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At that first prenatal visit you feel queasy and tired. The nurse informs you that bloodwork will be necessary today so you dutifully roll up your sleeve. Next thing you know, seemingly half of your blood is in various colored tubes on the counter and you are feeling more nauseated than even before.

What are they testing you for anyways? Here is a breakdown of common first trimester prenatal tests:

  • Blood type and antibody screen: Your blood type is A, B, AB or O and either Rh (Rhesus factor) positive or negative. While there are several different Rh factors, the most commonly described one is the D antigen. If you are Rh positive, your red blood cells carry this factor on them and your immune system has produced antibodies to attach to that factor; about 85 percent of Caucasians and between 95 and 99 percent of African-Americans are Rh positive. The antibody screen also looks for past exposure to other blood types, which can occur as a result of pregnancy, miscarriage or blood transfusion. If exposure occurs, your body can form an immune system response against the foreign proteins on those cells. With subsequent pregnancies, these antibodies can cross the placenta and affect the developing baby. This is why it is recommended women who are Rh negative receive a medication called Rhogam during pregnancy so that they don’t develop an anti-D antibody.
  • Complete blood count (CBC): This test looks at the composition of your blood by percentage of types of cells. It is important especially to know red cell levels, which could signal anemia, and levels of platelets, which are important for blood clotting.
  • Rubella titer: Rubella is another name for German measles, which if contracted during pregnancy can cause birth defects, including hearing and vision loss, or miscarriage. This test will show if a woman is immune against the disease (the “R” in the commonly given MMR vaccine, along with protection against measles and mumps). Most women who received the vaccination in childhood will have immunity, but occasionally, despite having received the vaccine, immunity will have waned. The MMR vaccine is not safe during pregnancy, so if a woman is not immune, she must be extra vigilant to avoid exposure and should be sure to get a vaccine after pregnancy to provide immunity during any future pregnancies.
  • Hepatitis B screening: Hepatitis B is a virus that affects the liver. It can be transmitted sexually or through needle sharing, contact with infected blood and body fluids, and — rarely — blood transfusions. If a mother has Hepatitis B, then her baby will need to receive special medication as well as immunization at birth to reduce the risk of transmission.
  • Syphilis screening: The most common test for syphilis is called an RPR. Syphilis is a sexually transmitted disease that fortunately has become less common. Syphilis can cross the placenta and cause birth defects for baby, but is highly treatable in the mother. Pregnancy can sometimes cause a false positive on the RPR test, in which case the lab will usually automatically do a more sensitive test for confirmation.
  • Human Immunodeficiency Virus (HIV): The Centers for Disease Control and Prevention recommend that all pregnant women be tested for HIV, and for many women this will be the first time they are tested. HIV transmission from mom to baby can be significantly reduced with medications. If you never do it again, it’s a good idea to seriously consider the test when you consider pregnancy or become pregnant.
  • Gonorrhea and chlamydia: This test doesn’t use blood but instead either a urine sample or a cervical swab. Gonorrhea and chlamydia are sexually transmitted diseases that often cause no symptoms. Both can cause eye infections in babies if untreated and increase the risk for a mother’s water breaking prematurely, low birth weight and preterm birth. Both are very treatable with antibiotics.
  • Urine culture: Infection in the bladder without symptoms (called asymptomatic bacteriuria) can lead to more serious infection of the kidneys. If bacteria called Group B Strep is found then it is recommended that the mother receive antibiotics in labor to prevent transmission to baby.

Some offices will also do tests to screen for thyroid problems and diabetes at the first visit. If you are due for a Pap smear, this will likely be collected. Depending on how far into your pregnancy, options for genetic testing may be offered as well.

It seems like a lot, but these tests are very important for your health and the health of your baby. Of course, talk with your provider if you have any questions.

Bethany Sanders is a Certified Nurse Midwife and cares for women at the West End Women’s Health Center and Cole Family Practice. A graduate of Vanderbilt, she is thrilled to be back in Nashville after spending the last six years in rural Northeast Georgia. When not attending births or measuring pregnant bellies, she can be found at the local park chasing after her two-year-old son or talking about cloth diapers with anyone who will listen.



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Understanding Strep Throat

It’s that time of year again when more time spent indoors and in closer contact with one another puts us at higher risk of catching and spreading infections like colds, flu and strep throat.

While many symptoms including sore throats may be due to viral infections, strep throat is a bacterial infection of the throat cause by group A streptococcus. It’s most common in school-aged children and is spread easily from person to person in mouth secretions (by coughing, sneezing, sharing cups and eating utensils).

Unlike viral infections, strep is treated with antibiotics so it is important to know the difference.

Here are some common questions that parents may have about strep throat:

What are the common symptoms of strep throat? Typically, children will have throat pain, especially when they swallow. You may notice your child not eating or drinking as well as usual. Fever, headache and abdominal pain as well as swollen glands are also frequent symptoms of strep throat. Some children will develop a “scarlet fever” rash along with the infection (more about this below). Not all children have throat pain with strep throat, so sometimes your doctor may test for strep if they symptoms like fever with a headache or abdominal pain.

