Signs of Pregnancy:

About one week would have passed since fertilization by the time your developing embryo called a blastocyst, soon to be your baby, would have traveled through the fallopian tube and implanted itself inside the lining of your womb.

It’s at this time that you may experience spotting, a very small amount of mentrual flow or yellowish vaginal discharge. Some women often mistake this as the beginning of the next normal menstrual period.

1. Spotting: a small amount of menstrual flow or yellowish vaginal discharge is in fact one of the first signs of pregnancy and this bleeding is caused by the implantation of the blastocyst into the lining of your womb, also referred to as implantation bleeding.
2. Tender Breasts: Other symptoms of pregnancy are tender breasts or a tingling feeling within them.
3. Urinate Frequently: You may need to bathroom a little more than usual.
4. Fatigue: You may be feeling more tired than usual.
5. Change in Taste: Experiencing changes in taste, for example you may suddenly be turned off your morning cup of coffee.
6. Nauseous: You may feel sick or nauseous, especially in the mornings.
7. Change in Mood: You may feel down or just plain moody.
8. Missed Period: Last but not least a missed period may be a sign that you are pregnant.

The first day after a missed period is a good time to take your first pregnancy test. These tests measure the amount of human chorionic gonadotropin known as HCG in your urine and is produced by the placenta even thought it is quite small at this early stage it is already producing hormones.

The blood tests that are offered during pregnancy are performed for many reasons. Some to see whether you are low in iron, have diabetes and other reasons but the serum screening blood test, done around 15 to 18 weeks is specifically performed to screen for Mom’s that may be at risk of carrying a baby with a problem.

Prenatal serum screening blood tests can measure between two, three or four substances within the Mother’s blood to predict whether your baby is at risk for Down’s syndrome or a neural tube defect such as spina bifida. These tests are commonly carried out between 15 to 18 weeks.

It is very important to remember what a screening test is before have one performed which will also help alleviate some of the anxiety that can accompany test results. These tests, called screening tests are just that…a screening, and not a definite diagnosis. These tests try to identify those babies that may be at a higher risk for an abnormality but this does NOT diagnose a problem. The test only gives us an indication or risk level and determine a need for further investigation or not.  It is important to discuss the risks and benefits of testing at length with your doctor before pursuing any screening. You may not want to pursue any further investigations and this is important to establish. Whatever decision you feel most comfortable with is the right one, but it is always good to speak with your doctor.

There Are Three Different Serum Screen Blood Tests:

Some facilities may only offer one of the following tests.

1. The double test measures the level of two substances in the Mother’s blood, alpha-fetoprotein and free beta-HCG.

2. The triple test measures the level of three substances in the Mother’s blood, alpha-fetoprotein, free beta-HCG, and oestriol.

3. The quadruple test measures the level of four substances in the Mother’s blood, alpha-fetoprotein, free beta-HCG, oestriol and inhibin A. In my opinion, the quad screen in place of the double or triple test increases the likelihood of identifying pregnancies at risk for Down Syndrome and also lowers the false positive rate.

• Alpha-fetoprotein is a protein that is produced by the fetus
• Free beta-HCG (beta-human chorionic gonadotropin) is a hormone produced within the placenta
• Oestriol is an estrogen produced by both the fetus and the placenta
• Inhibin A is a protein produced by the placenta and the ovaries

Not every women or couple choose to have the serum blood screening done. But, the quad serum screen may be recommended for women who:

• Have used certain harmful medications or drugs during early pregnancy
• Are 35 years or older
• Have a family history of birth defects
• Have had a viral sickness during pregnancy such as toxoplasmosis, rubella, cytomegalovirus
• Are diabetic and are on insulin

These substances (Alpha-fetoprotein, Free beta-HCG, Oestriol, Inhibin A) that are carried in the Mother’s blood give an indication of a possible risk that Mother is carrying a fetus with an abnormality but one must remember that if one of these tests is positive it does not mean that your baby has an abnormality just that there is a higher risk of one.

What does the quad screen test check ?

The quad blood screen measures high or low levels of alpha-fetoprotein , abnormal levels of hCG and oestriol, and high levels of Inhibin-A. These results are combined with the mother’s age and ethnicity in order to assess probabilities of any potential genetic disorders. These results are to be interpreted by your doctor.

High levels of alpha-fetoprotein may suggest that the developing baby has a neural tube defect such as spina bifida or anencephaly (an-en-sef-uh-lee), which is a baby that is developing without the top of the head.

Low levels of alpha-fetoprotein  and abnormal levels of hCG and estriol may indicate that the developing baby has Trisomy 21(Down syndrome), Trisomy 18 (Edwards Syndrome) or another type of chromosome abnormality.

I want to emphasize that the most common reason for elevated alpha-fetoprotein levels is due to inaccurate dating of the pregnancy. This means that while you may have thought you were 15 weeks pregnant you may actually be 17 weeks pregnant, which explains the adjusted level of alpha-fetoprotein levels in your blood.

How Are The Tests Performed?

These tests are carried out by taking a sample of Mother’s blood, which only takes a few minutes. The blood is then sent to a special laboratory to be analyzed. It may take several days to receive the results.

The blood results are not the only element of this screening process that determine your risk factor. Ethnic background, age of the Mother,  gestational age of the baby and the levels of these substances togeather are entered into a computer algorithm to calculate your individual risk.

Except for the discomfort of drawing blood, there are no known risks or side effects associated with the quad screen test.

What do results mean?

