First trimester

At 8 weeks

(or after we see a good heart beat on an ultrasound) we will do the following routine blood work:

• Your blood type (such as O positive or A negative). If your blood type is Rh negative (O negative, A negative or B negative) we will need to know the blood type of the baby's father. If he doesn't know his blood type, we will draw blood from him at one of your next visits. This is important to help prevent a disease that can affect your future pregnancies if your blood type is Rh negative and your partner is Rh positive. If you are Rh negative a doctor will discuss this with you in more detail.
• A complete blood count is done to rule out anemia and platelet problems that could contribute to bleeding problems.
• Screening for some common STDs (Gonorrhea, Chlamydia, syphilis, hepatitis B, HIV). This is very important information because we can prevent spreading these diseases from the mom to the baby. The pediatricians will want to know this information before they take care of the baby. These tests are required by law. We recommend that you agree to this testing because the hospital will have to test and treat the baby if we do not have these test results on your chart (at least once during the pregnancy).
• Rubella antibodies. You were immunized against rubella (German Measles) as a child. We do this test to see if you still have that immunity. If you do not, you will get another rubella vaccine after delivery and before leaving the hospital. This is to prevent a rubella infection during any subsequent pregnancies.
• Urine culture. We look for an asymptomatic urinary tract infections in all pregnant women because you are more likely to have a bladder infection or kidney infection while you are pregnant. If it is a severe infection it can lead to preterm labor. If we find a certain bacteria in your urine (Group B Strep) we will also need to give you an antibiotic in labor. (See GBS testing later on this list.)
• Cystic Fibrosis is an optional test. A doctor should have discussed this with you at one of your previous visits (either an annual exam, preconception visit or visit #1 on this timeline) and you should have received a pamphlet on Cystic Fibrosis. If you have not had this discussion or received this pamphlet, please let one of the office staff know and we will explain this in more detail. We do not recommend this test for everyone but we want you to know what it is and that it is available so that you can decide for yourself if you want to have it done. This is an expensive, once-in-a life time test so please do not consent to having the test done if you may have had it previously. We can attempt to get old records if you may have had it done previously.
• Hemoglobin electrophoresis. If you are African American, Asian or from a strong Mediterranean background we will do this blood test to determine if you are likely to have a baby with a genetic anemia such as Sickle Cell Disease or Thalassemia.

At 11 weeks

We strongly recommend you have some type of genetic screening for Down's Syndrome and Trisomy 18 (as well as other less common genetic conditions). If you are older (relative term now but traditionally greater than 35 years old), have a family history of this condition, or feel strongly about having a child with a chromosome problem, you may consider having genetic counseling with a CVS (or later amniocentesis) at the hospital. We should schedule this for you after your 8 week ultrasound. Your doctor should have already discussed this with you and given you a handout on CVS and amniocentesis. If this has not happened and you would like to know more information please let someone in our office know and we will make sure your questions are answered. For most patients who aren't going to have the CVS or amniocentesis, the "first trimester screening" will be performed between 11 and 14 weeks. This test consists of an ultrasound which measures the thickness of the skin fold behind the babies neck. This is a technically difficult ultrasound and we currently send you to the high risk doctor to have this done. We hope that this service will be provided in our office in the future. At this visit you will also have blood drawn. The results of the blood tests and the ultrasound will then be used to calculate your risk for having a child with a chromosome problem. If the risk is then elevated you can consider having a CVS or amniocentesis for definitive diagnosis. This test has been available for a relatively short while and we cannot guarantee insurance coverage. Because of this we have a handout you can use to call your insurance company and inquire on your benefits.