Prenatal care

Information to comfort you and boost your confidencePregnancy checkups are a good opportunity to ask any questions you might have.

To prepare for your next appointment, write down questions you want to ask your health professional as you think of them so you don’t forget.

Prenatal care includes

  • Appointments with your health professional
  • Blood tests, urine analyses, and vaginal swabs
  • One or more ultrasounds
  • Screening tests (in some cases)

Regular visits allow you to check that your pregnancy is going well and to get screened for potential problems. These visits also give you the opportunity to get answers to your questions and help you prepare for delivery and the arrival of your newborn.

Remember, at any time you can

  • Ask for an explanation of any tests or examinations your health professional wants to perform
  • Seek a second opinion from another health professional if you have any concerns
  • View your file

Frequency of prenatal visits

The frequency of prenatal visits may vary. If you have a specific health problem, more frequent visits may be necessary, but generally visits will be scheduled as follows:

  • As soon as you know you are pregnant until 11 weeks after your last period: first visit
  • Between 12 and 30 weeks: one visit every 4 to 6 weeks
  • Between 31 and 36 weeks: one visit every 2 to 3 weeks
  • From 37 weeks until the baby is born: one visit per week

Description of prenatal visits

At every appointment, your health professional will check

  • Your weight
  • Your blood pressure
  • The size of your uterus (starting around 20 weeks)
  • The baby’s heartbeat; although it cannot be heard until 10 to 12 weeks, your baby’s heart began beating 5 weeks after the start of your last menstrual period

Usually the first prenatal appointment will take place between the 8th and 11th week of pregnancy. This gives parents time to arrange for tests like genetic screening if they wish, as these tests should ideally be performed between the 11th and 13th week of pregnancy.

This first visit generally lasts longer than subsequent appointments because your health professional will need time to ask questions about your health history and evaluate your baseline condition at the start of your pregnancy.

Do you have questions? Are you hesitant to have some tests done? Do you think other tests might be helpful? Now is the time to bring these questions up with your health professional so you can make informed decisions.

Questions to expect

At your first prenatal visit, your health professional will probably ask about the following:

  • The date of your last menstrual period in order to determine your due date and how many weeks pregnant you are
  • Your health before and since the start of your pregnancy. You may also be asked whether you have taken any medication, suffered from allergies, had any operations or problems related to anaesthesia or physical illness, or if you have ever suffered from depression or any other physical or mental health problem
  • If you have ever been pregnant before, including any miscarriages or abortions
  • Your family history and the family history of the baby’s father. You will be asked what diseases run in your family and the father’s family, including things like heart disease, congenital defects, and hereditary diseases
  • If you have ever had gynecological problems, such as cervical surgery, or if you or your partner have herpes
  • What your living conditions and lifestyle are like (tobacco, alcohol, and drug use)
  • If there are any sources of stress in your life, and if so, what kind
  • What type of work you do in order to determine if it poses any risks during pregnancy

Physical and gynaecological examinations

A full physical exam, including a gynecological exam, will be performed at your first visit.

If you have not had one in recent months, a pap smear will be done to test for cervical cancer. This examination can also be done later in pregnancy or after the baby is born.

It is also recommended that pregnant women be tested for sexually transmitted infections (STIs) like chlamydia and gonorrhoea. Many of these diseases can go undetected and affect your health and that of your baby. If you think you may have had contact putting you at risk for an STI after your initial screening, don’t hesitate to talk to your health professional about repeating the tests.

Your health professional will suggest a vaginal swab to check for Group B Streptococcus at around 36 weeks. This type of bacteria poses no problems for the mother, but can in rare cases harm the baby if it is not treated. If it is present, you will be treated with antibiotics during labour.

You may notice light bleeding within 24 hours of the gynaecological examination. Don’t worry, the bleeding is from the cervix, which is more sensitive during pregnancy.

Blood tests and urine analyses

During your visits, your health professional may prescribe lab tests and give you information about blood tests, urine analyses, ultrasounds, and screening for congenital defects.

Blood tests and urine analyses are used to determine

  • If you are anaemic
  • If you have an infectious disease that you could transmit to your baby
    • If you have an infectious disease like syphilis, HIV/AIDS, or Hepatitis B, you may be given medication during pregnancy or your baby may be vaccinated at birth to eliminate or reduce the risk of the infection being transmitted to the baby.
  • If your blood glucose (blood sugar level) is normal
  • Your blood type and rhesus factor (Rh factor);
    • For example, if you are Rh negative, some precautions must be taken. You may be given anti-Rh immunoglobulin (also called WinRho®) at 28 weeks and possibly after the delivery. This treatment will prevent you from developing anti-RH antibodies that could endanger this or a future pregnancy. You may be given WinRho® for other reasons as well, for instance if you have a miscarriage, undergo amniocentesis, or you have bleeding
  • If you have anti-rubella antibodies
    • If you do not have these antibodies and have never been vaccinated against rubella, you will probably be advised to get the vaccine after the baby is born.
  • If you have a urinary tract infection, even if you have no symptoms

Ultrasound

Ultrasound is a type of exam that will be offered by your health professional. Ultrasound enables your health professionnal to:

  • Determine how far along you are (especially if you have irregular cycles or are unsure of the date of your last period)
  • Check that your baby is the right size for his/her age
  • See most of your baby’s organs (heart, liver, kidneys, stomach, bladder, brain, etc.) and limbs
  • Confirm how many babies there are
  • Determine the location of the placenta

During the ultrasound, it is often possible (but not always) to determine whether your baby is a boy or a girl, although there is a slight risk of error. If you want to keep the baby’s sex a surprise, tell the technician and your doctor to avoid any misunderstanding.

