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Antenatal Scans and Screenings
Pregnancy is a very exciting time, doesn’t matter if this is your first or not. So it is very important to look after yourself and your unborn baby by getting familiar with your Antenatal care or “Pregnancy Care”. Antenatal Car is a package of healthcare and support you should have while you are pregnant. This care package is in place to make sure you and your unborn baby are safe and well throughout your pregnancy journey.
Regular Antenatal care is important to:
-keep an eye on how your baby is growing
-pick up some conditions that might not have any early symptom to notice but routine checks and can pick up on them even you feel perfectly fine.
-check the health of your baby through blood tests and ultrasound scans (find more information about ultrasound scans and blood tests below).
Ultrasound scans
Ultrasound scans are the safest way to look at your baby at your womb. Scans can tell the approximate date your baby is due, confirm whether you are having more than one baby and pick up on some possible pregnancy problems.
We know that seeing your baby for the first time can feel like an exciting event and that you may feel anxious too. So you can bring your partner, a friend or a family member along with you to share it.
How does the ultrasound scan work?
Ultrasound is a safe and non-invasive imaging technique using high frequency sound waves to produce black and white or colour images of your baby, which has been around for half a century with no known harm to the unborn child. All medical care of the pregnancy relies heavily on the ultrasound findings of during pregnancy.
Pregnancy is divided to 3 trimesters each lasting around 12 weeks which makes the length of the pregnancy 38-42 weeks approximately. During the 3 trimesters of pregnancy different ultrasound imaging and techniques are used to help management of regular monthly care and medical or surgical intervention if needed.
First Trimester
From the first day of your last period up to week 12 of your pregnancy is the first trimester. During this time, the fertilised egg and sperm, the new baby cells, implants itself inside the lining of the womb(endometrium). Sometimes this does not happen, and the pregnancy starts to grow outside the womb and is called ectopic, which is a medical/surgical emergency. Sometimes there might be a hidden bleeding inside with possibility of miscarriage or the tissue of placenta becomes abnormal which is called molar tissue both of which need medical intervention.
In the early stages of first trimester between 5-7 weeks ultrasound has an invaluable diagnostic power. With two tools of external scanning (Transabdominal with full bladder) and internal (Transvaginal with empty bladder) ultrasound is used to diagnose the followings:
1) Determination of the site of the pregnancy sac whether in the correctly placed in the womb or abnormally and ectopically outside the womb.
2) Determination of the number of pregnancy sacs and the number of babies present single or multiple pregnancy.
3) Determination of viability of the baby by visualisation of the heartbeat. This usually starts around 5-6 weeks of gestation. A rescan is always offered if heartbeat cannot be seen in very early gestations to recheck the viability few days later.
4) Determination of possibility of complications such as bleeding, possibility of miscarriage, or abnormality of the tissue of placenta such as molar pregnancy.
5) Determination of the health of ovaries and the corners of your pelvis which is called adnexa.
6) During 5-7weeks baby appears as a bean shaped structure with no arms and legs and presence of heartbeat is considered as baby’s health.
Later, around 10 weeks, the baby’s arms and legs and top of the head can be seen and internal structure start to show themselves and spine and front of the abdomen can also be checked. At around 10 and 4 days -12 weeks the baby is big enough to be checked for possible chromosomal abnormalities. The two most common tests available are based on ultrasound scan and a blood test from mother’s arm are NIPT and NT screening.
Second trimester
During the second trimester of the pregnancy from 12 weeks to 24 weeks, the baby’s structures are fully formed and can be checked by ultrasound. Gradually from 16 weeks onwards the baby’s gender (Sex) can be identified. During gender scan, baby’s health and anatomy is checked. Development of brain and heart and all internal organs are checked.
Further along from 18-22 weeks with an anomaly scan which is a very detailed scan, baby’s growth, health, heart, spine, abdomen, and kidney structures can be checked in details. Fingers and toes are counted for. Placenta position is checked to be high in relation to the cervix to allow safe passage for natural delivery. Blood flow from placenta to the baby is also checked by colour Doppler imaging.
With anomaly scan completed, usually no other scan is offered to mothers under NHS. However, with a reassurance scan which looks at any concerns you might have during 2nd and 3rd trimesters you can have a detailed scan checking your concerns and have a piece of mind.
When can I tell if I am having a boy or girl?
At your 16-40 week of pregnancy, the sonographer may be able to see if your baby is a boy or a girl.Tell them if you would like to know – and tell them too if you don’t want to find out until the birth.
