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 to pack in your hospital bag before a C-section delivery

Opting for an elective c-section allows you to have more time to think and prepare what you will need to pack in your hospital bag.  

Instead of being worried and stressed, the best thing o is to ensure being prepared as you can be – and one of the things you may focus on is what to pack in your  hospital bag.

Being prepared can make all the difference to make certain your pre and post delivery experience is as smooth as possible.

Below are the top items to pack;

For mother:

• ·         A favorite pillow:  Or my "comfort" pillow
• ·         A few sets of Socks/a Cozy Blanket -  hospitals are known to be notoriously cold
• ·         A Compression binder – this can help to support the stomach muscles after surgery. These are also great to wear in the weeks following, though you may want to check this with your Physician!
• ·         Several disposable underwear (Vaginal bleeding is expected even after a c-section and disposable underwear means less fuss and more time to concentrate on your new little person).  
• ·         Slippers/flip flops – something easy to get on and off your feet.
• ·         Mobile phone – you're going to want to take lots of photos and send them to your loved ones back home
• ·         Toiletries (the usual - wash goods, toothbrush, hair brush etc)
• ·         x4 Loose long dresses
• ·         A bathrobe
• ·         Towels
• ·         A going home outfit – we recommend loose drawstring pants, a maternity bra, underwear and a loose shirt
• ·         Of course, don’t forget all your paperwork - photo ID, insurance card, medical papers/ antenatal reports etc. A file folder with  everything neatly in a clear folder to ensure everything was kept together and organized.
• ·         Other things you may wish to pack include; books, photographs of loved ones, magazines; portable devises (not forgetting their chargers/ power banks).

For your baby;

• ·         x4 receiving blankets
• ·         x4 sets baby clothes for the duration of the hospital stay – I brought stretchy onesies with snaps in front for easy diaper changes
• ·         A going home outfit ( a onesie and if his/her feet are exposed, be sure to bring a pair of socks or soft booties. I’d also recommend a soft hat – as babies can really feel the cold in their first few days).
• ·         A baby carrier (I’d recommend one which also serves as a car seat for the journey home)

Myleen R. Camama-Cerilla
Administrative Manager
Marketing Incharged
Feto Maternal and GenetYX Center

First Trimester Screening

Possible accidental chromosomal anomalies are one of these risky events of pregnancy. To overcome this risk a close well defined follow up of the fetus at different stages of development has been settled over the last decades by different western gynecological associations after a lot of studies. Each trimester should benefit from a particular fetal scan beside the traditional fetal checkup done by your own gynecologist.

Three important and essential fetal scans are recommended during pregnancy. One at 12-14 weeks of gestation known as NT scan, one at 20 weeks of gestation known as morphology scan and a third one at 28 weeks of gestation known as Doppler scan. A respect of these dates is fundamental to be able to detect specific fetal features.

The first scan is the Nuchal Translucency scan (NT scan = thickness of the fluid at the back of the neck of your baby). It is performed from 12 up to 14 weeks. During this scan fetal specialist will check for fetal heart beats, total length of the baby, nuchal translucency and presence of nasal bone. The accuracy of this scan is from 60-65% only. However, to increase a little bit the accuracy of this scan we usually perform a blood test with the scan.

Two different options exist for this blood test, the first one is to do biochemical test. It is a blood sample in which we are detecting the levels of two placental hormones {Free Beta Human Chorionic Gonadotropin (FBHCG) and Pregnancy Associated Plasma Protein-A (PAPP-A)}. Both hormonal levels are used to determine the condition of the placenta. Moreover, the biochemical risk and the ultrasound risk will be used together to determine the combined risk for major common chromosomal anomalies (trisomy 21, 18 and 13). This combined risk has a sensitivity of 90-92%.

Another possible blood test during this visit is Non Invasive prenatal test (NIPT). This test will detect cell free fetal DNA fragments coming from fetal chromosomes (Chromosomes 13, 18, 21 and sex chromosomes) and circulating in maternal blood. Its sensitivity varies from 97-99%. It is considered as a screening test but has a high accuracy. It is usually recommended with advanced maternal age (above 35 years old mothers) and when mild fetal variations are detected by NT scan.

If major fetal anomalies are detected in the NT scan, an invasive prenatal test is recommended in order to obtain a piece of the placenta or some of the amniotic fluid and do fetal genetic analyses according to the ultrasound findings. 

Dr. Azza Abd El Moneim Attia Mohamed

French Board

Consultant Clinical Genetics

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