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Prenatal Tests

Many expectant parents also choose to have one or more of the following prenatal tests, which can help predict the likelihood, or even detect the presence, of certain developmental or chromosomal abnormalities in the fetus:

Alpha-fetoprotein screening (AFP): Between 16 and 18 weeks, the level of alpha-fetoprotein, a protein produced by the fetus, can be measured in the woman’s blood. If the level is high, she may be carrying more than one fetus or a fetus with spina bifida or other neural tube defects. A high level can also indicate that the date of conception was miscalculated. If the level is low, the fetus may have chromosomal abnormalities, such as Down syndrome. It’s important to keep in mind that low or high results don’t automatically indicate a problem; rather, they indicate the need for further testing, which yields normal results in many cases.

Multiple marker screening (also called a maternal serum screening, triple screen, triple marker, quadruple screen, quad screen, quadruple marker, or quad marker): Also between 16 and 18 weeks, your health care provider may measure the levels of certain hormones in your blood, along with AFP. For this screening, a sample of blood is drawn from the mother to measure the level of AFP, as well as the levels of hCG (human chorionic gonadotropin) and estriol, which are produced by the placenta. The levels of these three substances (which is why the test is often called the triple screen or triple marker) in the blood can help doctors identify a fetus at risk for certain birth defects or chromosomal abnormalities. The test is called a quadruple screen (or marker) when the level of an additional substance, called inhibin-A, is also measured.

Amniocentesis (also called an amnio): In this test, a needle is used to remove a sample of the amniotic fluid from the womb; it’s generally performed between 15 and 20 weeks. Testing the fluid can identify certain fetal abnormalities such as Down syndrome or spina bifida. Typically, amniocentesis is recommended only if there is reason to believe that the risk for such conditions is higher than usual, perhaps due to maternal age (35 or older), abnormal AFP or multiple marker screening results, or family history. Although the test poses a small risk for causing preterm labor and inducing miscarriage, the large majority are performed without any problem.

Chorionic villus sampling (CVS): This procedure is used during the first trimester for the same purposes as an amniocentesis. (Women usually have one or the other, but not both, if such testing is deemed necessary.) It involves taking a sample of the tissue that attaches the amniotic sac (the sac around the fetus) to the wall of the uterus. Like amniocentesis, CVS is typically done only when there are certain risk factors; its primary advantage is that results are available sooner. CVS also carries a slightly increased risk of miscarriage and other complications.

Ultrasound (also called a sonogram, sonograph, echogram, or ultrasonogram): You’ll likely have at least one ultrasound examination to make sure the pregnancy is progressing normally and to verify the expected date of delivery. Usually, an ultrasound is performed at 18 to 20 weeks to look at the baby’s anatomy, but can be done sooner or later and sometimes more than once. An ultrasound poses no risk to you or your baby.

Some health care providers may have the equipment and trained personnel necessary to provide in-office ultrasounds, whereas others may have you go to a local hospital or radiology center.

Wherever the ultrasound is done, a technician will coat your abdomen with a gel and then run a wand-like instrument over it. High-frequency sound waves “echo” off your body and create a picture of the fetus inside on a computer screen.

Ultrasound scanning is used to:

• determine whether the fetus is growing at a normal rate
• record fetal heartbeat or breathing movements
• see whether you might be carrying more than one fetus
• identify a variety of abnormalities that might affect the remainder of the pregnancy or delivery

There are ultrasounds available at shopping malls as a way to have a “portrait” of your baby. However, the individuals using the equipment are not necessarily trained as ultrasound technicians. Before committing to having one of these done, it would be wise to discuss it with your health care provider.

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