Blood pressure (BP ) needs to be checked to detect pregnancy induced hypertension or pre-eclampsia. High blood pressure may cause severe headaches or flashing lights. If this happens, tell your doctor immediately or inform the midwife of the maternity unit you have been booked in for delivery.
Urine tests A mid-stream urine sample (MSU ) is collected in early pregnancy to check for infection. You will also be asked to supply a sample of your urine at each visit to check for protein (recorded as + or ++ = presence of ), which may be a sign of pre-eclampsia.
Fetal movements (FM or FMF = fetal movements felt ). You will usually start feeling some movements between 16 and 22 weeks. Later in pregnancy your baby will develop it's own pattern of movements. This will range from kicks and jerks to rolls and ripples. Sometimes your baby will hiccup. You will very quickly get to know the pattern of your baby's movements. At each antenatal contact your doctor will talk to you about this pattern of movements, which you should feel each day. A change, especially a reduction in movements, may be a warning sign that the baby needs checking by ultrasound and Doppler. Become familiar with your baby's typical daily pattern of movements and contact your doctor or maternity unit immediately if you feel that the movements have altered.
Fetal heart (FH or FHHR - fetal heart heard and regular ). If you wish, your doctor can listen to the baby's heart with a Doptone (e.g. Sonicaid ). With a doptone, you can hear the heartbeat yourself.
Liquor refers to the amniotic fluid, the water around the baby. A gentle examination of the abdomen can give an idea of whether the amount is about right (recorded as NAD, no abnormality detected, or just N ), or whether there is suspicion of there being too much or too little, in which case an ultrasound is needed to check.
Assessing Fetal Growth
Accurate assessment of the baby's growth inside the womb is one of the key tasks of good antenatal care. Problems such as growth restriction can develop unexpectedly, and are linked with a significantly increased risk of adverse outcomes, including stillbirth, fetal distress during labour, neonatal problems, or cerebral palsy. Therefore it is essential that the baby's growth is monitored carefully.
Fundal height. Fundal height measurements from 26-28 weeks onwards, taken every 2-3 weeks (preferably by the same doctor ), are best first line of assessment. The measurements are taken with a centimeter tape, from the fundus (top of the uterus ) to the top of the symphysis (pubic bone ). They are marked on the growth chart to form a curve. The slope of the measurement should be similar to the slope of the three curves printed on the chart, which predict the optimal growth of your baby.
Growth restriction. Slow growth is one of the most common problems that can affect the baby in the womb. If the fundal height measurements suggest there is a problem, an ultrasound scan should be arranged and the estimated fetal weight (degree of error 10-15%) plotted on the customised chart to assess whether the baby is small for gestational age. If it does record as small, assessment of Doppler flow is recommended, which indicates how well the placenta is managing the blood supply needed for the baby. If there is a serious problem, your doctor will need to discuss with you the best time to deliver the baby.
Large baby (macrosomia ). Sometimes the growth curve is steep and the growth is larger than expected. A large fundal height measurement is usually no cause for concern, but if the slope of subsequent measurements is too steep, you will need an ultrasound scan to check the baby and the amniotic fluid volume. Big babies may cause problems either before or during birth (obstructed labour, shoulder dystocia etc.). However, most often they are born normally.
Customised Growth Charts. Customised growth charts which are individually adjusted for you and your baby. The information required includes:
- your name, unit number and date of birth (for identification )
- your height and weight in early pregnancy
- your ethnic origin
- number of previous babies, their name, sex, gestation at birth and birthweight
- the expected date of delivery (EDD) which is usually calculated from the 'dating ultrasound'
The chart is usually printed after your pregnancy dates have been determined by ultrasound (preferably ) or by last menstrual period. If neither dates are available, regular ultrasound scans are recommended to check that the baby is growing as expected.
Common pregnancy symptoms. You may experience a number of symptoms during pregnancy. Most of these are normal and will not harm you or your baby, but if they are severe or you are worried about them, speak to your doctor. You may feel some tiredness, sickness, headaches or other mild aches and pains, or have heartburn, constipation or haemorrhoids. There may also be some swelling of your face, hands or ankles or you may develop varicose veins. Changes in mood and sex drive are also common. Sex is safe unless you are advised otherwise by your doctor.
Problems in pregnancy require additional visits for tests and surveillance of you and your baby's well-being. Many conditions will only improve after delivery of the baby, therefore it may be necessary to induce your labour or undertake a planned elective caesarean section. Please discuss any worries with your doctor.
Body mass index. Is a test to see if you are a healthy weight for your height and is calculated by dividing your weight in Kg by height in metres squared. During pregnancy there are increased risks of certain complications if your BMI is less than 18 or more than 35.
