancies are relevant when making decisions about the care you receive. Some of the main topics are described below. If there is anything else you think may be important, please tell your doctor.
Para. This is a term which describes how many babies you already have. Usually early pregnancy losses are also listed after a 'plus' sing. For example, the shorthand for two previous births and one miscarriage is '2+1'.
High blood pressure and/or pre-eclampsia. If you had this condition last time, you are more likely to have it again, although it is usually less severe and starts later in pregnancy. It is more likely to happen again if you have a new partner.
Premature birth. This means any birth before 37 weeks but the earlier the baby is born, the more likely that it will have problems and need special or intensive neonatal care. The chance of premature birth is increased because of smoking, infection, ruptured membranes, bleeding, or poor growth. Having had a baby prematurely increases the chances of it happening again.
Small babies (fetal growth restriction ), If one of your previous babies was growth restricted, there is a chance of it happening again. Arrangements will be made to watch this baby's growth more closely, offering ultrasound scans and other tests as necessary.
Big babies (macrosomia ). A baby over 4.5 kg is usually considered big - but this also depends on your size and how many weeks pregnant you were when the baby was born. You may be offered a blood test to check for high blood sugar (diabetes ), which may be linked to having big babies.
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Previous caesarean section. If you have had one caesarean section in the past you have a good chance (at least 2 in 3 ) of having a vaginal birth this time. This is known as VBAC - vaginal birth after caesarean section. Your doctor will discuss with you the reason for your last caesarean and the options for childbirth this time. Labour after a previous caesarean section is monitored more closely, to make sure the old scar does not tear, although in over 99% of cases this does not happen. If you have had two or more caesarean sections in the past, you will usually be advised to have your next baby(ies ) also by caesarean section.More information @ Birth after previous caesarean section And Vaginal Birth after Cesarean Delivery.
Bleeding after birth. Postpartum haemorrhage (PPH ) means a significant loss of blood after birth (usually 500ml or more ). Often this happens when the womb does not contract strongly and quickly enough. There is a chance of it happening again, but your carers will make sure they are prepared.
Postnatal wellbeing. The postnatal period lasts up to 6 weeks after the birth and it is during this time your body recovers. However, for some women problems can occur, including feeding difficulties, slow perineal healing, or concerns with passing urine, wind and/or stools. If you have experienced these or any other complications, talk to your doctor.
Depression. It is quite common to feel low for a little while after having a baby because of hormonal changes and tiredness. However, some mothers do become seriously depressed. This can carry on for months or even years and may require help, counseling and/or medication. Depression can happen again, so it is important that we know about it. We can then discuss any special worries or anxieties you may have and arrange counseling and help to suit your needs.More information @ Postnatal Depression .
Miscarriages. A miscarriage (sometimes also called spontaneous abortion) is usually thought to happen because of a one-off problem with the baby's chromosomes, causing an abnormality. After one miscarriage, the chances of a successful next pregnancy are as good as before. If you have had three or more miscarriages, there is still a good chance that this pregnancy will go well, but special tests may be required.
What if I've had a termination (abortion ) but do not want anyone to know? This information can be kept confidential between yourself,and your doctor and can be recorded elsewhere.
Prenatal Screening and Diagnosis
The first half of pregnancy is a time when various tests are offered to test for potential problems, by blood test and ultrasound scans. The tests listed here are the ones offered in general. Only brief points are mentioned here, but further information can be found on www.screening.nhs.uk and at screening tests for you and your baby nhs
Do not hesitate to ask what each test means. The choice is yours and you should have all relevant information to help you make up your mind, before the visit when the test(s ) are actually done.
Blood Tests and Investigations
Asymptomatic bacteriuria is a bladder infection that has no symptoms. Identifying and treating it can reduce the risk of developing a kidney infection. It can be detected by testing a urine sample (Mid stream urine).
Anaemia is caused by too little haemoglobin (Hb) in the red blood cells. The Hb is usually tested as part of the 'full blood count'. Hb carries oxygen and nutrients around the body and to the baby. Anaemia can make you feel very tired. If you are anaemic, you will be offered iron supplements and advice on diet . More information @ Anemia in Pregnancy And Iron in your diet.
Blood group & antibodies. This test tells us your blood group; whether your blood is Rhesus Positive (Rh +ve) or Negative (Rh -ve); and whether you have any antibodies (foreign blood proteins). If you are Rh-ve, you will be offered blood tests to check for antibodies. If your baby has inherited the Rh+ve gene from the father, antibodies to the baby's blood cells can develop in your blood. To prevent this, you will be advised to have 'anti-D' injections whenever there is a chance of blood cells from the baby spilling into your blood stream (e.g. due to miscarriage, amniocentesis or CVS, vaginal bleeding, a blow to the abdomen, and after the birth of the baby). It is recommended that Anti-D is given routinely to all Rh -ve mothers at 28 and 34 weeks of pregnancy.
Until recently a maternal blood test ( plasma DNA ) can detect fetal Rh ( +ve or -ve )in pregnancy and thereby identify which Rh-ve mother will need 'anti-D' injection. But, this test is expensive. It is available in Hong Kong.
Rubella (German measles ). Rubella infection early in pregnancy can damage your baby. A test is offered to check your immunity (ability to fight infection). Most women are protected by routine rubella vaccinations given in childhood, but if you are not immune, you will be advised to be immunised after the birth. Inform your doctor if you develop a rash.
Hepatitis B is a virus which infects the liver. If you are a carrier of the virus or have become infected during pregnancy, you will be advised to have your baby immunised at birth to avoid infection.
Syphilis is a sexually transmitted disease and can seriously damage your baby if left untreated. If detected, treatment can be offered with antibiotics to control the infection and to help protect your baby.
HIV (Human Immunodeficiency Virus ) affects the body's ability to fight infection. This test is important because any woman can be at risk. It can be passed on to your baby during pregnancy, at birth or through breastfeeding. Treatment given in pregnancy can greatly reduce the risk of infection being passed from mother to child. A negative test does not affect past or future life assurance claims.
Sickle cell and Thalassaemia are blood disorders that can be passed from parent to child. You will be offered a blood test if you are living in an area with high occurrence of the disorder, or if there is an increased chance of you being a carrier without knowing. This is the case if you or your family come from Africa, the Caribbean, India, Pakistan, Bangladesh, South East Asia, China, the Middle East, or Mediterranean countries (e.g. Greece, Italy, Turkey, Cyprus ). The results may require the baby's father to be tested.
Additional tests may be offered as necessary, for example to check for infections which can cause damage to the developing baby, but rarely cause problems for the mother. Inform your doctor if you develop any rashes or if you think you have been in contact with any of the following:
- Chicken pox can cause problems to the developing baby if caught before 20 weeks of pregnancy. It can also be passed to the newborn baby if caught within 10 days prior to the birth.
- Cytomegalovirus (CMV ) prevention involves careful hygiene especially thorough washing of hands.
- Parvovirus (Slapped cheek syndrome ) often causes a red rash on the face and is mostly seen in children.
- Toxoplasmosis is caused by an organism that is found in cat faeces, so always wear gloves when gardening or changing cat litter. Also make sure that all food is washed and thoroughly cooked before it is eaten.
Chlamydia is a sexually transmitted infection which can result in pelvic inflammatory disease and infertility. If you are under 25, you may be offered a simple test, either a vaginal swab or urine test. If positive, antibiotics will be offered to you and your partner.