In early pregnancy tests are arranged to check for anaemia (full blood count and iron studies), thyroid function, blood group, red cell antibodies, blood sugar level (diabetes check) Rubella (German measles) immunity, chicken pox immunity, Hepatitis B and Hepatitis C, syphilis, HIV and urinary tract infection.
If these tests have already been done by your general practitioner can you please bring a copy of the results.
A Pap smear should also be taken if this is due and you are in early pregnancy. Pap smear can result in minor bleeding but this is not associated with miscarriage. Taking a Pap smear doesn’t increase your risk of miscarriage. See http://www.obstetricexcellence.com.au/pap-smear-in-pregnancy/. I recommend that the specimen collected be checked not only by the conventional slide but also by ThinPrep Pap checking, which is more accurate than the slide check. ThinPrep checking is not covered by Medicare.
I will give you a referral to Douglass Hanly Moir Pathology for pathology tests. Douglass Hanly Moir Pathology has collection rooms all over Sydney. I will request that you are ‘bulk billed’ for pathology testing.
I will give you a referral to Douglass Hanly Moir Pathology in later pregnancy to check for anaemia, red cell antibodies (if your blood group is Rhesus negative), diabetes and Group B Streptococcus (GBS). I will also give you a swab stick so you can collect the vaginal specimen for GBS testing. Group B Streptococcus checking is important if you are planning a vaginal delivery. It is not indicated if you are you are having an elective Caesarean section delivery.
Other tests may be necessary because of special considerations. If you are aware of any health issues, past medical problems (personal or in the family) that may have an impact on your pregnancy, please inform me.
There is now available a very accurate maternal blood test (Non-Invasive Prenatal Test (NIPT)) to screen for Down Syndrome and other chromosomal abnormalities in your baby. It checks the DNA of your baby from your baby’s blood cells present in your blood. It can be done as early as 10 weeks pregnancy. This test is not covered by Medicare and has a cost of $520 with Sydney Ultrasound for Women or the San Ultrasound for Women or $900 with Douglass Hanly Moir. Your blood is sent to USA for analysis. The cost variation is because Sydney Ultrasound for Women and the San Ultrasound for Women use Harmony and Douglass Hanly Moir uses Verifi. The analysis technique is different, with possibily Verifi being slightly more accurate. NIPT is more accurate than NTS with serum and almost as accurate as amniocentisis or CVS (and without the associated risk of miscarriage with an amniocentesis or CVS). Aswell you can accurately find out the sex of your baby if you wish with a NIPT.
Externally sourced Ultrasound Scans
Between 11 and 13 weeks a nuchal translucency ultrasound scan (NTS) can be done to check the risk of Down syndrome and other major chromosomal abnormalities in your baby, if you have not had the NIPT. A blood test is also offered to increase the accuracy of the NTS screening test. The screening will identify 92% of chromosomal abnormalities checked for. If the NTS result is ‘high risk’ fetal chromosomal studies (chorionic villus sampling (CVS) or amniocentesis) are recommended to check. Foetal chromosomal studies carries a 1 in 200 – 300 risk of miscarriage. Hence a NTS should only be done if you would consider not continuing the pregnancy if your baby had such an abnormality diagnosed. See blog post Nuchal Translucency scan – consider carefully first. For more information see Nuchal Translucency scan and Non-invasive prenatal test (NIPT) in the Question and Answers section of this web site.
Between 18 and 20 weeks an externally sourced ultrasound scan (called a “morphology scan“) is recommended to exclude non-chromosomal foetal abnormalities and other problems that could complicate your pregnancy.
There may be situations where externally sourced scans at other times. But my personal dependence on referring you to an externally sourced ultrasound unit, which can be expensive, is less than other obstetricians as I personally scan your baby at each antenatal visit.
You can choose to have these external scans done at a general radiology practice. While a general radiology practice is usually cheaper (often charging you the Medicare rebate only) the quality of their equipment and the training and accuracy of staff in diagnosing problems is usually less than that offered by a specialised female ultrasound unit. This means greater likelhood of an inaccurate result.
Charges for tests
I advise Douglass Hanly Moir to charge the Medicare rebate for your pathology testing arranged by me where applicable. For Douglass Hanly Moir to do this there needs to be a Medicare item number for the test. If there is not then there will be an out of pocket expense payable by you to Douglass Hanly Moir. All routine pathology tests listed above are covered by Medicare except the the ThinPrep Pap test (if a Pap smear is taken) and the NIPT. The ThinPrep Pap test and the NIPT will be an out of pocket expenses.
There will be an out of pocket cost for ultrasound scans done by the San Ultrasound for Women and the Sydney Ultrasound for Women. The gap you pay will vary from one unit to another. I will give you a referral to the ultrasound unit that is closest to the hospital you have chosen. Both give good quality reporting and so I am happy for you to choose the alternative such unit. Part of their invoice can be claimed through Medicare.
Some patients prefer to go to a radiology imaging centre for their ultrasound scans as the radiology centre will ‘bulk bill’. The downside is radiology imaging centres are run by radiologists rather than by obstetricians who have subspecialised in female obstetric and gynaecology ultrasound scanning. Also well it is possible the radiology centre sonography staff have no special training in pregnancy scanning and also the scanning equipment is of more inferior quality. So while there will be a cost saving there is more likelihood of missing an abnormality in your baby.
There will be no out of pocket cost for ultrasound scans I do in my office.
See also Tests during pregnancy