Prenatal screening for trisomy 21

Essential information to rememberBefore you have these tests run, think about the decision you will have to make if you find out the baby has a chromosomal abnormality.

At your first prenatal visit, your health professional will ask if you want to be screened for trisomy 21. This test is not mandatory; the decision to have any prenatal screening test run is yours alone.

In Québec there is a public program that provides free trisomy 21 screening tests for all pregnant women who want one. For more information on this program, visit www.msss.gouv.qc.ca/sujets/santepub/depistage-prenatal/index.php?accueil-en.

Trisomy 21, also known as Down syndrome, is one of the most common chromosomal abnormalities. Those with the disease have slower intellectual development. It is difficult to determine the severity of the disease as it varies from one person to the next, and depends to some extent on the stimulation and support they receive. People with trisomy 21 may also have health problems like heart defects.

Although there is no treatment for trisomy 21, people with the disease should not be defined only by their disability. They also have the resources and potential to develop close emotional bonds and lead a fulfilling life, for themselves and their loved ones. Of course, most people with trisomy 21 will need some degree of lifelong support.

Trisomy 21 is generally not hereditary. Any woman could potentially carry a fetus with this chromosomal abnormality, although risk varies with age, as illustrated in the table.

Risk of having a child with trisomy 21 (full-term pregnancy)
Age of the mother Risk
20 1 in 1,500
30 1 in 900
35 1 in 385
40 1 in 100

Prenatal screening test

The screening test involves an analysis of the mother’s blood and, in some cases, an ultrasound. It determines if the odds (risk) of the baby having trisomy 21 are low or high. There is no danger for the fetus.

  • If the odds are low, your doctor will not recommend further testing. However, low odds do not guarantee that the baby will not have trisomy 21. Because of natural variations between individuals, screening tests cannot detect all cases.
  • If the odds are high, that does not necessarily mean your baby will have trisomy 21. Another diagnostic test called amniocentesis with chromosome analysis will be proposed to you. It is normal to feel anxious if you have to have this test done, but most women who undergo an amniocentesis have normal results and give birth to a baby that does not have trisomy 21.

Diagnostic test: amniocentesis

Amniocentesis with chromosome analysis is the most common prenatal diagnostic technique. It is used to determine with certainty whether the fetus has trisomy 21.

This test can be done any time after 15 weeks, sometimes sooner. It involves inserting a thin needle into the abdomen to take a sample of amniotic fluid from the uterus.

Amniocentesis does carry some risk of complication, including miscarriage. That is why it is most often offered to women whose screening results show them to be at high risk.

Amniocentesis results

  1. The vast majority of parents-to-be learn that their baby does not have trisomy 21 or any other chromosomal abnormality.
  2. When the results indicate that the baby does have trisomy 21, the parents must choose between two options:
    • Move forward with the pregnancy and prepare to be parents of a child with trisomy 21
    • Terminate the pregnancy and mourn the loss of the baby
  3. In rare cases, amniocentesis reveals other chromosomal abnormalities. If this happens, your doctor will refer you to a genetic specialist.

If you are faced with the difficult choice of continuing or terminating your pregnancy, you may need help. Don’t hesitate to discuss this choice with your loved ones or a health professional. You may also want to contact trisomy 21 parent groups; they can help you make the decision that is best for you. To find groups in your area, contact your CLSC.

Other screening tests

After you give birth, you will be given the option of having your baby pass blood and urine tests in order to detect rare diseases that require early monitoring or treatment (see Blood screening).

Trisomy 21 screening tests

Ultrasound

An ultrasound may be recommended to see how far along you are in the pregnancy.

An ultrasound may also be offered to measure nuchal translucency, i.e., the space between the skin of the fetus’s neck and its spine (between the 11th and the 13th weeks). Higher than normal nuchal translucency may indicate a high risk of trisomy 21, other chromosomal abnormalities, or heart defects. Ultrasound screening for trisomy 21 must be done in conjunction with blood testing to increase accuracy.

Blood tests

The prenatal screening test for trisomy 21 offered free of charge throughout Québec consists of two blood tests. The first is performed in the first trimester (between 10 and 13 weeks), and the second in the second trimester (between the 14th and the 16th weeks). Screening takes into account your age and the results of the two blood tests to determine whether your risk of having a baby with trisomy 21 are high or low.

Two blood samples yield more reliable results than a single sample, but if you have only the first blood test done, your risk will be calculated based on the one test result and your age. If it is too late to have the first test done, you can have one run in the second trimester. Again, your risk will be calculated based on the one test result and your age.

Other screening tests

Other tests may also be proposed. Knowledge about trisomy 21 screening is constantly evolving and can change rapidly. Your health professional will tell you what is available in your area.

Source: Ministère de la Santé et des Services sociaux du Québec


Rhesus (Rh) factor: One of the characteristics of blood. You are either Rh positive or Rh negative.

Amniocentesis: Procedure that involves taking a sample of amniotic fluid for analysis.