Blood work during pregnancy

Routine Tests During Pregnancy | ACOG

Acquired Immunodeficiency Syndrome (AIDS): A group of signs and symptoms, usually of severe infections, in a person who has human immunodeficiency virus (HIV).

Anemia: Abnormally low levels of red blood cells in the bloodstream. Most cases are caused by iron deficiency (lack of iron).

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Bacteria: One-celled organisms that can cause infections in the human body.

Birth Defects: Physical problems that are present at birth.

Cells: The smallest units of structures in the body.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Chlamydia: A sexually transmitted infection caused by bacteria. This infection can lead to pelvic inflammatory disease and infertility.

Chromosomes: Structures that are located inside each cell in the body. They contain the genes that determine a person’s physical makeup.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Gene: Segments of DNA that contain instructions for the development of a person’s physical traits and control of the processes in the body. The gene is the basic unit of heredity and can be passed from parent to child.

Genetic Counselor: A health care professional with special training in genetics who can provide expert advice about genetic disorders and prenatal testing.

Gestational Diabetes: Diabetes that arises during pregnancy.

Glucose: A sugar in the blood that is the body’s main source of fuel.

Gonorrhea: A sexually transmitted infection that can lead to pelvic inflammatory disease, infertility, and arthritis.

Group B Streptococcus (GBS): A type of bacteria that many people carry normally and can be passed to the fetus at the time of delivery. GBS can cause serious infection in some newborns. Antibiotics are given during labor to women who carry the bacteria to prevent newborn infection.

Hepatitis B: An infection caused by a virus that can be spread through blood, semen, or other body fluid infected with the virus.

Hepatitis C: An infection caused by a virus that can be spread through infected blood.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).

Immune: Protected against infectious disease.

Intravenous (IV) Line: A tube inserted into a vein and used to deliver medication or fluids.

Measles–Mumps–Rubella (MMR) Vaccine: A shot given to protect against measles, mumps, and rubella. The shot contains live viruses that have been changed to not cause disease. The shot is not recommended for pregnant women.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision.

Rectum: The last part of the digestive tract.

Rh Factor: A protein that can be found on the surface of red blood cells.

Rubella: A virus that can be passed to the fetus if a woman becomes infected during pregnancy. The virus can cause miscarriage or severe birth defects.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Syphilis: A sexually transmitted infection (STI) that is caused by an organism called Treponema pallidum. This infection may cause major health problems or death in its later stages.

Trimester: A 3-month time in pregnancy. It can be first, second, or third.

Tuberculosis (TB): A disease that affects the lungs and other organs in the body. TB is caused by bacteria.

Urinary Tract Infection (UTI): An infection in any part of the urinary system, including the kidneys, bladder, or urethra.

Vaccine: A substance that helps the body fight disease. Vaccines are made from very small amounts of weak or dead agents that cause disease (bacteria, toxins, and viruses).

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Common Tests During Pregnancy | Johns Hopkins Medicine

Genetic Screening
First Trimester
Second Trimester
Ultrasound
Amniocentesis
Chorionic Villus Sampling
Fetal Monitoring
Glucose
Group B Strep Culture

Your health care provider may recommend a variety of screenings, tests and imaging techniques during your pregnancy. These tests are designed to provide information about the health of your baby and may help you optimize your child’s prenatal care and development.

Genetic Screening

Many genetic abnormalities can be diagnosed before birth. Your doctor or midwife may recommend genetic testing during pregnancy if you or your partner has a family history of genetic disorders. You may also choose to have genetic screening if you have had a fetus or baby with a genetic abnormality.

Examples of genetic disorders that can be diagnosed before birth include:

Cystic fibrosis
Duchenne muscular dystrophy
Hemophilia A
Polycystic kidney disease
Sickle cell disease
Tay-Sachs disease
Thalassemia

The following screening methods are available during pregnancy:

Alpha-fetoprotein (AFP) test or multiple marker test
Amniocentesis
Chorionic villus sampling
Cell-free fetal DNA testing
Percutaneous umbilical blood sampling (withdrawing a small sample of the fetal blood from the umbilical cord)
Ultrasound scan

First Trimester Prenatal Screening Tests

First trimester screening is a combination of fetal ultrasound and maternal blood testing. This screening process can help determine the risk of the fetus having certain birth defects. Screening tests may be used alone or with other tests.

