critical screening tests during pregnancy?

My medical provider is an HMO, and recently they had a major flood occur at
my clinic when a large pipe ruptured. Ever since then, I have had to be
seen in whichever clinic they had available, all over the Portland metro
area.

Because of this I feel very lost in the shuffle. I am 26 weeks pregnant,
and need to know which screening tests are really important, and when they
normally occur, so I can make sure it happens. I know they normally do the
glucose test sometime around now, but no one has mentioned it, perhaps
because I see a different doc every time I go in.

Thanks,
Betsy

oregonchick wrote:
My medical provider is an HMO, and recently they had a major flood occur at
my clinic when a large pipe ruptured. Ever since then, I have had to be
seen in whichever clinic they had available, all over the Portland metro
area.

Because of this I feel very lost in the shuffle. I am 26 weeks pregnant,
and need to know which screening tests are really important, and when they
normally occur, so I can make sure it happens. I know they normally do the
glucose test sometime around now, but no one has mentioned it, perhaps
because I see a different doc every time I go in.

Well, there are few things that are absolutely essential, depending
on your point of view. For myself:

Pregnancy 1:
- regular prenatals (weight, fundal height, palp, urine, fetal heart
rate, BP)
- standard obstetric blood panel
- some additional blood tests after BP went up to check for any symptoms
of pre-eclampsia

Pregnancy 2:
- regular prenatals
- standard obstetric blood panel

Pregnancy 3:
- regular prenatals
- standard obstetric blood panel
- routine prophylactic anti-D
- ultrasound for suspected breech at 37 weeks, followed by ECV and
associated u/s, indirect Coombs blood test, and anti-D.

That's all I had, and all I wanted. Personally, I did not feel that
additional screening tests (routine u/s, triple screen, amnio,
glucose challenge, etc.) were tests I was interested in. You may
feel differently, depending on what you might do differently based
on any of those test results.

Best wishes,
Ericka

I declined all tests simply based on high false positive rates. I
figured there was always a risk factor (and my midwife agreed) that
would indicate a need for testing. Especially the glucose one. If you
feel great and your blood pressure and urine are good why put yourself
through the unnecessary testing? I'm due in a week and haven't had
even one ultrasound. Aside from blood tests and the GBS test (my
choice) I've had no screening what-so-ever. I did get my blood
pressure and urine checked regularly.
All your choice for your own peace of mind, but a false positive test
would have sent me over the edge - good bye good blood pressure!

Raebo wrote:
I declined all tests simply based on high false positive rates. I
figured there was always a risk factor (and my midwife agreed) that
would indicate a need for testing. Especially the glucose one.

That is absolutely incorrect. There are frequently *NO*
signs whatsoever for gestational diabetes, and even pre-eclampsia
could cause serious problems if you weren't screening for blood
pressure and/or proteinuria. I declined screening for gestational
diabetes because I am not convinced that it improves outcomes
(particularly if you know that you are not an undiagnosed diabetic),
not because I figured something else would clue me in if I actually
had gestational diabetes. If I thought gestational diabetes was
essential to diagnose in order to protect my or my baby's health,
I would have tested for it.

Best wishes,
Ericka

oregonchick wrote:
My medical provider is an HMO, and recently they had a major flood occur at
my clinic when a large pipe ruptured. Ever since then, I have had to be
seen in whichever clinic they had available, all over the Portland metro
area.

Because of this I feel very lost in the shuffle. I am 26 weeks pregnant,
and need to know which screening tests are really important, and when they
normally occur, so I can make sure it happens. I know they normally do the
glucose test sometime around now, but no one has mentioned it, perhaps
because I see a different doc every time I go in.

Thanks,
Betsy

I'm a whole week further along than you, so here's what I anticipate
having done:
Gestational Diabetes around 28 wks
Group B strep 35-37 weeks
Almost every visit: urine test for protein (dipstick in the urine...I
do it myself at the office), blood pressure, weight, fundal height
measurement (I'm seeing a midwife), listen to heartbeat

"Standard" tests I already had: (I'm not including the infertility
related stuff and complication related stuff):
Blood tests for STDs, HIV, Hep B
Blood typing (to confirm Rh factor)
first and second trimester ultrasounds and 16 wk AFP to replace 16 wk
"triple screen" and second trimester ultrasound combo

Here's a good website list of different tests with timing:
http://www.babycenter.com/prenatal-tests

Everyone's definition of "critical" is different...I tend to have a lot
of testing, others prefer none.

HTH,
Amy

Here in New Zealand we have a fraction of the routine pre-natal testing that
is done in the US, and it has not negatively impacted our birth outcomes.
This is just a guess, but the fact that we don't do the AFP or triple screen
probably leads to fewer unnecessary amnios and fewer miscarriages across the
population.

With #1 I had:

-Midwife appointments from about 8-10 weeks, checking heartbeat, fundal
height from appropriate gestations and urine at every appointment.
-Blood work at the beginning and later part of the pregnancy (routine
pregnancy screen for blood typing, iron levels, cbc etc.)
-An early u/s at 10w5d for bleeding (not really necessary & was at my
request)
-20 week u/s - pretty standard here, though I'm sure you opt out if you
wanted to
- 1 hour glucose screen

With #2 I had:

-Midwife appointments from about 8-10 weeks, checking heartbeat, fundal
height from appropriate gestations and urine at every appointment.
-Blood work at the beginning and later part of the pregnancy
-hCG levels done at about 6 weeks due to bleeding with small clots (I
declined u/s this early because of the chance the heartbeat would not be
visible anyway)
-u/s at 13w5d for dating the pregnancy - I was sure I had ovulated very
late in my cycle and that my lmp would be unreliable (I conceived the month
I ditched the thermometer!) which was important to me as I was looking at
induction for personal reasons - though it wasn't *really* important, KWIM?
-20 week u/s
- 1 hour glucose screen
-Several late pg u/s, and to be honest I can't remember exactly how many,
due to previous stillbirth
- Several NST's, again some of these were at my request.

Of course, it's one of those YMMV things, and very few of these are going to
be necessary for you, let alone 'critical'! Many of them weren't even
necessary for me, but under the circumstances they gave me peace of mind
without IMO posing any substantial risk.


--
Amy
Mum to Carlos born sleeping 20/11/02,
& Ana born screaming 30/06/04
http://www.freewebs.com/carlos2002/
http://www.babiesonline.com/babies/a/ana%5Fj%5F2004/
My blog: http://spaces.msn.com/members/querer-hijo-querer-hija/


"oregonchick" wrote in message
...
My medical provider is an HMO, and recently they had a major flood occur
at my clinic when a large pipe ruptured. Ever since then, I have had to
be seen in whichever clinic they had available, all over the Portland
metro area.

Because of this I feel very lost in the shuffle. I am 26 weeks pregnant,
and need to know which screening tests are really important, and when they
normally occur, so I can make sure it happens. I know they normally do
the glucose test sometime around now, but no one has mentioned it, perhaps
because I see a different doc every time I go in.

Thanks,
Betsy

oregonchick writes:
: My medical provider is an HMO, and recently they had a major flood occur at
: my clinic when a large pipe ruptured. Ever since then, I have had to be
: seen in whichever clinic they had available, all over the Portland metro
: area.

: Because of this I feel very lost in the shuffle. I am 26 weeks pregnant,
: and need to know which screening tests are really important, and when they
: normally occur, so I can make sure it happens. I know they normally do the
: glucose test sometime around now, but no one has mentioned it, perhaps
: because I see a different doc every time I go in.

: Thanks,
: Betsy

We only had the GTT, and that only because it was required.

Larry