Scans and tests during pregnancy in Spain, trimester by trimester

Key rules

• Routine scans: A low-risk pregnancy gets three routine scans in the public system, with extra scans only when there is a medical reason.
• Glucose test: The O'Sullivan test is done at weeks 24-28 for everyone, and earlier if you have risk factors.
• Group B strep: The swab is taken at weeks 35-37.
• Regions: Each region has its own protocol, so confirm your schedule with your midwife.

The short version

In a low-risk pregnancy, the public system schedules three routine scans, plus blood and urine tests in each trimester. Your region sets the exact protocol, so your schedule may differ a little from the one below. The planner below shows the week-by-week order.

First trimester

Your first visit is ideally before week 10. Expect blood tests for:

• blood group and Rh, with a Coombs test if you are Rh negative
• a full blood count
• glucose
• rubella, syphilis, HIV and hepatitis B
• toxoplasma, if you are not immune
• hepatitis C and Chagas, often only if you are in an at-risk group

You will also give a urine sample to check for a symptomless bladder infection.

The first scan comes at about weeks 11 to 14. It dates the pregnancy and measures the baby's neck fold and length. These measurements feed the combined screening result, which also uses a blood test.

Second trimester

The detailed morphology scan comes at about weeks 18 to 22, usually around week 20. It checks how the baby is developing.

At weeks 24-28 you have the O'Sullivan glucose test, which screens for gestational diabetes. It is done earlier if you have risk factors. These include previous gestational diabetes, obesity, age over 35 or a previous large baby. If you have risk factors, tell your midwife early.

In the same weeks you repeat the blood count and have a urine check. If you are Rh negative, you also repeat the Coombs test. If you are not immune to toxoplasma, it is repeated, in some regions every 4 to 6 weeks.

Third trimester

The third scan comes at about weeks 32 to 36. It checks the baby's growth, position and the placenta.

The group B strep swab is taken at weeks 35-37. It is a vaginal-rectal swab. If it is positive, you get antibiotics through a drip during labour, usually penicillin. You may get them without waiting for the result if any of these apply:

• group B strep showed up in your urine during the pregnancy
• a previous baby had a group B strep infection
• labour starts early
• you have a fever or your waters have been broken a long time

Around this time you also have another blood count. Some regions repeat the HIV and syphilis tests, and add a urine culture if needed. At your visits, a urine dipstick checks for protein and sugar.

Extra scans

Extra scans are done only when there is a medical reason.

How regions differ

Health care is run by each of Spain's 17 autonomous communities, so each has its own pregnancy protocol. Regions can differ on:

• the number and timing of scans, with extra ones in some places
• the cut-offs for the combined screening
• whether a non-invasive blood test (NIPT) is offered as a second step
• extra blood tests
• how the midwife (matrona) visits are organised

Your midwife or GP at your health centre can give you your region's protocol. It is also on your regional health service's website.

Pregnancy appointment planner by week

Pregnancy appointments by week

• First-trimester combined screening blood test (checks for Down, Edwards and Patau syndromes): Between weeks 8 and 13+6, usually weeks 9-12

• First scan: dating, nuchal translucency and crown-rump length, which feed the combined screening risk result: At about weeks 11 to 14

• If the combined screening shows high risk, talk through a diagnostic test (amniocentesis or CVS) or, in some regions, a blood test on fetal DNA first: After the combined screening result, which is usually a risk above 1 in 270

• O'Sullivan glucose test: a sugar drink, then a blood sample after 1 hour: At weeks 24-28, and earlier if you have risk factors such as past gestational diabetes

• Repeat blood count, repeat Coombs test if you are Rh negative, and urine check: At weeks 24-28

• If the 1-hour glucose result is at or above the cut-off (usually 140 mg/dl), do the 3-hour glucose tolerance test to confirm or rule out gestational diabetes: After a high O'Sullivan result

• Third scan: baby's growth, position and placenta: At about weeks 32 to 36

• Group B strep swab, then antibiotics in labour if positive: At weeks 35-37

• Third-trimester blood count, plus urine culture or repeat HIV and syphilis tests where your region or risk group requires them: At weeks 35-37

• Urine dipstick for protein and sugar: At routine visits throughout pregnancy

• Extra scans or tests if your doctor sees a medical reason: Only when medically needed

Checklist

• Ask your midwife for your region's pregnancy protocol and compare it with your own schedule.

• Check your first-visit blood and urine tests are done: blood group and Rh, blood count, glucose, rubella, syphilis, HIV, hepatitis B and a urine culture.

• Ask whether you need a toxoplasma test, and how often it is repeated if you are not immune.

• Ask whether hepatitis C or Chagas tests apply to you if you are in an at-risk group.

• Book the O'Sullivan glucose test for weeks 24-28 and repeat the blood count in the same period.

• Ask for a repeat Coombs test at weeks 24-28 if you are Rh negative.

• Ask whether your region repeats HIV and syphilis tests in the third trimester.

• Bring a urine sample to your visits, as protein and glucose are checked then.

Frequently asked questions

Can I get extra scans on the public system?

Yes, but extra scans are done only when there is a medical reason, such as a risk found in a routine scan. In some regions the standard schedule already includes an extra scan, so ask your midwife what applies where you live.

Who decides if I need the glucose test earlier than usual?

Your midwife or doctor decides, based on your risk factors. Earlier testing applies if you had gestational diabetes before, are obese, are over 35, or had a large baby. If the early result is normal, the test is repeated at the usual time.

What happens if my group B strep swab is positive?

If your group B strep swab is positive, you get antibiotics through a drip during labour, usually penicillin. You may get them without waiting for a swab if you had a urine infection with this bacteria in the pregnancy, a previous baby had the infection, labour starts early, or you have a fever.

Where do I find my region's pregnancy protocol?

Look on your regional health service website for the pregnancy, birth and postpartum care pathway (proceso embarazo, parto y puerperio). Your midwife (matrona) or GP at the health centre can also give you a copy. Regions differ in extra scans, screening cut-offs, whether a non-invasive blood screening (NIPT) is offered and extra blood tests.