Prenatal Testing

When you come in for prenatal care at Cleveland Clinic, the topic of testing will enter the conversation pretty early. And that’s because it’s an important part of your care. Prenatal testing helps our providers get an idea of what’s going on inside your body throughout your pregnancy. It’s a chance to check your progress — and the progress of your fetus — and keep an eye out for any risk factors or possible conditions.

Different health conditions can develop during pregnancy. You could also have had a condition before getting pregnant that we need to keep an eye on. We can even spot genetic conditions using prenatal genetic testing. These tests provide details that are useful throughout this journey. They’re like details on the map. Without them, we wouldn’t be as confident of where we’re going.

But who handles all of these tests? Most of the time, your provider (Ob/Gyn or midwife) will let you know what you need and when. You can expect to have prenatal tests during each of your three trimesters of pregnancy.

Meet Our Prenatal Testing Team

We take a team-based approach to prenatal care at Cleveland Clinic. And testing is no exception. During your pregnancy, you’ll work with different providers not only to get your tests, but to go over your results. Some of the providers you’ll meet with can include:

• Obstetricians.
• Perinatologists.
• Nurse practitioners.
• Primary care providers.
• Pathologists.
• Radiologists.
• Radiologic technologists.
• Phlebotomists.
• Genetic counselors.

There are several different types of prenatal tests you’ll get throughout your pregnancy. Some tests will involve drawing your blood. Some will be physical exams with your provider. And then there are ultrasounds. This is probably the first test most people think of, and it can be one many people look forward to. But it’s important to know that all prenatal tests are done for medical reasons. We do them at particular times and for specific reasons. So even though you might want to have frequent ultrasounds to sneak a peek at your developing fetus, you’ll only have a few when they’re medically needed.

Physical exams and routine monitoring

You’ll see your provider more often as your pregnancy moves towards the finish line. And at some appointments, you may have a physical exam. In the first trimester, this could include a pelvic exam and a Pap test (Pap smear). As your bump grows, your provider will also measure your stomach with a paper ruler to check something called the fundal height. This quick check clues in your provider to your fetus’s size and how that’s matching up to how many weeks along you are. Your provider might also touch your stomach to feel for the fetus.

Your provider will also check out the fetal heart rate during routine monitoring. This is done with a small device called a doppler, and it’s a quick way to listen to the heartbeat.

Rh factor blood test

This test is ordered as early as possible in your first trimester, often at your very first prenatal visit. We’ll check something called your Rh factor (the Rhesus factor). This is a type of protein that lives on the outside of your red blood cells. It’s something that’s passed down through families. Most people are Rh-positive (meaning you have the protein), but if you don’t have it, you’re considered Rh-negative. There can be complications if you’re positive and your fetus is negative. We do a blood test to check for this. If you do have a different Rh factor from your fetus, we can give you medications to prevent incompatibility during your pregnancy.

Ultrasound

This imaging test lets us take a look inside at how your fetus is developing. It’s like opening a window to what’s going on inside the bump. Ultrasounds are medical tests, and we use them to check out fetal development and look for anything unusual, so we have that information as early as possible. That said, it can also be exciting to watch your fetus moving around on the screen. It can be a moment where you can connect those kicks and wiggles you’ve been feeling to arms and legs that you can see.

Typically, you’ll have an ultrasound between weeks 11 and 14 for a test called nuchal translucency. This measures the thickness of the back of the fetus’s neck. It can offer clues about any possible risks of abnormal numbers of chromosomes or other potential conditions. You’ll also have an ultrasound about half-way through your pregnancy at 20 weeks. This is called the anatomy scan. During this test, your provider will look at your fetus’s brain, heart, lungs and other organs. You might also learn if the sex will be assigned male or female at birth during this test.

In some cases, your provider may need to do a transvaginal ultrasound. This is done with a wand-like device that’s inserted into your vagina. This type of ultrasound can let your provider get a close look at what’s going on inside your uterus.

Maternal serum screening

Around week 11, your provider will let you know if and when they’ll do serum screenings. These blood tests check the levels of different proteins that flag possible fetal chromosome conditions, like an extra or missing one. An example of a serum screening is an alpha-fetoprotein (AFP) test.

Quad screen

Also known as a multiple marker screen, we may suggest a quad screen between weeks 15 and 22. This blood test checks for four substances that can cause chromosomal problems and neural tube conditions, like spina bifida.

Chorionic villus sampling (CVS)

If you have a high-risk pregnancy, your provider may recommend doing chorionic villus sampling between weeks 10 and 13. This test checks for:

• Down syndrome.
• Cystic fibrosis (CF).
• Edwards syndrome (Trisomy 18).
• Sickle cell.
• Tay-Sachs.

For this test, your provider will insert a needle through your belly or into your vagina to get a sample of cells from your placenta.

Amniocentesis

We may suggest doing an amniocentesis sometime after week 15 to check for Down syndrome or neural tube conditions, Tay-Sachs or conditions caused by Rh factor. Markers of these conditions can show up in an amniotic fluid sample. Your provider will use a needle to reach your uterus through your belly to get the fluid sample.

Oral glucose screening test

We check your blood sugar levels between weeks 24 and 28 to screen for gestational diabetes (high blood sugar during pregnancy). During an oral glucose screening test, you’ll:

• Drink a syrupy beverage (similar to flat soda) in a set amount of time.
• Wait an hour.
• Provide a blood sample so we can see if you have high blood sugar.

Noninvasive prenatal testing (NIPT)

We use noninvasive prenatal testing (NIPT) to see if your blood has any signs of passing along chromosome conditions like Down syndrome. We’ll do this bloodwork after week 10. NIPT tests aren’t diagnostic tests. But they can give us information about any possible congenital conditions. These are conditions that someone is born with. Your provider will talk you through these tests and explain your results.

Biophysical profile (BPP)

After the 28th week, we may recommend a biophysical profile to check fetal health and movement. This includes:

• Ultrasound to check fetal body movement, muscle tone, breathing and the amount of amniotic fluid.
• Nonstress test (NST) to measure fetal heart rate in response to movement and contractions.

Taking the Next Step

There are a lot of unknowns throughout pregnancy. Prenatal testing can’t always answer all the questions and remove all surprises, but it can help give your providers important information. Learning as much as possible about you, your health and your fetus’s development lets us make a plan for each part of your pregnancy. We’ll guide you through what tests you need along the way and help you understand the results. Throughout it all, we’ll be with you — listening to your questions and answering them as best we can.