First trimester screening includes:

Ultrasound for fetal nuchal translucency. Nuchal translucency screening uses an ultrasound to examine the area at the back of the fetal neck for increased fluid or thickening.
Ultrasound for fetal nasal bone determination. The nasal bone may not be visualized in some babies with certain chromosome abnormalities, such as Down syndrome. This screen is performed using an ultrasound between 11 and 13 weeks gestation.
Maternal serum (blood) tests. These blood tests measure two substances found in the blood of all pregnant women:
- Pregnancy-associated plasma protein A. A protein produced by the placenta in early pregnancy. Abnormal levels are associated with an increased risk of chromosomal abnormality.
- Human chorionic gonadotropin. A hormone produced by the placenta in early pregnancy. Abnormal levels are associated with an increased risk of chromosomal abnormality.

When used together as first trimester screening tests, nuchal translucency screening and maternal blood tests have a greater ability to determine if the fetus might have a birth defect, such as Down syndrome (trisomy 21) and trisomy 18.

If the results of these first trimester screening tests are abnormal, genetic counseling is recommended. Additional testing, such as chorionic villus sampling, amniocentesis, cell-free fetal DNA or other ultrasounds, may be needed for an accurate diagnosis.

Second Trimester Prenatal Screening Tests

Second trimester prenatal screening may include several blood tests called multiple markers. These markers provide information about your potential risk of having a baby with certain genetic conditions or birth defects. Screening is usually done by taking a sample of your blood between 15 and 20 weeks of pregnancy (16 to 18 weeks is ideal). The multiple markers include:

AFP screening. Also called maternal serum AFP, this blood test measures the level of AFP in your blood during pregnancy. AFP is a protein normally produced by the fetal liver that is present in the fluid surrounding the fetus (amniotic fluid). It crosses the placenta and enters your blood. Abnormal levels of AFP may indicate:
- A miscalculated due date, as the levels vary throughout pregnancy
- Defects in the abdominal wall of the fetus
- Down syndrome or other chromosomal abnormalities
- Open neural tube defects, such as spina bifida
- Twins (more than one fetus is producing the protein)
Estriol. This is a hormone produced by the placenta. It can be measured in maternal blood or urine to be used to determine fetal health.
Inhibin. This is a hormone produced by the placenta.
Human chorionic gonadotropin. This is also a hormone produced by the placenta.

Abnormal test results of AFP and other markers may mean that additional testing is needed. An ultrasound is used to confirm the milestones of your pregnancy and to check the fetal spine and other body parts for defects. An amniocentesis may be needed for an accurate diagnosis.

Since multiple marker screening is not diagnostic, it is not 100 percent accurate. It helps determine who in the population should be offered additional testing during pregnancy. False-positive results may indicate a problem when the fetus is actually healthy. On the other hand, false-negative results indicate a normal result when the fetus actually does have a health problem.

When you have both first and second trimester screening tests performed, the ability of the tests to detect an abnormality is greater than using just one screening independently. Most cases of Down syndrome can be detected when both first and second trimester screenings are used.

Ultrasound

An ultrasound scan is a diagnostic technique that uses high-frequency sound waves to create an image of the internal organs. A screening ultrasound is sometimes done during the course of your pregnancy to check normal fetal growth and verify the due date.

When are ultrasounds performed during pregnancy?