High blood pressure. You need to tell your doctor or midwife of the maternity unit you are booked in immediately if you get headaches or spots before your eyes, as these can be signs that your blood pressure has risen sharply. If there is also protein in the urine, you may have pre-eclampsia which in its severe form can cause blood clotting problems and fits. It is often linked to restricted growth and other problems for the baby.
Diabetes may be present before pregnancy, or may only happen during pregnancy (gestational diabetes ). It can show as sugar in the urine, when blood sugar levels become high due to a lack of insulin. High sugar levels cross the placenta and can cause the baby to grow large (macrosomic ). The baby gets used to these high sugar levels and sometimes can have difficulty getting used to managing without them - causing it to have low blood sugar (hypoglycaemia ) after birth. If you have or develop diabetes you will be looked after by a diabetics specialist and the obstetrician will check you and your baby closely throughout the pregnancy. Gestational diabetes usually settles after pregnancy but can happen again in future pregnancies.
Itching. Severe itching, especially on the hands and feet, can be caused by a liver condition known as Obstetric Cholestasis. Cholestasis can affect the baby and may result in stillbirth if not treated. Blood tests can check to see if you have the condiion. If you do, you may require tablets and the baby will require careful monitoring. The timing of delivery should be discussed with you by your doctor according to your individual needs.
Thrombosis (clotting in the blood ). Your body has naturally more clotting factors during pregnancy to stop the bleeding as quickly as possible once the 'afterbirth' is delivered. However this also means that all pregnant women are at a slightly increased risk of developing blood clots during pregnancy and in the first weeks thereafter. The risk is higher if you are over 35, overweight, smoke cigarettes, or have a family history of thrombosis. You are advised to see your doctor immediately if you have pain or swelling in your leg, or pain in your chest, or cough up blood.
Vaginal bleeding. Bleeding may come from anywhere in the birth canal, including the placenta (afterbirth ). Occasionally, there can be an 'abruption', where a part of the placenta separates from the uterus, which puts the baby at great risk. If the placenta is lying low in the uterus, tightenings or contractions may also cause bleeding. Any vaginal blood loss should be reported immediately to your doctor or the midwife or labour ward staff of the hospital you are booked in for delivery. You will be asked to go into hospital for tests, and advised to stay until after the bleeding has stopped or until the baby is born. If you are Rh -ve, you will require an Anti-D injection.
If the waters break. Spontaneous rupture of the membranes (SROM ) is followed by a gush, leak or trickle of amniotic fluid. You are advised to contact the midwife of the maternity unit you are booked in to check whether you are in labour, and to make sure that the baby's cord has not slipped down. If you are not in labour, swabs will be taken to check for infection. Labour often starts within a day of SROM.
Prematurity. Labour may start prematurely (before 37 weeks ), for a variety of reasons. Before about 34 weeks, most maternity units have a policy of trying to stop labour for at least a day or two, whilst giving steroid drug injections (e.g. betamethasone ) to help the baby's lungs to mature. However once labour is well established, it is difficult to stop
Before about 34 weeks pregnancy if your waters break or the labor starts you will be trasferred to a tertiary maternity hospital with Neonatal intensive care facilities
Breech. If the baby's presentation is not head first (cephalic), there is an increased chance that labour will not be straightforward. If your baby is presenting bottom first (breech ) it is now usually recommended to try to turn the baby before labour commences (ECV = external cephalic version ). However, the procedure is not always successful. Your obstetrician will discuss with you the options on how best to deliver a baby that stays in the breech position: delivery by a planned (elective) caesarean section is now often recommended, but the alternative may be to allow labour to start naturally, to watch and see how things go and to intervene only as necessary; as always, the decision is yours.
Lie and Presentation. This describes the way the baby lies in the womb (e.g L = longitudinal; O = oblique, T = transverse ), and which part it presents towards the birth canal (e.g head first or cephalic = C, also called vertex = Vx; bottom first or breech = B or Br ).
Engagement is how deep the presenting part - e.g. the baby's head - is below the brim of the pelvis. It is measured by the proportion which can be still felt through the abdomen, in fifths: 5/5 = free; 4/5 = sitting on the pelvic brim; 3/5 = lower but most is still above the brim; 2/5 = engaged, as most is below the brim; and 1/5 or 0/5 = deeply engaged, as hardly still palpable from above. In first time mothers, engagement tends to happen in the last weeks of pregnancy; in subsequent pregnancies, it may occur later, or not until labour has commenced.
Internals / vaginal examinations are NOT usually done at antenatal visits unless there is a specific reason. Please discuss with your doctor if you have any concerns about this.