The Anomaly Scan at 18-22 weeks

An anomaly scan, also known as detailed morphology scan, intends to take a closer look at the baby and the uterus. 

The Fetal Medicine Specialist will check how the baby is developing plus the position of the placenta. 

Anomaly scan is often called a 20-week scan; however, a patient may have it any time between 18 weeks and 22 weeks. 

Although the main target of the scan is as mentioned above, the gender, however, may be revealed by the Fetal Medicine Specialist if desired by the patient.  By 12 weeks gestation, gender accuracy is 95% while at 16 weeks, it is 99%++.

The whole scan takes about 30 minutes for a single gestation.  The Fetal Medicine Specialist will assess the fetal organs.

Major organs are mostly checked by cross section and measured, these are:

·         

    The shape and structure of the head and brain.

·         The Face - Cleft lip and Palate are checked while focusing on the face.

·         The Spine, its length and in cross section, making sure that all the bones            align, and that the skin covers the spine at the back.

·         The Heart. Normal structure, location, normal rhythm pattern.

·         The Abdominal wall making sure it covers all the internal organs at the              front.

·         The Stomach.

·         The Kidneys, confirming that the baby has 2 kidneys and bladder is visible.

·         Fetal Extremities. Arms, Hands, Fingers, Legs, Feet, Toes

The placenta location and structure, umbilical cord and the amniotic fluid are also checked.

To see how well the baby is growing, the HC (head circumference), AC (abdominal circumference) and FL (femur length-thigh bone) measurements should match up depending on when is the expected delivery date.

Authored by Dr. Afshin PourMirza, MD, PhD

Obstetrics and Gynaecology – Maternal Fetal Medicine

Managing Director of Feto Maternal and GenetYX Center

What is Tubal Patency Check (Hystero Salpingo Sonography)?

Females have a pair of fine fallopian tubes which eggs travel form the ovaries to the uterus.  To obtain a successful pregnancy, one has to have an "open" or "patent" tubes.  Women who are trying to get pregnant, but are having difficulty conceiving should get an appointment for tubal assessment.  Normal fallopian tubes cannot be seen by a regular ultrasound, hence, contrast is used. 

Tubal patency check is performed during the first half of cycle before ovulation which  means between day 8-12 of that cycle.   This test is done before ovulation to make sure there is no pregnancy even if the chance of being pregnant is low.

The pain that may be experienced varies from women to women.  Some would say they did not feel any pain at all or some would complain of cramping when the contrast is injected.  It would be safe to say that majority of women feel mild to moderate pain during the procedure.  It could be recommended that pain reliever tablets be taken an hour before the procedure.

A pelvic ultrasound is performed to assess the pelvic anatomy.  If the findings are normal then tubal assessment will proceed.   There is a special catheter  inserted through the cervix and this is where the contrast is injected while the vaginal probe is also inserted.  If the contrast is seen flowing through the fallopian tubes towards the ovary on both sides, it means that the tubes are patent.  However, if the results show that the tubes are blocked, the Physician would discuss further assessment.  It is best to always ask questions and be informed.

Dr. Afshin PourMirza, MD, PhD
Medical Director

Obstetrics & Gynaecology
Feto Maternal Medicine Specialist

www.fetalmedicine.ae

Feto Maternal and GenetYX Center 

I Am Offered Screening Tests, why?

Different screening tests are offered at different times during pregnancy.  

It can be an ultrasound scan, blood test or history (clinical) based assessment. Screening is done to allow the obstetrician to categorize whether the pregnancy is at higher chance, or risk, of a problem or not.

The tests can help decide further tests and care or treatment during pregnancy or after the baby's born.  This means earlier, possibly more effective, treatment or informed decisions.   

Let's say, advanced maternal age or a history of diabetes in the family can put one at risk for high blood pressure (preeclampsia) or pregnancy related diabetes respectively.

Screening literally means recognizing people at risk. It cannot diagnose the problem. However, it can be give the signal for the need for further investigations. The downside of screening tests is it cannot detect all the conditions.  Screening tests do not give us a yes or no answer. In most scenarios, further definitive tests will be required to confirm the diagnosis.

It is very important to understand that the risk assessments are derived from population-based data and modified by the individual’s test results. Once should understand the concept and the obstetrician or Geneticist should explain this in-depth to avoid misconception.

It is all about you and your unborn baby's safety to assure a smooth journey through the pregnancy and giving both parents that peace of mind.

Dr. Afshin PourMirza, MD, PhD
Medical Director

Obstetrics & Gynaecology
Feto Maternal Medicine Specialist

www.fetalmedicine.ae

Feto Maternal and GenetYX Center 

Your question…Am I pregnant?

You missed your period, a question comes into your mind, am I pregnant?  Next thing you do is take a pregnancy test by using one of those over the counters.  You got 2 lines!  Does this mean you are soon to be a mother? 

It is important to know what positive or negative result means.  If you get a positive result, you are pregnant, no matter how indistinct the line, color, or sign is.  Most of the time, since you doubt the result, you tend to repeat an over the counter pregnancy test.  If you get a positive result, a visit to the obstetrician and taking folic acid are advised.  In fact, if you are really planning to have a baby, you should start folic acid right away.

On your visit to the obstetrician, your blood will be taken to test for bhCG (beta-human chorionic gonadotropin).  This is a quantitative test wherein the result is given as a number, indicating the measured concentration of the hormone in the blood.  At this stage, your result will be <400mIU/ml.   You will be asked to comeback since the bhCG level usually doubles approximately every 2 days.  If the levels are getting high, it is a clear indication of pregnancy and you will therefore be scheduled for your ultrasound scan between 6-8 weeks.  

A trans-vaginal scan will be performed to:

• confirm a viable intrauterine pregnancy by achieving a visible embryo pole with a fetal heart beat
• know the age of the pregnancy by measuring the crown lump length (CRL) or measurement from the top of the head to the bottom of the fetus
• confirm if it is single or multiple pregnancies

An internal scan is needed.  In this way, the probe gets much closer to the womb thus a clearer image.  This is more commonly needed in the early stages of pregnancy, if the mother is overweight or have a retroverted uterus.

Dr. Afshin PourMirza, MD, PhD
Medical Director

Obstetrics & Gynaecology
Feto Maternal Medicine Specialist

www.fetalmedicine.ae

Feto Maternal and GenetYX Center