Ultrasounds may be done at various times throughout pregnancy for several reasons:

First Trimester

To establish the due date (this is the most accurate way of determining the due date)
To determine the number of fetuses and identify placental structures
To diagnose an ectopic pregnancy or miscarriage
To examine the uterus and other pelvic anatomy
To detect fetal abnormalities (in some cases)

Midtrimester (also called the 18- to 20-week scan)

To confirm the due date (a due date set in the first trimester is rarely changed)
To determine the number of fetuses and examine the placental structures
To assist in prenatal tests, such as an amniocentesis
To examine the fetal anatomy for abnormalities
To check the amount of amniotic fluid
To examine blood flow patterns
To observe fetal behavior and activity
To measure the length of the cervix
To monitor fetal growth

Third Trimester

To monitor fetal growth
To check the amount of amniotic fluid
To conduct the biophysical profile test
To determine the position of the fetus
To assess the placenta

How is an ultrasound scan performed?

Two types of ultrasounds can be performed during pregnancy:

Abdominal ultrasound. In an abdominal ultrasound, gel is applied to your abdomen. The ultrasound transducer glides over the gel on the abdomen to create the image.
Transvaginal ultrasound. In a transvaginal ultrasound, a smaller ultrasound transducer is inserted into your vagina and rests against the back of the vagina to create an image. A transvaginal ultrasound produces a sharper image than an abdominal ultrasound and is often used in early pregnancy.

Which ultrasound imaging techniques are available?

There are several types of ultrasound imaging techniques. As the most common type, the 2-D ultrasound provides a flat picture of one aspect of the baby.

If more information is needed, a 3-D ultrasound exam can be done. This technique, which provides a 3-D picture, requires a special machine and special training. The 3-D image allows the health care provider to see the width, height and depth of the images, which can be helpful during the diagnosis. The 3-D images can also be captured and saved for later review.

The latest technology is 4-D ultrasound, which allows the health care provider to visualize the unborn baby moving in real time. With 4-D imaging, a three-dimensional image is continuously updated, providing a “live action” view. These images often have a golden color, which helps show shadows and highlights.

Ultrasound images may be captured in still photographs or on video to document findings.

What are the risks and benefits of ultrasound imaging?

Fetal ultrasound has no known risks other than mild discomfort due to pressure from the transducer on your abdomen or in your vagina. No radiation is used during the procedure.

Transvaginal ultrasound requires covering the ultrasound transducer in a plastic or latex sheath, which may cause a reaction in women with a latex allergy.

Ultrasound imaging is constantly being improved and refined. As with any test, the results may not be completely accurate. However, an ultrasound can provide valuable information to parents and health care providers, helping them manage and care for the pregnancy and the baby. In addition, ultrasound imaging gives parents a unique opportunity to see their baby before birth, helping them to bond and establish an early relationship.

Fetal ultrasound is sometimes offered in nonmedical settings to provide keepsake images or videos for parents. While the ultrasound procedure itself is considered safe, it is possible that untrained personnel may miss an abnormality or give parents false assurances about their baby’s well-being. It is best to have an ultrasound performed by trained medical personnel who can correctly interpret the results. Talk with your doctor or midwife if you have questions.

Amniocentesis

An amniocentesis involves taking a small sample of the amniotic fluid that surrounds the fetus. It is used to diagnose chromosomal disorders and open neural tube defects, such as spina bifida. Testing is available for other genetic defects and disorders depending on your family history and the availability of lab testing at the time of the procedure.

Who is an ideal candidate for amniocentesis?

An amniocentesis is generally offered to women between the 15th and 20th week of pregnancy who have an increased risk of chromosomal abnormalities. Candidates include women who will be over age 35 at the time of delivery or those who have had an abnormal maternal serum screening test.

How is an amniocentesis performed?

An amniocentesis involves inserting a long, thin needle through your abdomen into the amniotic sac to withdraw a small sample of amniotic fluid. The amniotic fluid contains cells shed by the fetus, which contain genetic information. Although specific details of each procedure may vary, a typical amniocentesis follows this process:

Your abdomen will be cleansed with an antiseptic.
Your doctor may or may not give a local anesthetic to numb the skin.
Your doctor will use ultrasound technology to help guide a hollow needle into the amniotic sac. He or she will withdraw a small sample of fluid for lab analysis.