Which symptoms help us tell the difference between a sore throat caused by a virus and one caused by strep? Most sore throats are caused by viral infections. Colds, flu and strep have many overlapping symptoms.

  • Colds most often cause a runny or stuffy nose and cough. If throat pain accompanies a cold, it is often describes as scratchy or dry, and your child might have a hoarse voice.
  • Flu causes high fever, chills, body aches, cough, runny nose and throat pain. Be sure your child has had a flu vaccine to help prevent the flu.
  • Strep infections in school-aged children do not typically cause runny nose or cough, and generally they don’t cause a hoarse voice. Younger children are not as prone to strep infections but if they do have strep throat, they may have some runny nose or congestion with it.

How is testing for strep done? Once your doctor has examined your child, he or she may recommend strep testing. The throat culture is the very best way to test, but this takes up to 48 hours for results. In our fast-paced world, it’s difficult to wait for results. Quick strep tests have been developed to help answer this question. In our office, we obtain two samples by swabbing the back of the throat – one for a quick strep test and the other for a backup throat culture. If the quick strep test is positive, we have our diagnosis and will start antibiotic treatment. If the quick test is negative, we send the second sample off to the lab for culture to be certain of the result. It’s best to hold off antibiotics in most situations until we have confirmation of a strep infection. (Side note: Please don’t tell your child we’re sticking the swab “down their throat”. This is frightening to many children. Better to say we’re going to “touch” the back of their mouth with a swab.)

There are a few exceptions to the general guidelines to test for strep. If a child has a “scarlet fever” rash, if another household member has a documented strep infection within the past few days or if your child has an additional infection such as an ear infection that needs treatment with an antibiotic, your doctor might skip strep testing and treat with antibiotics.

What is scarlet fever? Scarlet fever is a rash that accompanies strep infections once in a while. It’s a fine, raised, red rash with the texture of sandpaper. The rash is often located on warmer body areas like the neck, underarms and lower abdomen, sometimes on the face. It may itch, and later in the course of infection may cause peeling especially on the fingertips and toes. If present, it is quite helpful in making the diagnosis of strep.

Will symptoms of strep improve if not treated? Strep infections will improve without treatment if they are not diagnosed. Antibiotics help children feel better sooner, but treatment is not just to make the symptoms go away. We are careful to test suspected cases and treat children diagnosed with strep to avoid complications, which are fortunately uncommon but can be very serious, even life-threatening. Complications may include formation of an abscess (pocket of pus) in the back of the throat, acute rheumatic fever/ heart disease or kidney problems.

When should I call the doctor? Call when your child:

  • Has throat pain with one or more of the following: fever, headache, abdominal pain, or red sandpaper-like rash.
  • Has pain with swallowing that prevents him or her from swallowing saliva (in other words, drooling instead of swallowing).
  • Has signs of dehydration.
  • Has been in close contact with someone with a documented strep infection even if the other symptoms are not present.

How can we treat the symptoms? Keep your child’s throat comfortable by having him or her drink plenty of fluids. Water, Gatorade, apple juice, popsicles and other cool foods and drinks may be comforting. Older children might feel better by gargling warm salt water. Acetaminophen or ibuprofen may help relieve pain. If you are worried about strep, contact the doctor’s office for additional advice and testing.

What about prevention? It’s the usual advice – thorough and consistent hand washing, cover coughs and sneezes, don’t share cups, straws and eating utensils with others. Teach your children to keep their hands away from their eyes, nose and mouth – this is how germs enter our bodies. A flu vaccine does not prevent strep, but will decrease the risk of flu this winter.

Last few other details: Strep infections are contagious until 24 hours after starting antibiotic treatment, so your child should not return to childcare or school until after 24 hours. The strep germ can live in toothbrushes, so be sure to discard your child’s toothbrush after 24 hours and use a new one. If your child does have strep throat, be sure to complete the full course of antibiotics to reduce the risk of those serious complications.

Dr. Rachel Lenox Mace is a general pediatrician with the University Pediatrics practice at Vanderbilt Health at One Hundred Oaks.  She is the mother of 3 and enjoys cooking and reading.



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7 Winter Activities for Toddlers

December 15th, 2014 | Posted by KristenSteele in Parenting - (0 Comments)
Winter Activities with your toddler

My 18-month-old son is incredibly active, and I’m pretty sure he’d play outdoors all day if we’d let him! Alas, most days are now too cold for that. I’ve been asking other moms for some great winter/indoor playing ideas for toddlers. Here are 7 to try (and to spark your imagination): An indoor ball pit … Read more



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Why All Parents Should Read to the Their Kids

One of my favorite times of day is reading to my boys at bedtime. We settle into our rocking chair, snuggle in tight, and immerse ourselves in stories of pirate adventures, mysterious ninja warriors, friendship, and love. Here are just a few reasons why reading to your children can be so spectacular: The bonding experience: … Read more



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5 Healthy Eating Tips for Families During the Holidays

When I think back to the holiday seasons when my grown kids were young, I remember a much more hectic schedule, decadent temptations and the increased stress to do so much. I found that by choosing a few simple behaviors to focus on maintaining throughout the holiday season, we were able to stay on track … Read more

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