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Available Tests for Pregnant Women (Resources)

By Maria Elena Baca
Minneapolis-St. Paul Star Tribune

The woman on the examining table lay in a darkened room, her eyes fixed on a black-and-white computer monitor at her side. She seemed momentarily oblivious to the technician who ran a sensor over the curve of her belly. A faint smile played on her lips as she watched the shadowy image on the monitor.

The woman, who asked not to be named, was in Dr. Virginia Lupo's examining room last month to make sure that her placenta was in good position for the birth of her baby in a few weeks. That day's test showed that the placenta was low, but would not pose a danger during a vaginal birth. Ultrasound is one of many tests available to pregnant women. Some tests are routine, and their benefits generally go unquestioned. But with others, potential parents might want to discuss whether the benefit outweighs the risk and what they would do with the information the test might reveal.

"Some women want every test; some want nothing," said Lupo, a perinatologist at Hennepin County Medical Center in Minneapolis. "What they do need is for someone to explain to them the risks of all the different stuff so they can make an informed decision."

Here are a few of the available tests:

Chorionic villius sampling (CVS): In a CVS screen, performed in the first trimester, doctors take a sample of the tissue that eventually will become the placenta, using a needle in the mother's abdomen or a catheter through her cervix. Although it can provide early diagnosis of Down syndrome, cystic fibrosis, hemophilia and other genetic problems, the CVS test also carries a 1-in-100 risk of causing miscarriage. Some studies also have suggested a risk of limb deformities. People who have reason to believe that their fetus has a high risk of a genetic problem might opt for this test.
Alpha-feto protein (AFP) screen: AFP, a substance naturally made by the fetus' liver, is secreted into the mother's blood during pregnancy, and can be detected in a maternal blood sample. High levels could indicate neural-tube defects such as spina bifida, a paralysis-causing spinal cord defect, or anencephaly, a condition in which the brain does not develop normally. Low levels can be a sign of Down syndrome or other chromosomal defects. An abnormal result usually is followed up with an ultrasound or possibly amniocentesis.
Amniocentesis: Like the CVS screen, an amniocentesis -- a test of the amniotic fluid -- yields a wealth of genetic information, but carries a risk of miscarriage, generally 1 in 200. It generally is offered to expectant mothers older than 35 who have an elevated risk of carrying a fetus with Down syndrome, and those who have a family history of genetic defects.
Ultrasound: In addition to its use to detect some genetic problems, this sonar-based test may be used to detect a fetal heartbeat -- or no heartbeat -- as early as the sixth week. It also is used to diagnose multiple pregnancies, to check the development of the fetus' limbs and organs and to monitor its growth. Although amniocentesis is the most accurate way to determine the fetus' gender, ultrasound is the most common method. Gender usually is apparent by the 20th week, if the fetus cooperates. Ultrasound gender diagnosis can be tricky, though, so Lupo won't say unless she thinks she's 100 percent sure. "I will buy back the wallpaper if I'm wrong," she said.

Parents also are advised to have a heart-to-heart talk about how the possibility of bad news would affect the rest of the pregnancy.

Janis Keil Day, a certified nurse-midwife at Fairview Riverside Women's Clinic, said that in seven years of practice there, she remembers only a few women who have decided to end a pregnancy after a defect was found; in most of those cases, the fetus either wouldn't live to be born or would die within minutes of birth.

And prenatal screening isn't perfect. An abnormal result usually is followed up by another test. The vast majority of those will be normal, but the wait for conclusive results can be excruciating. At the same time, early diagnosis can make all the difference in a baby's health, Keil Day noted. A fetus with spina bifida, for example, would undergo tremendous trauma during a vaginal birth; early diagnosis would allow the parents and doctors to plan a surgical birth. Surgery sometimes can repair spinal problems before the birth. And an early diagnosis may allow caregivers to better plan which medical teams need to be present at delivery.

Whether the result of testing is finding a problem or reassuring parents that everything is OK, Lupo and Keil Day agree that a woman needs to inform herself and make the call. "I think a woman needs to quietly reflect on her level of concern," Lupo said. "Some women hear they have a 1-in-1,000 chance of Down's and think that's a high rate. Some hear they have a 1-in-50 chance and they think that's a low rate. She has to decide whether to live through the anxiety of knowing or not knowing."

Resources:

Books: The Pregnancy Book" by Dr. William Sears and Martha Sears; Boy or Girl: 50 Fun Ways to Find Out" by Shelly Lavigne; A Child Is Born" by Lennart Nilsson; Oh, Baby, the Places You'll Go: A Book to Be Read in Utero" by Tish Rabe and Dr. Seuss; Expecting Adam: A True Story of Birth, Rebirth and Everyday Magic" by Martha Beck. A book for dads: She's Having a Baby -- and I'm Having a Breakdown" by James Douglas Barron.

RESOURCES :
The Pregnancy Book: Month-by-Month, Everything You Need to Know From America's Baby Experts
Model: 0316779148
Author: William Sears MD and Martha Sears, RN
(1997)