You may feel some cramping during or after the amniocentesis. Strenuous activities should be avoided for 24 hours following the procedure.

Women who are pregnant with twins or other higher-order multiples need sampling from each amniotic sac to study each baby. Depending on the position of the baby and placenta, amount of fluid, and woman’s anatomy, sometimes the amniocentesis cannot be done. The fluid is then sent to a genetics lab so that the cells can grow and be analyzed. AFP is also measured to rule out an open neural tube defect. Results are usually available in about 10 days to two weeks, depending on the lab.

Chorionic Villus Sampling (CVS)?

CVS is a prenatal test that involves taking a sample of some of the placental tissue. This tissue contains the same genetic material as the fetus and can be tested for chromosomal abnormalities and some other genetic problems. Testing is available for other genetic defects and disorders, depending on your family history and the availability of lab testing at the time of the procedure. Unlike amniocentesis, CVS does not provide information on open neural tube defects. Therefore, women who undergo CVS also need a follow-up blood test between 16 and 18 weeks of pregnancy to screen for these defects.

How is CVS performed?

CVS may be offered to women with an increased risk of chromosomal abnormalities or who have a family history of a genetic defect that is testable from the placental tissue. CVS is usually performed between the 10th and 13th week of pregnancy. Although exact methods may vary, the procedure involves the following steps:

Your doctor will insert a small tube (catheter) through your vagina and into your cervix.
Using ultrasound technology, your doctor will guide the catheter into place near the placenta.
Your doctor will remove some tissue using a syringe on the other end of the catheter.

Your doctor may also choose to perform a transabdominal CVS, which involves inserting a needle through your abdomen and into your uterus to sample the placental cells. You may feel some cramping during and after either type of CVS procedure. The tissue samples are sent to a genetic lab for growth and analysis. Results are usually available in about 10 days to two weeks, depending on the lab.

What if CVS is not possible?

Women with twins or other higher-order multiples usually need sampling from each placenta. However, because of the complexity of the procedure and the positioning of the placentas, CVS is not always feasible or successful with multiples.

Women who are not candidates for CVS or who did not get accurate results from the procedure may require a follow-up amniocentesis. An active vaginal infection, such as herpes or gonorrhea, will prohibit the procedure. In other cases, the doctor may take a sample that does not have enough tissue to grow in the lab, generating incomplete or inconclusive results.

Fetal Monitoring

During late pregnancy and labor, your doctor may want to monitor the fetal heart rate and other functions. Fetal heart rate monitoring is a method of checking the rate and rhythm of the fetal heartbeat. The average fetal heart rate is between 120 and 160 beats per minute. This rate may change as the fetus responds to conditions in the uterus. An abnormal fetal heart rate or pattern may mean that the fetus is not getting enough oxygen or indicate other problems. An abnormal pattern also may mean that an emergency cesarean delivery is needed.

How is fetal monitoring performed?

Using a fetoscope (a type of stethoscope) to listen to the fetal heartbeat is the most basic type of fetal heart rate monitoring. Another type of monitoring is performed with a hand-held Doppler device. This is often used during prenatal visits to count the fetal heart rate. During labor, continuous electronic fetal monitoring is often used. Although the specific details of each procedure may vary, standard electronic fetal monitoring follows this process:

Gel is applied to your abdomen to act as a medium for the ultrasound transducer.
The ultrasound transducer is attached to your abdomen with straps so it can transmit the fetal heartbeat to a recorder. The fetal heart rate is displayed on a screen and printed onto special paper.
During contractions, an external tocodynamometer (a monitoring device that is placed over the top of the uterus with a belt) can record the pattern of contractions.

When is internal fetal monitoring needed?

On occasion, internal fetal monitoring is needed to provide a more accurate reading of the fetal heart rate. Your bag of waters (amniotic fluid) must be broken and your cervix must be partially dilated to use internal monitoring. Internal fetal monitoring involves inserting an electrode through the dilated cervix and attaching the electrode to the scalp of the fetus.

