The tests that women perform when they learn about pregnancy provide the doctor with important information about the health of the expectant mother and the fetus. Dr. Małgorzata Olesiak-Andryszczak, a specialist in gynecology, obstetrics and perinatology, explains which tests are performed as standard. Is prenatal testing mandatory or is it only recommended by doctors?
- Dr. Małgorzata Olesiak-Andryszczak: Prenatal examinations should be offered by gynecologists to all pregnant women, regardless of the patient’s age. These are the current guidelines
- Women of any age can give birth to a child with a genetic condition. Youth does not guarantee the birth of a healthy child. And it is not that only older patients are at risk of giving birth to a child with a genetic disease
- Patients are more and more aware, which is why they often report to prenatal tests themselves, regardless of whether their gynecologist reminds them about it or not
- More current information can be found on the Onet homepage.
Edyta Brzozowska, Medonet: Your experience shows that patients who come to your office know what tests they must and should perform during pregnancy?
Dr Małgorzata Olesiak-Andryszczak: Women more and more often prepare very carefully for pregnancy and motherhood, therefore they are aware of what tests they are to perform and what care they should be covered. And there is a lot of this research. These include various laboratory tests, ultrasound and CTG.
What does such diagnostics show?
A blood test is important primarily because it can screen for or rule out many different conditions, such as diabetes, thyroid disease, and hepatitis B or C. The blood count is the basic test most often performed during pregnancy. It can indicate, inter alia, whether the patient is not suffering from anemia, whether the number of white blood cells is normal, because an increased number may indicate, for example, inflammation in her body. It allows you to see if your platelet count is normal and thrombocytopenia is a common abnormality during pregnancy.
A general urine test, on the other hand, provides many more information: about the condition of the kidneys, possible urinary tract infection. As standard, blood pressure is measured at each visit and the patient’s weight is assessed. Each doctor also performs a general gynecological examination and ultrasound.
Are I-trimester prenatal tests recommended as standard for all pregnant women?
Until recently, there was a belief that prenatal tests should only be offered to women over 35. I strongly disagree with this and fight a similar stereotype. Prenatal examinations should be offered by gynecologists to all pregnant women, regardless of the patient’s age. These are the current guidelines. This is very important, especially as women can give birth to a child with a genetic disease at any age. Youth does not guarantee the birth of a healthy child. And it is not that only older patients are at risk of giving birth to a child with a genetic disease.
What do these prenatal tests show?
The first such tests, performed between 11 and 13 weeks and 6 days of pregnancy, are very important. They allow to assess the anatomy of the fetus – to the extent that the size of the fetus allows. And although it is tiny at this stage, as it measures 45 to 84 mm in this period, an experienced doctor can already find many abnormalities in the structure of the fetus.
The second element of the study is the risk assessment of genetic diseases. The risk is calculated based on the patient’s age, ultrasound results and the results of biochemical tests (the so-called double test). In ultrasound, several so-called markers of genetic diseases, the most important of which are neck translucency and the presence of the nasal bone.
In a double test, we assess the concentration of two substances: free beta-hCG subunit and PAPP-A protein. They are present in the blood of every pregnant woman, but in cases with a genetic disease in the fetus, the levels of these substances are abnormal.
Calculating the risk of genetic diseases based on the patient’s age, the results of biochemical tests and prenatal ultrasound gives us the greatest sensitivity in the assessment of the probability of genetic diseases. The use of special calculators helps to assess this risk, which may be high, medium or low.
The medical management is also different depending on the value of the calculated risk of genetic diseases in the fetus?
Yes, depending on the final result, further diagnostic tests are proposed. Further medical treatment is based on current medical knowledge.
It follows from all this that women should strongly demand the possibility of prenatal testing.
Definitely. Fortunately, more and more gynecologists refer their patients to such examinations. Therefore, it can be said that long-term education brings results. We also know more and more about genetic diseases and their diagnosis. And women are becoming more and more aware, which is why they often self-report for prenatal examinations, regardless of whether their gynecologist reminds them or not. For me, as a doctor, it is unfortunate that in the case of diagnosis of fetal defects, unfortunately, we do not always have the option of introducing intrauterine treatment. However, there are diseases, the effects of which we can minimize using appropriate methods, including intrauterine therapy.
And what is equally important for the future mother of a sick child – to plan the birth?
Yes, and this is the most important thing in prenatal diagnosis – first of all, planning the place where the birth is to take place, setting the date of termination of pregnancy, and the manner in which it is to be done. All this is of great importance, because proper perinatal procedure will not eliminate the defect, but improve the baby’s prognosis.
And already at the stage of pregnancy, think about specialist care.
Because mother and family will surely need it, both psychological and medical. Identifying a child’s defects is always a huge burden. This is a situation in which one has to face the awareness of the child’s disease, reporting such a pregnancy is always different than when there are no complications. So how we, the doctors, manage this pregnancy, how we prepare the family for the birth of a sick child, depends on how the mother and her family will function in the future.
A graduate of the Medical Academy (today the Medical University) in Wrocław. For 20 years he has been dealing with the issues of diagnostics and therapy of the fetus, pathological pregnancy, prenatal examinations and obstetric ultrasound.
She works at the Gynecology and Obstetrics Department of the Provincial Specialist Hospital in Wrocław, where she runs a pregnancy pathology department. She is also the medical director of the Sonokard-Wrocław Medical Center.
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