Third trimester
From 24 weeks onwards your fully formed baby starts to put on weight and grow. Growth scans are set to examine baby’s who on routine monthly maternity examinations by GP or midwife are either suspiciously too big or too small on maternal fundal height measurements. Some mothers can develop gestational diabetes or have high blood pressure or any other medical history or complications which might affect the growth of the baby. You might be just curious about the weight of your baby or anxious over the function of the placenta. Growth scans are designed to check the baby’s estimated weight by measuring baby’s head circumference, abdomen circumference and baby’s length of the thigh bone measurements. The blood flow from placenta to baby is checked to ensure placental health, amniotic fluid is measured and baby’s internal organs such as heart, lungs, diaphragm, kidneys, stomach, and bladder are also checked.
Between 24-32 weeks if you are interested to see you baby in real time imaging or still images in colour imaging you can book 3/4D scans. You may be lucky to see him/her sucking their thumb, have yawn and stretch, smile or frown and see you baby’s face in real time and further bond with your little bundle of joy.
Presentation scan
Some pregnancies might need a much later scan as there might be a chance that baby’s head is not down and maybe breech or transverse. A presentation scan is performed from 36-37 onwards and it not only checks the position of the head and give information regarding presentation and a safe passage for delivery, but also checks all information regarding baby’s growth and wellbeing, blood flow from placenta and amniotic fluid volume is checked.
Cervical length scan
Some women have history of late 2nd and 3rd trimester miscarriages in their previous pregnancies, some are worried about the possibility of shortened cervix, and some have history of surgery on the cervix, and all are worried to know if their cervix is long enough, closed (competent) and able to keep the pregnancy for it’s duration.
Transvaginal Cervical length measurement is a safe non-invasive ultrasound method to establish the length and competency of the cervix. It can be performed from 16 weeks gestation.
It also can help determine if the placenta is on the cervix (placenta previa) or a loop of umbilical cord is trapped underneath the baby’s head or leg/feet near the cervix called cord presentation.
If transvaginal scan is prohibited or undesired by the patient trans labial scan (Scanning between the mother’s leg over the genital area) is the second best option to perform such examination to get accurate measurements.
Screening and diagnostic tests
Screening tests will let you know whether your baby has a high chance of particular conditions such as Down’s syndrome, Edwards syndrome, and Patau syndrome.
At London Private Ultrasound we can provide you with the most completed package of screening tests as follows:
Transvaginal Cervical length measurement is a safe non-invasive ultrasound method to establish the length and competency of the cervix. It can be performed from 16 weeks gestation.
It also can help determine if the placenta is on the cervix (placenta previa) or a loop of umbilical cord is trapped underneath the baby’s head or leg/feet near the cervix called cord presentation.
If transvaginal scan is prohibited or undesired by the patient trans labial scan (Scanning between the mother’s leg over the genital area) is the second best option to perform such examination to get accurate measurements.
NT and NIPT Tests
These two tests are non-invasive screening tests which check 3 major chromosomal abnormalities in early pregnancy. Trisomy 21 or Downs syndrome, Trisomy 18 or Edwards syndrome and Trisomy 13 or Patau syndrome.
NIPT (Non-invasive prenatal test)
This test is carried out as early as 10 weeks and 4 days. A dating or an early ultrasound scan is performed, and the gestational age is established. The baby’s body is checked thoroughly, and structures are identified to be normal. Then Blood is drawn from mother’s arm. The blood is sent to the lab and is analysed for the baby and placental cells floating in mother’s blood stream. With NIPT the baby’s gender(sex) and health of sex chromosomes can be checked also. Once all is established a comprehensive report is issued which gives risk factor of the trisomy’s mentioned above. NIPT is 99% accurate.
NT screening test
This test is performed from 11 weeks to 13 weeks and 6 days. An early or dating scan is performed, and the gestational age is established. The baby’s body is checked thoroughly, and structures are identified to be normal. An advanced practitioner with relevant qualifications measures the thickness of the accumulation of fluid between two layers of the skin at the back of baby’s neck. This is called nuchal translucency or NT. All baby’s have some fluid at the back of their neck at this stage of the pregnancy, however, baby’s who have thickened layers tend to have a higher risk of chromosomal abnormalities or heart, lymphatic, or kidney disease. So just having an increased thickness does not necessarily mean that the baby has chromosomal abnormality (NT test on its own is only 70% accurate). By 14 weeks gestation, this fluid gradually disappears and cannot be measured accurately. Then Blood is drawn from the mother’s arm. The blood is sent to the lab and is analysed. Blood test results are based on pregnancy hormone or the placenta hormone called BHCG and a protein produced by the placenta called Papp-A, which are then combined with ultrasound NT measurement, and then the risk is given as a comprehensive result based on these findings and the baby’s gestation. This combined test is about 80-90% accurate.