Glucose Testing

Glucose testing is used to measure the level of sugar in your blood.

A glucose challenge test is usually conducted between 24 and 28 weeks of pregnancy. Abnormal glucose levels may indicate gestational diabetes.

What is involved in a glucose challenge test?

The initial one-hour test is a glucose challenge test. If the results are abnormal, a glucose tolerance test is needed.

How is a glucose tolerance test performed?

You may be asked to only drink water on the day the glucose tolerance test is given. Although the specific details of each procedure may vary, a typical glucose tolerance test includes the following steps:

An initial fasting sample of blood will be drawn from your vein.
You will be given a special glucose solution to drink.
Blood will be drawn at various times over the course of several hours to measure the glucose levels in your body.

Group B Strep Culture

Group B streptococcus (GBS) is a type of bacteria found in the lower genital tract of about 20 percent of all women. While a GBS infection does not usually cause problems in women before pregnancy, it can cause serious illness in mothers during pregnancy. GBS may cause chorioamnionitis (a severe infection of the placental tissues) and postpartum infection. Urinary tract infections caused by GBS can lead to preterm labor and birth or pyelonephritis and sepsis.

GBS is the most common cause of life-threatening infections in newborns, including pneumonia and meningitis. Newborn babies contract the infection during pregnancy or from the mother’s genital tract during labor and delivery.

The Centers for Disease Control and Prevention recommends screening all pregnant women for vaginal and rectal GBS colonization between 35 and 37 weeks gestation. The treatment of mothers with certain risk factors or positive cultures is important to reduce the risk of transmission of GBS to the baby. Babies whose mothers receive antibiotic treatment for a positive GBS test are 20 times less likely to develop the disease than those without treatment.

Blood test for pregnancy in the early stages - why you need and how to donate blood

Blood test for pregnancy is a procedure that is necessary to identify existing pathologies. It also allows you to determine the very presence of pregnancy, since it detects the presence in the blood of a woman of a hormone called "chorionic gonadotropin" (hCG).

In a situation where conception has not occurred, this substance is not produced in the patient's body, since its appearance is associated with the formation of the chorion. This is the tissue that occurs between the endometrium and the zygote after the attachment of a fertilized egg to the wall of the uterus.

Reasons for testing

A blood test can show pregnancy as early as six days after a successful conception. Whereas a standard pregnancy test in some cases can give incorrect results. Therefore, tests during pregnancy are prescribed to determine such conditions as:

Establishment of the actual fact of conception
Assessment of hormonal background for failures
Tracking abnormal pregnancy types:

Frozen - in this case, at a certain stage, the embryo stops its development
Ectopic - in this situation, the zygote is not attached to the wall of the uterus, but in the fallopian tube

Also, a blood test shows the presence of infections, other types of body dysfunctions and diseases such as:

Cytomegalovirus
Diphtheria
Tetanus
Herpes
Chlamydia
Hepatitis
Ureaplasmosis
HIV
Mycoplasmosis
Syphilis
Leptospirosis
Chlamydia

Any of these diseases is a danger not only to the body of the woman herself, but also to her unborn child. Therefore, if there are deviations in the results of the blood test, the doctor sends the patient for an additional examination.

Changes in hCG during pregnancy

After the physical onset of conception, the level of hCG in the female body begins to rise, and every two to three days its concentration almost doubles. It reaches its highest level at 8-11 weeks, and then it begins to gradually decrease.

The first analysis can be taken on the 6th day of the expected delay, but the result will be more accurate on the 11-12th day. Therefore, doctors recommend undergoing a blood test two to three times (every two days later).

Monitoring the level of hCG allows you to monitor the dynamics of pregnancy, the appearance of pathologies, etc.:

In ectopic pregnancy, the level of the hormone practically does not increase
If the development of the embryo has stopped, then the level of hCG drops from the moment of its death

Usually the result of the analysis is compared with a special table. In the first or second weeks, the concentration of hCG can range from 25 to 700 units, at the peak of the value it can reach 18,000–240,000 units, and at the end of the gestational age - 2,179-60,000 units.