It is important to remember that the quad screen is a screening test and not a diagnostic test. This test only notes that a mother is at risk of carrying a baby with a genetic disorder. Many women who experience an abnormal test result go on to deliver healthy babies.

Abnormal test results warrant additional testing in order to make a diagnosis. A more conservative approach involves performing a second quad screen followed by a high definition ultrasound. If the testing still maintains abnormal results, a more invasive procedure such as amniocentesis may be performed.

Any invasive procedure should be discussed thoroughly with your partner, your doctor and you may require additional counselling and discussions with a counsellor or social worker.

What are the reasons for further testing?

Reasons to pursue further testing vary from person to person and couple to couple. Further testing can confirm a diagnosis and then offer information and opportunities to:

Some individuals or couples may decide not to do any further testing for personal, religious or moral reasons and still other parents opt for no further invasive testing because of the potential risk of losing the pregnancy. It is important to discuss the risks and benefits of testing thoroughly with doctor as these decisions are important and your doctor can help you evaluate what tests are right for you and the benefits versus the risks.

About Your Placenta:

The placenta is truly an amazing organ. The word placenta is Latin for cake as this structure is round and flat and is attached to the inside of the womb. This organ is a single structure, one side facing the baby, the fetal portion of the placenta and the other side facing the mother, attached to the womb forming the maternal portion of the placenta.

Diffusion:

By a process known as diffusion, nutrients and oxygen are moved from the mother to the baby through the placenta. Waste products and carbon dioxide (deoxygenated blood) are taken from baby and returned back to the mother to be eliminated. Although the mother and the baby’s blood come very close together during this exchange, the blood never actually mixes.

Cell Division & Endometrium Development:

About a day after conception, the fertilized egg divides for the first time. This cell division continues on its way down the fallopian tube. After four or five days this newly fertilized egg, now known as a blastocyst has multiplied and divided into two sets of different cells. The outer set of cells develops into the baby’s part of the placenta and the inner set develops into the embryo, which will become your baby.

At the same time the mother’s endometrium or lining of the womb is undergoing it’s own changes and will become the mothers side of the placenta.

The endometrium increases in thickness and creates a flow path to increase maternal blood flow to where the placenta is attached to the lining of the womb. Spaces within this newly formed placenta are called intervillous spaces and provide channels where the transfer of oxygen and nutrients occur between mother and baby.

The Umbilical Cord

On the baby’s side of the placenta is where the umbilical cord enters this cake like structure called the placenta the other end of the cord enters into the baby’s mid abdomen, the place where we all find our belly button. This umbilical cord contains 3 vessels. One vein and two arteries. Oxygenated blood from the mother passes through the placenta and is carried to the fetus via the single vein, you can see this demonstrated in blue on the colour doppler ultrasound.

The baby’s deoxygenated blood passes via two umbilical arteries back to the placenta which is shown in red. You may notice during your ultrasound scan that the sonongrapher will make sure that the umbilical cord has 3 vessels. At the junction of umbilical cord and placenta, the umbilical arteries branch radially to form chorionic arteries. Chorionic arteries, in turn, branch again and these vessels eventually branch to form an extensive arteriocapillary venous system, bringing the fetal blood extremely close to the maternal blood; close enough for an exchange of nutrients by diffusion but no intermingling of fetal and maternal blood occurs. The exchange of nutrients happens through a series of pressure changes caused by arterial blood pressure and uterine contractions.

The placenta continues to grow throughout pregnancy. A well defined placenta can be seen on an ultrasound by 10 to 12 weeks. A normal placenta can grow to about 15 to 20cm in diameter.

The Placenta Organ:

Because the placenta is primarily a fetal organ, its size is often a reflection of the health and size of the baby. Throughout the pregnancy the placenta will grow continuously and it’s thickness is usually equal to the number of weeks of gestation, about 1mm for each week of the pregnancy. So for example if your baby is 15 weeks in gestation the placenta will be about 15mm in thickness.

Placenta Summary:

So in summary the placenta protects the baby, brings into close relationship two blood circulations that of the Mother and that of the baby to support fetal nutrition. Also near the time of delivery produces hormones that help mature baby’s organs in preparation for life outside the womb.

We receive a lot of questions in regards to swollen tummies. During pregnancy, hormones play havoc with your gastrointestinal tract. Under the influence of these hormones, mainly progesterone, smooth muscle within your body relaxes and unfortunately that includes the lining of our intestines, which causes your digestive system to slow down. Unlike the muscles of your arms and legs this type of muscle motion is involuntary so it’s not under your control.

The good news is that this slowing down of digestion allows increased nutrient absorption into your bloodstream therefore allowing increased nutrition to reach your baby. Although these hormones are important for baby’s health the bad news is that this slowing down of digestion can cause bloating and flatulence for you.

To minimize the amount of gas and bloating you experience you may want to keep your bowels moving. Constipation can be a common cause of these symptoms. To avoid this, drink plenty of fluids, eat a variety of foods high in fibre and partake in physical activity on a regular basis.

In addition we suggest you eat slowly so that you are not swallowing air. Eat small frequent meals so that you don’t overload your digestive system. It’s a good idea also to avoid gas-producing foods such as cabbage, cauliflower, garlic, broccoli, onions, fried foods, beans and carbonated beverages to name a few.

Everyone is different and so you may have to experiment a little to find out what foods you can tolerate well.

Give your stomach time to empty before lying down as this can cause heartburn and reflux.

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