After establishing the fact of conception, the doctor refers the patient to other blood tests:

General
Biochemical
For clotting
For hepatitis and HIV
For TORCH infections
For genetic pathologies
For Rh factor and blood group (if not previously determined)
For the content of hormones produced by the thyroid gland
Antiphospholipid syndrome
For STDs

Causes of deviation from the norm of the hormone hCG

Normally, after the onset of pregnancy, the level of human chorionic gonadotropin should gradually increase. If it decreases, then the doctor may assume the presence of such problems as:

In the early stages:

Fetal death
Probability of spontaneous termination of pregnancy
Absence of an embryo in the ovum

Late:

Placental abruption

In some cases, a low level of hCG may be associated with an incorrectly calculated gestational age. Therefore, in order to determine the exact cause of low hormone levels, early pregnancy tests are usually performed, as well as several types of other examinations.

Causes of an increase in hCG levels

In the results of blood tests, the level of hCG can be seriously higher than normal for the following reasons:

Presence of toxicosis
More than one fetus
Occurrence of hydatidiform mole
Presence of genetic problems
Complication due to diabetes mellitus

The level of human chorionic gonadotropin can be increased not only due to pregnancy, but also due to some abnormalities:

Extremely high hCG levels due to hormonal drugs
The presence of a malignant neoplasm in various organs (kidneys, gastrointestinal tract, uterus, lungs, etc.)
Preservation of an unstable hormonal background as a result of an abortion

In rare cases, in the presence of serious hormonal disorders, men may also be found to have elevated levels of hCG.

Preparation for procedure

The following preparations are required before taking hCG tests for pregnant women:

Fasting for 7-8 hours before the procedure
Limiting the intake of any liquid a few hours before the examination

Also tell your doctor if you are taking any medications.

Statistics show that the highest concentration of hCG in the blood is observed in the first half of the day, so the doctor usually prescribes such an analysis in the morning.

If the recommendations are not followed, the study may show an unreliable result, so additional procedures will have to be carried out.

How blood sampling is performed

Blood tests for pregnant women are taken from a vein in the area located on the inside of the arm at the elbow. The procedure is as follows:

The patient sits on a couch or chair and exposes her left or right arm
Medic applying a tourniquet above the elbow
After that, the woman performs several clenching of the palm into a fist
The doctor lubricates the area of the future puncture with a disinfectant
He then inserts the needle into the vein and fills the syringe (about 10 ml of blood is needed for the test)
After that, the tourniquet is removed, and a cotton swab is applied to the puncture area, which the patient must hold with her arm bent at the elbow (this helps to stop the release of fluid from the wound)

After these manipulations, the blood in the test tube is sent to the laboratory for analysis. The results of the analysis can be transferred directly to the attending physician, or issued to the patient. A woman can independently compare these indicators with the values in the tables, but it is recommended to entrust this process to professionals.

Advantages of the procedure at MEDSI

Highly qualified doctors work in the clinics, who not only develop comprehensive examination and treatment programs, but also help to properly prepare for childbirth in case of pregnancy
Special consultation mechanisms have been established for prospective parents
Clinics have their own laboratory for receiving and checking tests, which allows you to get an accurate result in the shortest possible time
For examinations and therapy, modern devices from leading manufacturers from countries such as Japan, USA, Germany, etc. are used.
Originator drugs (not generics) are used

To make an appointment, call 8 (495) 7-800-500 or contact one of the many registries located in Moscow, the region and regions of the Russian Federation.

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Physiological changes in blood parameters during pregnancy

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IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Changes in coagulogram and clinical blood tests.

Changes in the coagulogram (No. 1, 2, 3, 4, 190, 164, 194) * of a pregnant woman is a physiological process associated with the appearance of the uteroplacental circulation. This process is associated with the evolutionary, adaptive reactions of the body of a pregnant woman. The body of a woman prepares for the costs during gestation and possible blood loss during childbirth. During the physiological course of pregnancy, the activity of the procoagulant link increases. Already at the 3rd month of pregnancy, fibrinogen rises (this is the factor I (first) of the plasma coagulation system) and reaches maximum values on the eve of childbirth. Therefore, gynecologists reasonably recommend monitoring this indicator during pregnancy (1 time per trimester, if there are deviations of these indicators more often, 1 time per week). At the end of the third trimester of pregnancy, the concentration of fibrinogen in the serum increases, which may correspond to an increase in the processes of intravascular blood coagulation in the uteroplacental blood flow.

Simultaneously with an increase in fibrinogen and activity of the external coagulation pathway, the activity of the internal mechanism of blood coagulation also increases, while a shortening of the APTT is noted. Other links of the hemostasis system also change during pregnancy, such as a coagulation inhibitor - antithrombin III, which has a protein structure and has the ability to inhibit two or more fibrinolysis coagulation factors and the compliment system. As pregnancy progresses, there is a gradual decrease in antithrombin III activity. In pregnant women, starting from early pregnancy, the level of D-dimer in the blood gradually increases. By the end of the gestation period, its values can be 3-4 times higher than the initial level. Lupus anticoagulant should not be produced normally in a pregnant woman. Pregnant women may experience slight changes in the complete blood count (No. 5). Indicators such as hemoglobin, hematocrit may decrease in the second half of pregnancy, and leukocytes may increase (#119)*.

Changes in biochemical parameters

During pregnancy, a decrease in the total concentration of protein in the blood plasma is due to both partial dilution, as a result of fluid retention in the body, and a decrease in the concentration of albumin (No. 10) *. The decrease in albumin is due to its increased consumption for biosynthetic processes. However, it is impossible to exclude the factor of increasing vascular permeability and the redistribution of fluid and protein in the intercellular space, the violation of hemodynamics. Changes in the concentration of blood proteins are also found on the proteinogram. In the first and second trimester of pregnancy, albumin decreases, which is associated with physiological hypervolemia. In the third trimester, an increase in the alpha-1-globulin fraction (No. 29)*, alpha-fetoprotein (No. 92)*. Alpha-2-globulin fraction (#29)* may increase due to proteins associated with pregnancy (begins to increase from 8-12 weeks of pregnancy and reaches a maximum in the third trimester). Beta globulins (#29)* increase due to an increase in the concentration of transferrin (#50)*. Also, in most cases, there is a slight increase in the level of gamma globulins (#29)*.

Minor changes in C-reactive protein (No. 43) *, observed more often in early pregnancy, may be the body's response to proliferation processes (increased cell division). Changes in the volume of circulating blood (CBV) and blood supply to the kidneys lead to changes in the nitrogen excretion function of the kidneys. There is a delay and accumulation of nitrogenous substances, while the amount of urea (No. 26) * decreases, especially in late pregnancy due to increased protein utilization (positive nitrogen balance).

Creatinine (No. 22)* decreases to the maximum in the I-II trimester (its concentration can decrease by almost 1.5 times), which is associated with an increase in the volume of the muscle mass of the uterus and fetus. The level of uric acid (#27)* is often reduced due to increased blood supply to the kidneys, but even minor violations of kidney function can lead to an increase in this level, and this is regarded as symptoms of toxemia.

Lipid metabolism changes significantly during pregnancy (profile No. 53)*. Since oxidative processes intensify, there is an increased utilization of cholesterol in the adrenal glands, the placenta. This leads to compensatory transient hypercholesterolemia, characterized by an increase in cholesterol, HDL. The level of HDL practically does not change. An increase in estrogen levels leads to hypertriglyceridemia, which is facilitated by hypoproteinemia, functional cholestasis. This increases the deposition of fat in the mammary glands, subcutaneous fat, this process is also associated with an increase in the transition of carbohydrates to fats due to an increase in insulin production.

An indicator reflecting the level of endogenous insulin secretion is C-peptide (No. 148)*. Glucose readings (#16)* may vary slightly without reaching levels of hyperglycemia. Since during pregnancy the glomerular filtration rate increases and the permeability of the epithelium of the renal tubules increases, glucosuria (physiological) can be observed periodically. Most often, glucosuria appears at 27 to 36 weeks of gestation. The peculiarities of mineral metabolism in healthy pregnant women in comparison with non-pregnant women is the retention of sodium, potassium, chlorine salts in the body (No. 39)*, phosphorus (No. 41)*, it is the changes in phosphorus in the body of a pregnant woman that are associated with an increase in alkaline phosphatase (No. 36) *. This is due to changes during pregnancy in the bone tissue and changes in the liver. As you know, during pregnancy, the need for calcium salts increases, which are necessary for the formation of the fetal skeleton, and the mother may experience a calcium deficiency (#37)*. Hypocalcemia in pregnant women can manifest itself in muscle cramps, spastic phenomena. Increasing iron intake during pregnancy can lead to anemia. This condition is characterized by a decrease in iron (No. 48) *, ferritin (No. 51) *, vitamins: B12 (No. 117) *, folic acid (No. 118) *. Changes in the endocrine system

The pituitary gland, especially the anterior lobe, is enlarged. The pituitary hormones ACTH (No. 100)*, prolactin (No. 61)* play an important role in changing the metabolic processes of the pregnant woman's body. Therefore, these hormones can be elevated. The placenta also has hormonal activity. It produces progesterone (No. 63) *, free estriol (No. 134) *, b-hCG (No. 66) *, these hormones are similar in their action to growth hormone (No. 99) *. The thyroid gland also undergoes changes, it increases slightly, and in the first half of pregnancy its hyperfunction is noted. There is an increase in free T4 (No. 55) *, with normal T4 (No. 54) *. There is also an increase in the function of the parathyroid glands by a relative increase in parathyroid hormone (No. 102) *. FSH production (#59)* decreases during pregnancy.

* - Research numbers in the Independent laboratory INVITRO.

In preparing the article, data from the Bulletin of Laboratory Services No. 9, 2001 were used.

Sources:

Clinical guidelines "Normal pregnancy". Developed by: Russian Society of Obstetricians and Gynecologists. – 2020.
Clinical guidelines "Multiple pregnancy". Developed by: Russian Society of Obstetricians and Gynecologists. – 2021.

IMPORTANT!

Recommendations

PSA (prostate specific antigen) test

3315 may 13
Human papillomavirus

18788 04 May
Alkaline phosphatase

40343 16 April

ECO

Blood transfusion

Pregnancy

Rh-affiliation (Rh-factor, Rh)

Rh-affiliation: indications for prescribing, rules for preparing for the analysis, interpretation of the results and norm indicators.

ECO

Miscarriage

Pregnancy

hCG, Human Chorionic Gonadotropin

Human Chorionic Gonadotropin (hCG, β-hCG, beta-hCG, Human Chorionic Gonadotropin): indications for prescription, rules for preparing for the test, interpretation of the results and normal indicators.

Heredity

Pregnancy

ECO

Family Biology Testing: Paternity and Maternity

You can perform molecular genetic testing that reveals a predisposition to various diseases, and now you can also take tests to determine the biological relationship in the family: paternity and motherhood.

ECO

Hypogonadism

Menopause

Climax

Anti-Mullerian hormone (AMH, AMH, anti-Mullerian hormone)

Anti-Müllerian hormone: indications for prescription, rules for preparing for the test, interpretation of the results and norm indicators.

ECO

Thrombophilia

Stroke

Obesity

COVID-19

Nephrotic syndrome

Pregnancy

Propensity to thrombosis during pregnancy - minimal panel

Propensity to thrombosis during pregnancy: indications for prescribing, rules for preparing for the test, interpretation of the results and normal indicators.

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